Guideline: Vulvovaginal Candidosis (AWMF 015/072, Level S2k)

Farr, Alex; Effendy, Isaak; Frey Tirri, Brigitte; Hof, Herbert; Mayser, Peter; Petricevic, Ljubomir; Ruhnke, Markus; Schaller, Martin; Schaefer, Axel P. A.; Sustr, Valentina; Willinger, Birgit; Mendling, Werner

doi:10.1111/myc.13248

Cited by 184Antifungal resistance and susceptibilityReproductive tract infections researchNail Diseases and Treatments

Guideline: Vulvovaginal Candidosis (AWMF 015/072, Level S2k)

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Farr, Alex, Effendy, Isaak, Frey Tirri, Brigitte, Hof, Herbert, Mayser, Peter, Petricevic, Ljubomir, Ruhnke, Markus, Schaller, Martin +4 more·2021·Mycoses

DOI 10.1111/myc.13248PMC PMC8248160

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Abstract

Approximately 70-75% of women will have vulvovaginal candidosis (VVC) at least once in their lifetime. In premenopausal, pregnant, asymptomatic and healthy women and women with acute VVC, Candida albicans is the predominant species. The diagnosis of VVC should be based on clinical symptoms and microscopic detection of pseudohyphae. Symptoms alone do not allow reliable differentiation of the causes of vaginitis. In recurrent or complicated cases, diagnostics should involve fungal culture with species identification. Serological determination of antibody titres has no role in VVC. Before the induction of therapy, VVC should always be medically confirmed. Acute VVC can be treated with local imidazoles, polyenes or ciclopirox olamine, using vaginal tablets, ovules or creams. Triazoles can also be prescribed orally, together with antifungal creams, for the treatment of the vulva. Commonly available antimycotics are generally well tolerated, and the different regimens show similarly good results. Antiseptics are potentially effective but act against the physiological vaginal flora. Neither a woman with asymptomatic colonisation nor an asymptomatic sexual partner should be treated. Women with chronic recurrent Candida albicans vulvovaginitis should undergo dose-reducing maintenance therapy with oral triazoles. Unnecessary antimycotic therapies should always be avoided, and non-albicans vaginitis should be treated with alternative antifungal agents. In the last 6 weeks of pregnancy, women should receive antifungal treatment to reduce the risk of vertical transmission, oral thrush and diaper dermatitis of the newborn. Local treatment is preferred during pregnancy.

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SGLT2 inhibitors (e.g., dapagliflozin and canagliflozin) are supposed to increase the number of VVC episodes.
“This may be due to the fact that some diabetic patients are treated with SGLT2 inhibitors (e.g., dapagliflozin and canagliflozin), which are supposed to increase the number of VVC episodes [26].”
From Treatment of Vulvovaginal Candidiasis—An Overview of Guidelines and the Latest Treatment Methods (2023) · cites this paper as [26]
Currently available guidelines are largely consistent regarding the use of azoles in the therapy of VVC in pregnant women.
“Currently available guidelines are largely consistent when it comes to the usage of azoles in the therapy of VVC in pregnant women [26,36].”
From Treatment of Vulvovaginal Candidiasis—An Overview of Guidelines and the Latest Treatment Methods (2023) · cites this paper as [26]
A possible teratogenic effect is possible with 400 to 800 mg of fluconazole daily during pregnancy.
“a possible teratogenic effect is possible with 400 to 800 mg of fluconazole daily [26].”
From Treatment of Vulvovaginal Candidiasis—An Overview of Guidelines and the Latest Treatment Methods (2023) · cites this paper as [26]
For this reason, vaginal miconazole or clotrimazole may be a safer treatment for VVC in pregnancy.
“For this reason, vaginal miconazole or clotrimazole may be a safer treatment.”
From Treatment of Vulvovaginal Candidiasis—An Overview of Guidelines and the Latest Treatment Methods (2023) · cites this paper as [26]
Studies have not shown an increased risk of birth defects as a result of the use of 150 mg of fluconazole during pregnancy.
“While studies have not shown an increased risk of birth defects as a result of the use of 150 mg of fluconazole during pregnancy”
From Treatment of Vulvovaginal Candidiasis—An Overview of Guidelines and the Latest Treatment Methods (2023) · cites this paper as [26]

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Treatment of Vulvovaginal Candidiasis—An Overview of Guidelines and the Latest Treatment Methods
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Prevalence, drug resistance and genetic diversity of Candida glabrata in the reproductive tract of pregnant women in Hainan and comparison with global multilocus sequence data
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Authors: Farr, A., Effendy, I., Frey Tirri, B., Hof, H., Mayser, P., Petricevic, L., Ruhnke, M., Schaller, M., Schaefer, A. P. A., Sustr, V., Willinger, B., & Mendling, W.
Affiliations: Medical University of Vienna (AT)
Klinikum Bielefeld (DE)
Frauenklinik Kantonspital Baselland Liestal Switzerland
Labor Dr. Limbach und Kollegen Heidelberg Germany
Facharzt für Dermatologie und Allergologie Biebertal Germany
Division of Obstetrics and Feto‐Maternal Medicine Department of Obstetrics and Gynecology Medical University of Vienna Vienna Austria
Helios Klinikum Aue (DE)
Universitätsklinikum Tübingen (DE)
Facharzt für Frauenheilkunde und Geburtshilfe Berlin Germany
Deutsches Zentrum fuer Infektionen in Gynaekologie und Geburtshilfe Wuppertal Germany
Corresponding author: Farr, Alex
ORCID: Farr, Alex
Effendy, Isaak
Hof, Herbert
Mayser, Peter
Ruhnke, Markus
Schaller, Martin
Willinger, Birgit
Mendling, Werner
Venue: Mycoses
Publisher: Wiley
Published: 2021-02-27
Volume: 64
Issue: 6
Pages: 583-602
ISSN: 0027-5557 (ISSN-L)
0933-7407
1439-0507
DOI: 10.1111/myc.13248
PMC: PMC8248160
OpenAlex: W3129088316
Cited by: 184
References: 234
Citations by year: 2026: 31 · 2025: 52 · 2024: 38 · 2023: 32 · 2022: 25 · 2021: 6
FWCI: 8.00
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by-nc-nd
creativecommons.org/licenses/by-nc-nd/4.0/ (vor)
Locations: Mycoses (publishedVersion, cc-by-nc-nd)
PubMed Central (publishedVersion, cc-by-nc-nd)
PubMed (publishedVersion)
Publikationen an der Universität Bielefeld (Universität Bielefeld) (submittedVersion)
Topics: Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
Health Sciences › Medicine › Epidemiology › Nail Diseases and Treatments
Keywords: Candida albicans, vaginal infection, antifungal therapy, imidazole, triazoles, ciclopirox olamine, polyenes, maintenance therapy, pregnancy, vertical transmission, non-albicans Candida, vaginal microbiota
MeSH terms: Ciclopirox, Anti-Bacterial Agents, Antifungal Agents, Candida albicans, Candidiasis, Vulvovaginal, Contraceptive Agents, Diabetes Mellitus, Female, Hormones, Humans, Imidazoles, Infant, Newborn, Polyenes, Pregnancy, Vaginitis, Causality, Hyphae, Candida glabrata

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