Recurrent vulvovaginal candidiasis

Widespread use of over-the-counter antifungal medications has contributed to a large increase in the number of women who experience more than three episodes of candida vulvovaginitis per year. These women are particularly prone to chronic vulvovaginal pain syndromes; as such, the value of aggressive therapy based on detailed diagnosis extends well beyond immediate symptom relief. Diagnosis is complicated by the fact that a larger proportion of cases of are due to non-albicans species, which are not readily identifiable at office evaluation, and points to the value of fungal culture in such cases. Although most Candida albicans are sensitive to azole antifungals, non-albicans species are more often resistant, necessitating alternative therapies. In many cases therapy aimed at suppression of recurrence must extend 6 months. Ongoing studies may identify host factors that facilitate recurrence, and thus provide the basis for individually targeted therapy.