Vulvovaginal candidosis

Vulvovaginal candidosis is increasing in incidence in many developed countries. Although for many women the sporadic occurrence of symptomatic episodes causes no more than temporary inconvenience and discomfort, in others the chronic or recurrent pattern of symptoms can be very distressing and disabling. Knowledge of the pathogenesis, predisposing factors and clinical features, although still incomplete, permits improved individual patient management and more appropriate use of specific antifungal therapy. Topical treatment with either polyenes or imidazoles gives short term mycological cure rates greater than 90%, but subsequent recolonization of the vagina and symptomatic relapse is common. Azole drugs offer the possibility of oral treatment which has increased patient acceptability; in particular, fluconazole, in a single dosage of 150 mg, is effective, well tolerated and safe. In chronic or recurrent disease, when underlying and predisposing conditions have been excluded, intermittent prophylaxis (topical or oral) may reduce the frequency of acute symptomatic episodes.