The DOI matches its Crossref record; 20 of the 21 references it cites were found in a registry or an index.
Maintenance Fluconazole Therapy for Recurrent Vulvovaginal Candidiasis
Abstract
BACKGROUND: No safe and convenient regimen has proved to be effective for the management of recurrent vulvovaginal candidiasis. METHODS: After inducing clinical remission with open-label fluconazole given in three 150-mg doses at 72-hour intervals, we randomly assigned 387 women with recurrent vulvovaginal candidiasis to receive treatment with fluconazole (150 mg) or placebo weekly for six months, followed by six months of observation without therapy. The primary outcome measure was the proportion of women in clinical remission at the end of the first six-month period. Secondary efficacy measures were the clinical outcome at 12 months, vaginal mycologic status, and time to recurrence on the basis of Kaplan-Meier analysis. RESULTS: Weekly treatment with fluconazole was effective in preventing symptomatic vulvovaginal candidiasis. The proportions of women who remained disease-free at 6, 9, and 12 months in the fluconazole group were 90.8 percent, 73.2 percent, and 42.9 percent, as compared with 35.9 percent, 27.8 percent, and 21.9 percent, respectively, in the placebo group (P< 0.001). The median time to clinical recurrence in the fluconazole group was 10.2 months, as compared with 4.0 months in the placebo group (P<0.001). There was no evidence of fluconazole resistance in isolates of Candida albicans or of superinfection with C. glabrata. Fluconazole was discontinued in one patient because of headache. CONCLUSIONS: Long-term weekly treatment with fluconazole can reduce the rate of recurrence of symptomatic vulvovaginal candidiasis. However, a long-term cure remains difficult to achieve.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“Although symptom resolution is achieved in ~90% of women with RVVC who undergo ⩾6 months of maintenance therapy,16,21,22 up to 50% will have a recurrence after the termination of maintenance therapy. 13”
From Clinical challenges in diagnosis and treatment of recurrent vulvovaginal candidiasis (2022) · cites this paper as [21]
In the citing paper
“A landmark RVVC treatment study using an induction regimen of fluconazole (three 150 mg doses at 72 h intervals) followed by weekly maintenance doses of 150 mg of fluconazole for 6 months was shown to reduce symptoms and recurrences. 21”
From Clinical challenges in diagnosis and treatment of recurrent vulvovaginal candidiasis (2022) · cites this paper as [21]
In the citing paper
“The mainstay of treatment for most cases of uncomplicated VVC is azole antifungals, which, by inhibiting the fungal enzyme CYP51, prevent the accumulation of fungitoxic sterols [11,34].”
From Treatment of Vulvovaginal Candidiasis—An Overview of Guidelines and the Latest Treatment Methods (2023) · cites this paper as [34]
In the citing paper
“During the treatment phases, relapse rates vary between 21% (Donders et al., 2008a), 57.1% (Sobel et al., 2004), and 71.9% (Bolouri et al., 2009) at 12 months depending upon the characteristics of the therapeutic regimen used, as described in Supplementary Tables 2 and 3 .”
From Management of recurrent vulvovaginal candidosis: Narrative review of the literature and European expert panel opinion (2022) · cites this paper as Sobel et al., 2004
In the citing paper
“Likewise, other studies found that up to 50% of women with RVVC relapsed after stopping their maintenance therapy regimen (Sobel et al., 2004; Donders et al., 2008a) or that additional fluconazole therapy was continued for longer than 6 months due to either culture-confirmed VVC recurrence, microbiologically unconfirmed but clinically possible VVC recurrence, or due to patients’ preference to”
From Management of recurrent vulvovaginal candidosis: Narrative review of the literature and European expert panel opinion (2022) · cites this paper as Sobel et al., 2004
In the citing paper
“With the regimen proposed by Sobel et al. (Sobel et al., 2004) (150 mg of oral fluconazole or placebo once a week for 6 months, after a successful induction phase), 42.9% of 387 women were still disease free at 12 months, indicating over half relapsed after maintenance therapy with fluconazole was stopped.”
From Management of recurrent vulvovaginal candidosis: Narrative review of the literature and European expert panel opinion (2022) · cites this paper as Sobel et al., 2004
In the citing paper
“Median time to clinical and mycological relapse was 10.2 and 8.4 months, respectively.”
From Management of recurrent vulvovaginal candidosis: Narrative review of the literature and European expert panel opinion (2022) · cites this paper as Sobel et al., 2004
In the citing paper
“With the regimen proposed by Sobel et al. (Sobel et al., 2004) (150 mg of oral fluconazole or placebo once a week for 6 months, after a successful induction phase), 42.9% of 387 women were still disease free at 12 months, indicating over half relapsed after maintenance therapy with fluconazole was stopped.”
From Management of recurrent vulvovaginal candidosis: Narrative review of the literature and European expert panel opinion (2022) · cites this paper as Sobel et al., 2004
In the citing paper
“Although oral fluconazole is highly effective at reducing acute episodes during maintenance therapy, long-term remission after stopping the regimen is only present in about half of patients (Sobel et al., 2004; Donders et al., 2008a).”
From Management of recurrent vulvovaginal candidosis: Narrative review of the literature and European expert panel opinion (2022) · cites this paper as Sobel et al., 2004
Citations
Cites
Hepatic Injury Associated With Ketoconazole Therapy
Lewis, J. H., Zimmerman, H. J., Benson, G. D., & Ishak, K. G. (1984) · Gastroenterology · doi:10.1016/s0016-5085(84)80021-9 · Cited by 392
Epidemiology and pathogenesis of recurrent vulvovaginal candidiasis
Sobel, J. D. (1985) · American Journal of Obstetrics and Gynecology · doi:10.1016/s0002-9378(85)80003-x · Cited by 332
Self-citationImmunopathogenesis of recurrent vulvovaginal candidiasis
Fidel, P. L., & Sobel, J. D. (1996) · Clinical Microbiology Reviews · doi:10.1128/cmr.9.3.335 · Cited by 298
Self-citationRecurrent Vulvovaginal Candidiasis
Sobel, J. D. (1986) · New England Journal of Medicine · doi:10.1056/nejm198612043152305 · Cited by 219
Self-citationCandida vaginitis: Self-Reported Incidence and Associated Costs
Foxman, B., Barlow, R., Dʼarcy, H., Gillespie, B., & Sobel, J. D. (2000) · Sexually Transmitted Diseases · doi:10.1097/00007435-200004000-00009 · Cited by 158
Self-citationWeekly Fluconazole for the Prevention of Mucosal Candidiasis in Women with HIV Infection
Schuman, P. C., Capps, L., Peng, G., Vazquez, J., El-Sadr, W. M., Goldman, A. I., Alston, B., Besch, C. L., Vaughn, A., Thompson, M., et al. (1997) · Annals of Internal Medicine · doi:10.7326/0003-4819-126-9-199705010-00003 · Cited by 120
Self-citationFoxman, B., MARSH, J. V., Gillespie, B. W., & Sobel, J. D. (1998) · Journal of Women s Health · doi:10.1089/jwh.1998.7.1167 · Cited by 92
Self-citationHouang, E. T., Chappatte, O., Byrne, D., Macrae, P. V., & Thorpe, J. E. (1990) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.34.5.909 · Cited by 76
Epidemiologic characteristics of women with idiopathic recurrent vulvovaginal candidiasis
Spinillo, A., Pizzoli, G., Colonna, L., Nicola, S., Seta, F. D., & Guaschino, S. (1994) · International Journal of Gynecology & Obstetrics · doi:10.1016/0020-7292(94)90096-5 · Cited by 72
Management of recurrent vulvovaginal candidiasis with intermittent ketoconazole prophylaxis.
Sobel, J. D. (1985) · PubMed · Cited by 62
Self-citationPathogenesis of recurrent vulvovaginal candidiasis
Sobel, J. D. (2002) · Current Infectious Disease Reports · doi:10.1007/s11908-002-0038-7 · Cited by 59
Self-citationRecurrent genital candidosis in women and the effect of intermittent prophylactic treatment
Davidson, F., & Mould, R. F. (1978) · Sexually Transmitted Infections · doi:10.1136/sti.54.3.176 · Cited by 55
Spinillo, A., Carratta, L., Pizzoli, G., Lombardi, G., Cavanna, C., Michelone, G., & Guaschino, S. (1992) · PubMed · Cited by 50
Roth, A. C., Milsom, I., Forssman, L., & Wåhlén, P. (1990) · Sexually Transmitted Infections · doi:10.1136/sti.66.5.357 · Cited by 28
Clotrimazole treatment of recurrent and chronic candida vulvovaginitis
Sobel, J. D., Schmitt, C., & Meriwether, C. (1989) · International Journal of Gynecology & Obstetrics · doi:10.1016/0020-7292(89)90378-0 · Cited by 24
Self-citationTreatment of Complicated Candida Vaginitis: Comparison of Single and Sequential Doses of Fluconazole
Sobel, J. D., KAPERNICK, P., Zervos, M., Reed, B. D., Hooton, T. M., Soper, D. E., Nyirjesy, P., Heine, M. W., Willems, J., Panzer, H., et al. (2002) · Obstetrical & Gynecological Survey · doi:10.1097/00006254-200201000-00014 · Cited by 22
Self-citationBalsdon, M. J., & Tobin, J. M. (1988) · Sexually Transmitted Infections · doi:10.1136/sti.64.2.124 · Cited by 18
Fong, I. W. (1994) · Sexually Transmitted Infections · doi:10.1136/sti.70.2.124 · Cited by 11
Chronic or recurrent vaginal candidosis: short-term treatment and prophylaxis with itraconazole.
Creatsas, G. C., Charalambidis, V. M., Zagotzidou, E., Anthopoulou, H. N., MICHAILIDIS, D., & Aravantinos, D. (1993) · PubMed · Cited by 10
Chronic vulvovaginal candidosis: the role of oral treatment.
Merkus, J. M. W. M., & van Heusden, A. M. (1990) · PubMed · Cited by 7
Cited by
Sorted by citations
Pappas, P. G., Kauffman, C. A., Andes, D. R., Clancy, C. J., Marr, K. A., Ostrosky-Zeichner, L., Reboli, A. C., Schuster, M. G., Vazquez, J. A., Walsh, T. J., et al. (2016) · Clinical Infectious Diseases · doi:10.1093/cid/civ933 · Cited by 4,200
Self-citationPappas, P. G., Kauffman, C. A., Andes, D., Benjamin, D. K., Calandra, T. F., Edwards, J. E., Filler, S. G., Fisher, J. F., Kullberg, B.-J., Zeichner, L. O., et al. (2009) · Clinical Infectious Diseases · doi:10.1086/596757 · Cited by 3,191
Practice Bulletin No. 183: postpartum hemorrhage
(2017) · Obstetrics & Gynecology · doi:10.1097/aog.0000000000002351 · Cited by 1,406
Sobel, J. D. (2007) · The Lancet · doi:10.1016/s0140-6736(07)60917-9 · Cited by 1,270
Self-citationCandida Infections of the Genitourinary Tract
Achkar, J. M., & Fries, B. C. (2010) · Clinical Microbiology Reviews · doi:10.1128/cmr.00076-09 · Cited by 736
Metadata
- Authors
- Sobel, J. D., Wiesenfeld, H. C., Martens, M., Danna, P., Hooton, T. M., Rompalo, A., Sperling, M., Livengood, C., Horowitz, B., Von Thron, J., Edwards, L., Panzer, H., & Chu, T.-C.
- Affiliations
- Wayne State University (US)
- University of Pittsburgh (US)
- Hennepin County Medical Center (US)
- University of Washington (US)
- Johns Hopkins University (US)
- Pfizer (United States) (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2004-08-26
- Volume
- 351
- Issue
- 9
- Pages
- 876-883
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2106311471
- Cited by
- 487
- References
- 21
- Citations by year
- 2026: 12 · 2025: 17 · 2024: 17 · 2023: 26 · 2022: 22 · 2021: 21 · 2020: 22 · 2019: 15 · 2018: 28 · 2017: 30 · 2016: 26 · 2015: 29 · 2014: 23 · 2013: 24 · 2012: 23
- FWCI
- 11.43
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
- Health Sciences › Medicine › Urology › Urinary Tract Infections Management
- Keywords
- recurrent vulvovaginal candidiasis, fluconazole, maintenance therapy, Candida albicans, Candida glabrata, antifungal resistance, superinfection, recurrence prevention, clinical remission
- MeSH terms
- Administration, Oral, Adult, Antifungal Agents, Candida albicans, Candidiasis, Vulvovaginal, Double-Blind Method, Drug Administration Schedule, Female, Humans, Remission Induction, Time Factors, Vagina, Fluconazole, Logistic Models, Drug Resistance, Fungal, Candida glabrata, Secondary Prevention
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
