Management of chronic vulvovaginal candidiasis: a long term retrospective study

Chronic vulvovaginal candidiasis (CVVC) is an unremitting condition causally associated with species of Candida. Limited data are available on its management and long-term outcomes. This retrospective study aimed to explore the long-term outcomes of patients who had experienced symptom remission after a course of oral antifungals.

Retrospective study conducted over 1 year from data obtained from a vulval dermatology outpatient clinic in Sydney, Australia. Data from 208 patients satisfying presumptive or definitive criteria for CVVC who had been successfully treated with oral azole antifungal medication were collected from a database, including drugs, induction and maintenance treatment regimes, results and adverse effects.

Altogether 208 patients commenced an induction regime of oral fluconazole 50-100 mg daily for up to 12 weeks. All patients demonstrated a clinical improvement within 12 weeks. Of the 208 patients, subsequently 95% remained on oral fluconazole for maintenance treatment, 3% changed to other antifungals due to adverse effects and 2% ceased treatment. The most common maintenance regime was oral fluconazole 50 mg twice weekly (46%). Of the study cohort 99% remained on treatment with antifungal therapy for symptom suppression with the mean duration of follow up 26.2 months (range, 5 months to 8.5 years).

Long-term symptom remission was possible in this subset of women with CVVC using fluconazole 50-100 mg or itraconazole 50-100 mg. However, most were unable to cease treatment without experiencing relapse. Adverse effects in this cohort were minimal and there were no cases of drug-induced hepatitis.