Cited by 149Antifungal resistance and susceptibilityReproductive tract infections researchYeasts and Rust Fungi Studies

Vulvovaginal Candidiasis: A Review of the Evidence for the 2021 Centers for Disease Control and Prevention of Sexually Transmitted Infections Treatment Guidelines

Open access
Nyirjesy, Paul, Brookhart, Carolyn, Lazenby, Gweneth, Schwebke, Jane, Sobel, Jack D·2022·Clinical Infectious Diseases

Abstract

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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Crossref · 10.1093/cid/ciab1057

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47 of 47 references verified0 citation errors · 0 not checkable

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Research works printed but not linked: 1

  1. Buggio, 2019, Probiotcs and vaginal microbiology: fact or fancy?, BMC Women\'s Health, 25, 1

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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
Published
2022-04-13
Volume
74
Issue
Supplement_2
Pages
S162-S168
ISSN
  • 1058-4838 (ISSN-L)
  • 1537-6591
OpenAlex
W4205266914
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
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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