Etiopathogenic Bases and Therapeutic Strategies in Recurrent Candidal Vulvovaginitis

Authors

Keywords:

CANDIDA ALBICANS; CANDIDIASIS VULVOVAGINAL, FARMACORRESISTENCIA FÚNGICA MÚLTIPLE.; CANDIDA ALBICANS; CANDIDIASIS, VULVOVAGINAL; DRUG RESISTANCE, MULTIPLE, FUNGAL.; CANDIDA ALBICANS; CANDIDÍASE VULVOVAGINAL; FARMACORRESISTÊNCIA FÚNGICA MÚLTIPLA.

Abstract

Introduction: recurrent vulvovaginal candidiasis currently constitutes a serious problem that affects women’s quality of life.

Objective: to identify the predisposing etiology and therapeutic alternatives for recurrent vulvovaginal candidiasis.

Methods: an exhaustive literature search was conducted, consulting 27 sources from various databases, with prior compliance to the selection criteria of the analyzed sources. After reviewing the selected sources, an analysis of the available information was carried out, which allowed establishing a clear and updated overview of the existing scientific evidence.

Development: recurrent vulvovaginal candidiasis is a multifactorial gynecological infection, where genetic, immunological, hormonal, and environmental factors converge, favoring its persistence. Antifungal resistance, especially to azoles, complicates treatment, although fluconazole is recognized as first-line therapy. However, repeated use generates resistance, so combined and prolonged regimens, as well as alternatives and new drugs, are recommended.

Conclusions: the etiopathogenic bases of the disease were described, identifying the predisposing factors for its development, as well as its therapeutic management.

 

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References

1. Cooke G, Watson C, Deckx L, Pirotta M, Smith J, van Driel ML. Treatment for recurrent vulvovaginal candidiasis (thrush). Cochrane Database Syst Rev [Internet]. 2022 [citado 12/10/25]; 1(1):CD009151. Disponible en: https://doi.org/10.1002/14651858.cd009151.pub2

2. Jaqueti Aroca J, Ramiro Martínez P, Molina Esteban LM, Fernández González AM, García-Arata I, Prieto Menchero S. Epidemiología y etiología de la candidiasis vaginal en mujeres españolas e inmigrantes en Fuenlabrada (Madrid). Rev Esp Quimioter [Internet]. 2020 [citado 12/10/25]; 33(3):187-192. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC7262383/

3. Donders G, Sziller IO, Paavonen J, Hay P, de Seta F, Bohbot JM, et al. Management of recurrent vulvovaginal candidosis: Narrative review of the literature and European expert panel opinion. Front Cell Infect Microbiol [Internet]. 2022 [citado 12/10/25]; 12:934353. Disponible en: https://doi.org/10.3389/fcimb.2022.934353

4. Ugalde González F, Rivera Gutierrez H, Durán Méndez MJ. Candidiasis vulvovaginal recurrente. Rev. Méd. Sinerg. [Internet]. 2021 [citado 12/10/25]; 6(9): e700. Disponible en: https://www.revistamedicasinergia.com/index.php/rms/article/view/700

5. Sun Z, Ge X, Qiu B, Xiang Z, Jiang C, Wu J, et al. Vulvovaginal candidiasis and vaginal microflora interaction: Microflora changes and probiotic therapy. Front Cell Infect Microbiol [Internet]. 2023 [citado 12/10/25]; 13:1123026. Disponible en: https://doi.org/10.3389/fcimb.2023.1123026

6. Xiao Z, Liang Y, Zhang X, Zhu Y, Huang L, Fan S. Three-Dose Antifungal Treatment Improves the Efficacy for Severe Vulvovaginal Candidiasis. Mycopathologia [Internet]. 2024 [citado 12/10/25]; 189(6):93. Disponible en: https://doi.org/10.1007/s11046-024-00889-4

