Vulvovaginal candidiasis
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Vulvovaginal Candidiasis: An Overview
Introduction to Vulvovaginal Candidiasis (VVC)
Vulvovaginal candidiasis (VVC) is a common infection caused by Candida species, primarily Candida albicans, leading to symptoms such as itching, discharge, and inflammation in the vulvovaginal area . It affects millions of women globally, with significant implications for quality of life and healthcare costs .
Epidemiology and Prevalence
Global and Regional Prevalence
VVC is prevalent worldwide, with varying rates across different regions. In sub-Saharan Africa, the pooled prevalence is approximately 33%, with pregnant women showing slightly higher odds of infection. In Iran, the prevalence is reported to be around 47%, with Candida albicans being the most common etiologic agent. In Brazil, the estimated prevalence is 18%, though this number may be higher due to underreporting and asymptomatic cases.
Recurrent Vulvovaginal Candidiasis (RVVC)
Recurrent VVC (RVVC), defined as four or more episodes per year, affects about 138 million women annually worldwide, with the highest prevalence in the 25-34 age group. RVVC significantly impacts quality of life, mental health, and sexual activity.
Risk Factors and Etiology
Host-Related and Behavioral Risk Factors
Several factors predispose women to VVC, including pregnancy, hormone replacement, uncontrolled diabetes, immunosuppression, antibiotic use, and genetic predispositions. Behavioral factors such as the use of oral contraceptives, intrauterine devices, spermicides, and certain hygiene practices also contribute to the risk.
Candida Species and Antifungal Resistance
While Candida albicans is the primary cause of VVC, non-albicans Candida (NAC) species like Candida glabrata, Candida krusei, and Candida tropicalis are increasingly identified . Resistance to common antifungals, such as fluconazole, varies significantly, with some regions reporting resistance rates as high as 53.7%.
Diagnosis and Treatment
Diagnostic Methods
Yeast culture remains the gold standard for diagnosing VVC, though newer molecular assays have shown promising results. Accurate diagnosis is crucial, especially in distinguishing VVC from other conditions with similar symptoms, such as provoked vulvodynia.
Treatment Options
Azole antifungals are the treatment of choice for uncomplicated VVC. For recurrent cases, new drugs like oteseconazole and ibrexafungerp show promise. Boric acid is effective for non-albicans yeast infections. However, fluconazole use during pregnancy is associated with risks such as spontaneous abortion and congenital defects.
Emerging Therapies
A recent study on the NDV-3A vaccine, an immunotherapeutic approach for RVVC, showed promising results in reducing symptomatic episodes and increasing the time to recurrence. This vaccine could represent a significant advancement in the management of RVVC.
Conclusion
Vulvovaginal candidiasis is a prevalent and impactful condition affecting millions of women worldwide. While Candida albicans remains the primary causative agent, the rise of non-albicans species and antifungal resistance poses new challenges. Accurate diagnosis and effective treatment are essential, with emerging therapies offering hope for better management of recurrent cases. Continued research and awareness are crucial to improving outcomes for affected women.
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