Abstract
Candida species are one of the commonest causes of vaginitis in healthy women of reproductive age. Vulvovaginal candidiasis (VVC) is characterized by vulvovaginal itching, redness and discharge. Candida albicans, which is a common genito-urinary tract commensal, has been the prominent species and remains the most common fungal agent isolated from clinical samples of patients diagnosed with VVC. In recent times, however, there has been a notable shift in the etiology of candidiasis with non-albicans Candida (NAC) species gaining prominence. The NAC species now account for approximately 10% to as high as 45% of VVC cases in some studies. This is associated with treatment challenges and a slightly different clinical picture. NAC species vaginitis is milder in presentation, often occur in patients with underlying chronic medical conditions and symptoms tend to be more recurrent or chronic compared with C. albicans vaginitis. C. glabrata is the most common cause of NAC-VVC. C. tropicalis, C. krusei, C. parapsilosis, and C. guilliermondii are the other commonly implicated species. Treatment failure is common in NAC-VVC, since some of these species are intrinsically resistant or show low susceptibilities to commonly used antifungal agents. This article reviews the etiology, pathogenesis, clinical features, diagnosis, and management of NAC vulvovaginitis.
Highlights
Vulvovaginal candidiasis (VVC) known as vulvovaginal candidosis or Candida vaginitis is a common clinical condition with symptoms and signs of vaginal and vulval inflammation in the presence of Candida species [1].At least one episode of VVC is experienced in up to 70% to 75% of women in the reproductive age group in their lifetime [2]
Most cases of VVC are still caused by C. albicans, the non-albicans Candida (NAC) species are increasingly being implicated in the etiology of VVC [11,12,22,23,24]
There is a rising prevalence of infections caused by NAC species, while that of C. albicans is decreasing in spite of retaining its position as the most common Candida species in general [44,50]
Summary
Vulvovaginal candidiasis (VVC) known as vulvovaginal candidosis or Candida vaginitis is a common clinical condition with symptoms and signs of vaginal and vulval inflammation in the presence of Candida species [1]. Epidemiological information suggests that half of all women would have experienced at least one episode of VVC by the age of 25 years with the onset of sexual activity being an important risk factor in this group of individuals [3]. Those who have had at least four episodes of VVC during a 12-month period are considered to have recurrent VVC (RVVC). Older age, prior antifungal agents use, and low socioeconomic status are conditions that result in higher likelihood of non-albicans candidiasis. Identification and antifungal susceptibility testing are necessary for optimal treatment of these infections, especially in settings where diagnosis is based on clinical presentation or limited laboratory testing
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