7. Picheta N, Piekarz J, Burdan O, Satora M, Tarkowski R, Kułak K. Phytotherapy of Vulvovaginal Candidiasis: A Narrative Review. Int J Mol Sci [Internet]. 2024 [citado 12/10/25]; 25(7):3796. Disponible en: https://doi.org/10.3390/ijms25073796

8. Sobel JD, Nyirjesy P. Oteseconazole: an advance in treatment of recurrent vulvovaginal candidiasis. Future Microbiol [Internet]. 2021 [citado 12/10/25]; 16:1453-1461. Disponible en: https://doi.org/10.2217/fmb-2021-0173

9. Jaeger M, Pinelli M, Borghi M, Constantini C, Dindo M, van Emst L, et al. A systems genomics approach identifies SIGLEC15 as a susceptibility factor in recurrent vulvovaginal candidiasis. Sci Transl Med [Internet]. 2019 [citado 12/10/25]; 11(496): eaar3558. Disponible en: https://doi.org/10.1126/scitranslmed.aar3558

10. Sociedad Española de Ginecologia y Obstetricia. Diagnóstico y tratamiento de las infecciones vulvovaginales. Prog. obstet. Ginecol [Internet]. 2022 [citado 12/10/25]; 65(2): 61-75. Disponible en: https://dialnet.unirioja.es/servlet/articulo?codigo=8452285&orden=0&info=link

11. Jafarzadeh L, Ranjbar M, Nazari T, Naeimi Eshkaleti M, Aghaei Gharehbolagh S, Sobel JD, et al. Vulvovaginal candidiasis: An overview of mycological, clinical, and immunological aspects. J Obstet Gynaecol Res [Internet]. 2022 [citado 12/10/25]; 48(7):1546-1560. Disponible en: https://doi.org/10.1111/jog.15267

12. Denning DW, Kneale M, Sobel JD, Rautemaa-Richardson R. Global burden of recurrent vulvovaginal candidiasis: a systematic review. Lancet Infect Dis [Internet]. 2018 [citado 12/10/25]; 18(11):e339-e347. Disponible en: https://doi.org/10.1016/s1473-3099(18)30103-8

13. MacAlpine J, Lionakis MS. Host-microbe interaction paradigms in acute and recurrent vulvovaginal candidiasis. Cell Host Microbe [Internet]. 2024 [citado 12/10/25]; 32(10):1654-1667. Disponible en: https://doi.org/10.1016/j.chom.2024.08.018

14. Denison HJ, Worswick J, Bond CM, Grimshaw JM, Mayhew A, Gnani Ramadoss S, et al. Oral versus intra-vaginal imidazole and triazole anti-fungal treatment of uncomplicated vulvovaginal candidiasis (thrush). Cochrane Database Syst Rev [Internet]. 2020 [citado 12/10/25]; 8(8):CD002845. Disponible en: https://doi.org/10.1002/14651858.cd002845.pub3

15. Phillips NA, Bachmann G, Haefner H, Martens M, Stockdale C. Topical Treatment of Recurrent Vulvovaginal Candidiasis: An Expert Consensus. Womens Health Rep (New Rochelle) [Internet]. 2022 [citado 12/10/25]; 3(1):38-42. Disponible en: https://doi.org/10.1089/whr.2021.0065

16. Ordaya EE, Clement J, Vergidis P. The Role of Novel Antifungals in the Management of Candidiasis: A Clinical Perspective. Mycopathologia [Internet]. 2023 [citado 12/10/25]; 188(6):937-948. Disponible en: https://doi.org/10.1007/s11046-023-00759-5

17. Herreras Gómez LR, Cárdenas López V. Perfil de resistencia antifúngica en el tratamiento de candidiasis vaginal: Un diagnóstico de agentes etiológicos. Rev haban cienc méd [Internet]. 2022 [citado 12/10/25]; 21(2). Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1729-519X2022000200011&lng=es

