[Therapy problems in chronic recurrent vaginal mycosis]

Vulvovaginal candidiasis is one of the most frequent infectious diseases. The mainly acute forms occur sporadically, have an uncomplicated course and can mostly be treated effectively with topical antimycotics. However, chronic infections are almost always a therapeutic problem. In most cases, systemic therapy is indicated. Since some mycoses cannot be treated effectively with fluconazole and itraconazole, prior identification of the causative agent is obligatory. Treatment of chronic vulvovaginal candidiasis also comprises identification and clearance of existing endogenous (oral cavity, intestine) and exogenous (sex partner) sources of reinfection. The following three-ponged treatment is suggested: (1) depending on the colonization status, selective orointestinal fungal decontamination with a polyene antimycotic, (2) depending on the kind of fungal pathogen systemic treatment with fluconazole or itraconazole, (3) topical treatment using ciclopiroxolamine as a synergistic combination partner.