Treatment for recurrent vulvovaginal candidiasis (thrush).

Area of Science:

• Gynecology
• Infectious Diseases
• Pharmacology

Background:

• Recurrent vulvovaginal candidiasis (RVVC) affects up to 5% of women.
• No comprehensive systematic review of RVVC treatments has been published.

Purpose of the Study:

• To assess the effectiveness and safety of pharmacological and non-pharmacological treatments for RVVC.
• To evaluate patient preference for different treatment options.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs) published up to October 2021.
• Inclusion of 23 studies with 2212 women diagnosed with RVVC.
• Assessment of clinical recurrences and adverse events, with data pooled using fixed- or random-effects models.

Main Results:

• Antifungal treatments (oral and topical) may reduce clinical recurrences at 6 and 12 months compared to placebo (low-certainty evidence).
• No clear differences in recurrence rates were found between oral and topical antifungal treatments (very low-certainty evidence).
• Adverse events were scarce and low in both treatment and control groups.

Conclusions:

• Oral or topical antifungals may decrease symptomatic recurrences in women with RVVC compared to placebo.
• Evidence is insufficient to differentiate between various treatment options, doses, or durations.
• Further research is required to establish optimal RVVC treatment strategies, particularly for specific populations.