Pathogenesis and treatment of recurrent vulvovaginal candidiasis

In contrast to women who experience infrequent episodes of candidal vaginitis, patients with chronic and recurrent candidal vaginitis rarely have recognizable precipitating or causal factors. Analysis of vaginal yeast isolated from women with recurrent candidal vaginitis uncommonly reveals a higher percentage of non-albicans Candida species. There is no indication that resistance to azoles is a causal factor, and no other fungal virulence factors have been identified to explain the repeated attacks. Strain typing of sequential clinical isolates by means of molecular techniques indicate a pattern of relapse due to persistent yeast in the vagina rather than frequent vaginal reinfection. Attempts to reduce the number of attacks by treating sexual partners and suppressing a gastrointestinal tract focus have failed. Recent immunological studies suggest the possibility that an acquired Candida antigen-specific immunological deficiency results in uncontrolled vaginal Candida proliferation and hence repeated clinically evident attacks. Although no definitive cure for recurrent candidal vaginitis exists, numerous therapeutic maintenance regimens with azoles are available that effectively control symptomatic infection.