Clinical challenges in diagnosis and treatment of recurrent vulvovaginal candidiasis
Open accessAbstract
Vulvovaginal candidiasis is a common infection associated most often with the overgrowth of the fungal species Candida albicans. Although most women will have at least one episode of vulvovaginal candidiasis in their lifetime, some will experience recurrent infections. Recurrent vulvovaginal candidiasis can significantly impact quality of life, causing both physical and psychological symptoms, and poses a substantial financial burden for women and the health care system. Acute vulvovaginal candidiasis infections are often diagnosed symptomatically by clinicians or self-diagnosed by patients themselves; this can result in over- and underdiagnosis, as well as misdiagnosis, and has the potential to lead to ineffective treatment and incomplete infection resolution. Clinical diagnosis should include confirmatory laboratory tests, including microscopy and fungal culture, especially in women with a history of recurrent vulvovaginal candidiasis, who are more likely than women with vulvovaginal candidiasis to be infected with less-common Candida species or with azole-resistant strains. With proper diagnosis, most acute vulvovaginal candidiasis episodes can be successfully treated; however, women with recurrent vulvovaginal candidiasis may require long-term maintenance therapy. US-based guidelines recommend ⩽6 months of maintenance fluconazole treatment, but infection recurs in up to 50% of women treated. There are currently no US Food and Drug Administration–approved treatments for recurrent vulvovaginal candidiasis; however, several promising treatments for recurrent vulvovaginal candidiasis are in development.
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Written from the paper’s full text.
TL;DR
This narrative review summarizes the burden, pathogenesis, diagnosis, and treatment challenges of recurrent vulvovaginal candidiasis (RVVC), defined as ⩾3 symptomatic acute VVC episodes within 12 months. It emphasizes that RVVC is frequently misdiagnosed and that no FDA-approved treatments exist, though several promising agents are in development.
Key findings
- Up to 75% of women experience at least one VVC episode in their lifetime; ~9% of women with VVC are estimated to have RVVC, with worldwide annual prevalence estimated at 138 million women in 2018, projected to reach nearly 158 million by 2030.
- *Candida albicans* causes 85%–95% of VVC infections; non-albicans Candida (NAC) species are reported in ~10% of cases (up to 45% in some studies) and in 10%–20% of women with RVVC.
- Microscopy has low sensitivity (40%–70%) and poor ability to identify species like *C. glabrata*; fungal culture is the reference standard, and susceptibility testing is recommended in RVVC.
- Maintenance therapy achieves symptom resolution in ~90% of women with RVVC, but up to 50% recur after stopping therapy; breakthrough infections on long-term fluconazole are usually <5%.
- Self-diagnosis is unreliable: only one-third of women with prior clinically diagnosed VVC correctly self-diagnosed a subsequent episode, and self-diagnosed women reported symptom relief 57% vs 84% for physician-diagnosed women.
Methods
- Narrative literature review; searches in PubMed and Cochrane Library using terms including "recurrent vulvovaginal candidiasis," treatment, diagnosis, and management.
- Focused on US-based guidelines (CDC, ACOG, IDSA) and US FDA-approved treatments; includes a diagnostic algorithm figure and a table of recommended RVVC regimens by causative species.
- No primary data collection; findings synthesized from cited literature and guidelines.
Limitations
- The paper states it focused on US-based guidelines and FDA-approved treatments due to international differences in diagnostic and management guidelines, limiting generalizability.
- The authors note that evidence for adjuvant probiotics is low/very low quality, that RVVC trials were excluded from the cited Cochrane meta-analysis, and that more research is needed on genetic/immune hyperinflammatory responses.
- Evident from the text: as a narrative review without systematic search or quality appraisal, it does not report formal risk-of-bias assessment or meta-analytic synthesis.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
0 of 87 cited sources checked · 0 supported · 0 flagged
- Premisecitation
In approximately 20%−30% of women with RVVC, no predisposing factors have been identified.
“In approximately 20%−30% of women, no predisposing factors have been identified. 9”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [9] Rosati D Bruno M Jaeger M, et al. Recurrent vulvovaginal candidiasis: an immunological perspective. Microorganisms 2020; 8(2): 144. PMC7074770 31972980 source
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- Premisecitation
Genetic mutations, including polymorphisms in TLR2 and mannose-binding lectin 2, that may increase susceptibility to VVC infection have been observed in women with RVVC.
“Genetic mutations, including polymorphisms in TLR2 and mannose-binding lectin 2, that may increase susceptibility to VVC infection have been observed in women with RVVC. 9”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [9] Rosati D Bruno M Jaeger M, et al. Recurrent vulvovaginal candidiasis: an immunological perspective. Microorganisms 2020; 8(2): 144. PMC7074770 31972980 source
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- Premisecitation
US-based guidelines recommend up to 6 months of maintenance fluconazole treatment.
