A THEORY ON PATHOGENESIS AND NEW APPROACHES IN TREATMENT OF RECURRENT VULVOVAGINAL CANDIDIASIS (RVVC)

Abstract

Although as many as 75% women experience at least one episode of VVC during their lifetime and 5-10% will experience RVVC, diagnosis and treatment of RVVC continues to present a challenge. Based on our own theory on pathogenesis with the existing of Candida on vulval keratonizing epithelia proved by our histological findings, we desired to determine the impact of Candida cultures obtained from the external vulva on the diagnosis and the effectiveness of multi-dose of fluconazole in combination with ciclopiroxolamin cream in treatment of RVVC. Among 469 women with recurrent vulvovaginitis who refered to the outpatient clinic of the University Women’s hospital Freiburg, Germany, 156 (33%) women had a positive yeast culture, 120 (77%) of these with positive vulvar swabs. There was a significant association between acute RVVC and pruritus, vulvar erythema, vulvar edema, excoriation and fissure – specific signs of local infection other than contamination (OR were in turn 2,8; 2,4; 3,0; 1,7 and 2,0 times). After 1, 3, 6, 9 and 12 months post-treatment with multi-dose fluconazole in combination with ciclopiroxolamin cream, symptomatic recurrences with positive Candida cultures occurred in 3,6%, 17%, 26%, 32% and 33%, respectively. In conclusion, persisting of Candida in the vulval keratinizing epithelium plays a role in the pathogenesis of RVVC. The treatment regimen with fluconazole 100mg orally per day in 3 weeks in combination with ciclopiroxolamina cream locally shown better long-term cure rates than other current recommended protocols. More controlled randomized trial should be conducted to determined the best doses and regimens.