Abstract
Candida albicans, along with other closely related Candida species, are the primary causative agents of vulvovaginal candidiasis (VVC)—a multifactorial infectious disease of the lower female reproductive tract resulting in pathologic inflammation. Unlike other forms of candidiasis, VVC is a disease of immunocompetent and otherwise healthy women, most predominant during their child-bearing years. While VVC is non-lethal, its high global incidence and profound negative impact on quality-of-life necessitates further understanding of the host and fungal factors that drive disease pathogenesis. In this review, we cover the current state of our understanding of the epidemiology, host response, fungal pathogenicity mechanisms, impact of the microbiome, and novel approaches to treatment of this most prevalent human candidal infection. We also offer insight into the latest advancements in the VVC field and identify important questions that still remain.
Highlights
Candida albicans, along with other closely related Candida species, are the primary causative agents of vulvovaginal candidiasis (VVC)—a multifactorial infectious disease of the lower female reproductive tract resulting in pathologic inflammation
Work comparing the relative capacity of various Candida species to activate NLRP3 revealed that all, aside from C. albicans, are relatively poor inducers of these responses likely because they infrequently form hyphae and demonstrate significantly reduced ECE1 expression [31]
Recent advances in our understanding of VVC as an immunopathology and the mechanistic roles of candidalysin, inflammasome, and pattern recognition receptors (PRR)-mediated signaling at the vaginal mucosa have opened up multiple avenues for scientific exploration
Summary
Vulvovaginal candidiasis (VVC), is an exceedingly common mucosal infection of the lower female reproductive tract (FRT), caused mostly by the polymorphic opportunistic fungus Candida albicans. VVC can mimic several disease states of the lower FRT and the ability to distinguish Candida as a true pathogen from an asymptomatic colonizer can be difficult Many such reports identifying high proportions of NAC species come from tertiary vaginitis clinics, focused on patients who have failed conventional antifungal therapy [24,28]. Prepubescent girls and post-menopausal women are infrequently afflicted, unless they undergo hormone replacement therapy [33] Whether this susceptibility is exerted through effects on host immune function, vaginal epithelium stratification, or the fungus itself, are still unknown but all have been reported to potentially play a role [34,35]
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