Chronic vulvovaginal candidiasis: what we know and what we have yet to learn

Vulvovaginal candidiasis (VVC) is defined as vulvovaginitis, causally associated with Candida species in the vagina. It is seen commonly in vulval clinics as a cause of persistent vulvovaginitis and yet this chronic condition is yet to be formally defined and explained. The classic symptom complex of chronic itch, pain and dyspareunia exacerbating premenstrually and remitting during menstruation associated with an erythematous vulval eruption is well described but the exact aetiology remains elusive. Research in recent years has suggested that VVC is not an opportunistic infection or an immunodeficiency but a hypersensitivity response to a commensal organism that may be genetically determined. Further, it is apparent on clinical grounds that oestrogen plays an essential permissive role and that, in healthy non-diabetic patients, VVC does not occur in the absence of oestrogen whether endogenous or exogenous. The nature of this relationship has not been established. In this article I discuss the diagnostic features of VVC, its management and what is currently understood of its aetiology.