18. Conte J, Parize AL, Caon T. Advanced Solid Formulations For Vulvovaginal Candidiasis. Pharm Res [Internet]. 2023 [citado 12/10/25]; 40(2):593-610. Disponible en: https://doi.org/10.1007/s11095-022-03441-5

19. Powell A, Ghanem KG, Rogers L, Zinalabedini A, Brotman RM, Zenilman J, et al. Clinicians' Use of Intravaginal Boric Acid Maintenance Therapy for Recurrent Vulvovaginal Candidiasis and Bacterial Vaginosis. Sex Transm Dis [Internet]. 2019 [citado 12/10/25]; 46(12):810-812. Disponible en: https://doi.org/10.1097/olq.0000000000001063

20. Phillips NA, Rocktashel M, Merjanian L. Ibrexafungerp for the Treatment of Vulvovaginal Candidiasis: Design, Development and Place in Therapy. Drug Des Devel Ther [Internet]. 2023 [citado 12/10/25]; 17:363-367. Disponible en: https://doi.org/10.2147/dddt.s339349

21. Barnes KN, Yancey AM, Forinash AB. Ibrexafungerp in the Treatment of Vulvovaginal Candidiasis. Ann Pharmacother [Internet]. 2023 [citado 12/10/25]; 57(1):99-106. Disponible en: https://doi.org/10.1177/10600280221091301

22. Wang X, Chen L, Ruan H, Xiong Z, Wang W, Qiu J, et al. Oteseconazole versus fluconazole for the treatment of severe vulvovaginal candidiasis: a multicenter, randomized, double-blinded, phase 3 trial. Antimicrob Agents Chemother [Internet]. 2024 [citado 12/10/25]; 68(1):e0077823. Disponible en: https://doi.org/10.1128/aac.00778-23

23. Lanier C, Melton TC. Oteseconazole for the Treatment of Recurrent Vulvovaginal Candidiasis: A Drug Review. Ann Pharmacother [Internet]. 2024 [citado 12/10/25]; 58(6):636-644. Disponible en: https://doi.org/10.1177/10600280231195649

24. Li L, Zhang X, Li Q, Zhong W, Zou H. The Increasing Trend of Triazole-Resistant Candida from Vulvovaginal Candidiasis. Infect Drug Resist [Internet]. 2024 [citado 12/10/25]; 17:4301-4310. Disponible en: https://doi.org/10.2147/idr.s474304

25. Mittelstaedt R, Kretz A, Levine M, Handa VL, Ghanem KG, Sobel JD, et al. Data on Safety of Intravaginal Boric Acid Use in Pregnant and Nonpregnant Women: A Narrative Review. Sex Transm Dis [Internet]. 2021 [citado 12/10/25]; 48(12):e241-e247. Disponible en: https://doi.org/10.1097/olq.0000000000001562

26. Akinosoglou K, Schinas G, Polyzou E, Tsiakalos A, Donders GGG. Probiotics in the Management of Vulvovaginal Candidosis. J Clin Med [Internet]. 2024 [citado 12/10/25]; 13(17):5163. Disponible en: https://doi.org/10.3390/jcm13175163

27. Keikha N, Fouladi B, Yadegari MH. The efficacy and safety of current treatment of vulvovaginal candidiasis: An umbrella review of systematic reviews and meta-analyses. Naunyn Schmiedebergs Arch Pharmacol [Internet]. 2025 [citado 12/10/25]; 398(7):7713-7720. Disponible en: https://doi.org/10.1007/s00210-025-03852-2

Published

2026-02-28

How to Cite

1.
Chamorro Fuertes CN, Paspuezán Carlozama DM, Álvarez Escobar CJ. Etiopathogenic Bases and Therapeutic Strategies in Recurrent Candidal Vulvovaginitis. Rev Ciencias Médicas [Internet]. 2026 Feb. 28 [cited 2026 Apr. 15];30(1):e7170. Available from: https://revcmpinar.sld.cu/index.php/publicaciones/article/view/7170

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