Treatment of vaginal Candida infections

Candida vaginitis is most commonly caused by Candida albicans (> 85%) with little evidence of an increase in vaginitis due to non-C. albicans species. Epidemiological studies are no longer possible in the US in the era of self-diagnosis and -treatment by women empowered by the availability of over-the-counter antimycotics. A new classification of vulvovaginal candidiasis into uncomplicated and complicated vaginitis has simplified choice and duration of antifungal therapy. Vaginitis due to C. albicans responds well to available therapy. In contrast, vaginitis due to Candida glabrata is associated with a high treatment failure rate. Candida vaginitis infection rates in HIV-positive women remain undetermined and reports of refractory fungal vaginitis have not been substantiated. In spite of the wide array of antifungal agents currently available, considerable limitations in available therapy exist in the effective management of complicated vaginitis.