Pharmacological treatment of acute vulvovaginal candidiasis.

Abstract

Acute vulvovaginal candidiasis is a common infection affecting up to 75% of sexually active women at some time during their reproductive life! and up to 50% of these will have at least one further episode'. Additionally, Candida spp can be isolated from the vagina in approximately 20% of asymptomatic women and may persist for months if not yearsv'. There is an increased susceptibility to symptomatic vaginal infection and a higher prevalence of asymptomatic vaginal colonization among pregnant women, especiallyin the third trimester, and in those on the combined oral contraceptive pill with a high oestrogen content (50ILg)5,6 most likely due to a higher glycogen content in the vagina which provides a good source of nutrition for Candida spp', Although asymptomatic vaginal colonization with yeasts is more rommon among women with diabetes mellitus, particularly those who are insulindependent, symptomatic infection is unusual in the presence of good diabetic control-. Certainly, the commonest identified cause of acute vulvovaginal candidiasis follows the oral ingestion of broadspectrum antibiotics. Not only is there an increase in the prevalence of symptomatic candidiasis but higher rates of asymptomatic colonization, approaching 30%, have been reportedv. These effects are most likely due to the elimination of 'protective' bacteria, especially lactobacilli, which inhibit fungal colonization and germination of yeasts through mUlt~le factors which include competition for nutrients1 ,11. Infection is caused by yeast-like fungi of the Crupuxxxcaceae family of which C. albiams accounts for approximately 80% of clinical infections12, 13. The remaining 20% are caused by Torulopsis glabrata or other Candida spp such as C. krusei, C. guilliermondi, C. tropicalis and C. pseudoiropicdis. The non-albicans Candida spp are known to be less responsive to conventional antifungal treatments than C. albicane', The adjacent perianal area is the source of yeasts which gain access to the vagina and, once there, may act as either commensal organisms or as pathogens depending upon environmental or host factors: