Vulvovaginal Candidiasis: A Review of the Evidence for the 2021 Centers for Disease Control and Prevention of Sexually Transmitted Infections Treatment Guidelines
Open accessAbstract
Background: Vulvovaginal candidiasis (VVC) is a common cause of vulvovaginal itching and discharge. This article discusses the latest CDC STI Treatment Guidelines for VVC. Methods: A literature search of relevant topics was performed, and a team of experts was convened to discuss (1) diagnosis/testing modalities; treatment of (2) uncomplicated VVC , (3) complicated VVC, and (4) VVC caused by non-albicans yeast; (5) alternative treatment regimens; (6) susceptibility testing of yeast; Special Populations: (7) pregnancy and (8) HIV and VVC. Results: Yeast culture remains the gold standard for diagnoses. Newer molecular assays have been developed for the diagnosis of VVC and perform well. Azole antifungals remain the treatment of choice for uncomplicated VVC. Two new drugs, TOL-463 and recently FDA-approved ibrexafungerp, appeared promising in clinical trials. For recurrent VVC, oteseconazole, not yet commercially available, may represent a new option. For non-albicans yeast infections in symptomatic patients, boric acid appears useful. No evidence supports the use of alternative treatments, including probiotics. Fluconazole during pregnancy may be associated with spontaneous abortion and craniofacial and heart defects. In women with HIV infection, lower CD4+ T-cell counts are associated with increased rates of VVC, and VVC is associated with increased viral shedding. Treatment measures in women with HIV infection are identical to those women without HIV infection. Conclusions: There has been significant new knowledge generated about VVC since the 2015 CDC Guidelines which have led to changing recommendations.
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- Authors
- Nyirjesy, P., Brookhart, C., Lazenby, G., Schwebke, J., & Sobel, J. D.
- Affiliations
- Thomas Jefferson University (US)
- Drexel University (US)
- Medical University of South Carolina (US)
- University of Alabama at Birmingham (US)
- Wayne State University (US)
- Corresponding author
- Nyirjesy, Paul
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2022-04-13
- Volume
- 74
- Issue
- Supplement_2
- Pages
- S162-S168
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- OpenAlex
- W4205266914
- Semantic Scholar
- a386599dfec08ff933ebc36fc684a0da8e45a4e3
- Cited by
- 149
- References
- 48
- Citations by year
- 2026: 37 · 2025: 49 · 2024: 39 · 2023: 24
- FWCI
- 1.84
- Type
- journal article
- Language
- en
- Open access
- green
- jdc.jefferson.edu
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Clinical Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- The Medicine Forum (submittedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Yeasts and Rust Fungi Studies
- Keywords
- vaginal candidiasis, molecular diagnosis, azole antifungals, ibrexafungerp, oteseconazole, boric acid, recurrent vulvovaginal candidiasis, pregnancy, HIV infection, fluconazole, CD4 count, probiotics
- MeSH terms
- Antifungal Agents, Candida albicans, Candidiasis, Vulvovaginal, Centers for Disease Control and Prevention, U.S., Female, Humans, Pregnancy, Saccharomyces cerevisiae, United States, HIV Infections, Fluconazole
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