Chronic vulvovaginal candidosis: the role of oral treatment

Fluor vaginalis may have a diversity of causes, among which are fungal infections by Candida spp. It has been estimated that up to 75% of women will have at least one episode of vaginal candidosis during their reproductive years. Most of these women have had only one occasional episode of discomfort. However, a small group presents with a chronic recurrence of vaginal candidosis accompanied by symptomatic infections many times a year. Until now, investigations into the pathogenesis and treatment of these recurrent episodes gave no clear answer to the question as to why this occurs in these patients. The opportunity to treat vaginal candidosis with a systemic antifungal drug can have advantages over a topical drug, if extravaginal Candida spp. that may contribute to recurrence can be eliminated at the same time. In this trial, 18 patients with chronic recurrent vaginal candidosis (greater than 4 attacks of candidosis vaginalis per year) were treated with itraconazole 200 mg/day monthly for two days--Days 5 and 6 after menstruation. After the first therapeutic treatment, 17 patients were culture-negative and symptom-free. Results show that prophylaxis for six months with itraconazole was beneficial, as far as complaints were concerned, in 11 patients (64.7%).