“US-based guidelines recommend ⩽6 months of maintenance fluconazole treatment”
- Also stated in: § Clinical challenges in therapeutic management of RVVC · plain
“Fluconazole 150 mg orally (weekly for 6 months)”
Quote in the paperSubstantial claim0 of 3 sources checked- cites ACOG16
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- cites CDC 15
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- cites IDSA 17
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- Also stated in: § Clinical challenges in therapeutic management of RVVC · plain
- Premisecitation
Candida is a commensal organism in the vaginal area in many women, following migration from the lower gastrointestinal tract.
“Candida is a commensal organism in the vaginal area in many women, following migration from the lower gastrointestinal tract.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [3] Sobel JD. Recurrent vulvovaginal candidiasis. Am J Obstet Gynecol 2016; 214(1): 15– 21. 26164695 source
Not checked in the free run.
- Interpretationreasoning
Several promising treatments for RVVC are in development.
“however, several promising treatments for recurrent vulvovaginal candidiasis are in development.”
- Also stated in: § Treatment innovations for RVVC · plain
“Several promising therapeutic options are on the horizon.”
Quote in the paperNot a substantial claim - Also stated in: § Treatment innovations for RVVC · plain
- Premisecitation
In Phase 3 clinical trials, oteseconazole was shown to be highly efficacious in preventing recurrence of acute VVC episodes in women with RVVC, even women with azole-resistant C. albicans or C. glabrata infections.
“In Phase 3 clinical trials (CL-011 (NCT03562156) and CL-012 (NCT03561701), oteseconazole was shown to be highly efficacious in preventing recurrence of acute VVC episodes in women with RVVC, even women with azole-resistant C. albicans or C. glabrata infections. 31”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [31] Sobel JD Donders G Degenhardt T, et al. Efficacy and safety of oteseconazole in recurrent vulvovaginal candidiasis. NEJM Evidence 2022; 1(8). DOI:10.1056/evidoa2100055. 38319878 source
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- Interpretationreasoning
Symptomatic diagnosis or self-diagnosis of VVC can result in over- and underdiagnosis, as well as misdiagnosis.
“this can result in over- and underdiagnosis, as well as misdiagnosis”
- Also stated in: § Diagnosis of RVVC · plain
“These symptoms are largely nonspecific and should not be used in isolation for clinical diagnosis of VVC, 1 as this can result in under- and overdiagnosis, as well as misdiagnosis. 3”
Quote in the paperSubstantial claim0 of 2 sources checked - Also stated in: § Diagnosis of RVVC · plain
- Premisecitation
Signs and symptoms of vaginal infection are largely nonspecific.
“These symptoms are largely nonspecific and should not be used in isolation for clinical diagnosis of VVC, 1”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [1] Sobel J. Vulvovaginal candidosis. Lancet 2007; 369(9577): 1961– 1971. 17560449 source
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- Premisecitation
With proper diagnosis, most acute VVC episodes can be successfully treated.
“With proper diagnosis, most acute vulvovaginal candidiasis episodes can be successfully treated”
- Also stated in: § Clinical challenges in therapeutic management of RVVC · plain
“Mycologic cure 16 and symptom relief are achieved in 90% of women with uncomplicated acute VVC who complete their therapeutic regimen. 15”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [15] Centers for Disease Control and Prevention. Vulvovaginal candidiasis (VVC), 2021, https://www.cdc.gov/std/treatment-guidelines/candidiasis.htm
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- Also stated in: § Clinical challenges in therapeutic management of RVVC · plain
- Premisecitation
Oteseconazole has demonstrated potent antifungal activity against clinical isolates of Candida species, including those with reduced susceptibility to standard azole agents.
“It has demonstrated potent antifungal activity against clinical isolates of Candida species, including those with reduced susceptibility to standard azole agents. 30”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [30] Sobel JD Nyirjesy P. Oteseconazole: an advance in treatment of recurrent vulvovaginal candidiasis. Future Microbiol 2021; 16: 1453– 1461. 34783586 source
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- Premisecitation
Infection recurs in up to 50% of women treated with maintenance fluconazole.
“but infection recurs in up to 50% of women treated.”
- Also stated in: § Clinical challenges in therapeutic management of RVVC · plain
“up to 50% will have a recurrence after the termination of maintenance therapy. 13”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [13] Collins LM Moore R Sobel JD. Prognosis and long-term outcome of women with idiopathic recurrent vulvovaginal candidiasis caused by Candida albicans. J Low Genit Tract Dis 2020; 24(1): 48– 52. 31860575 source
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- Also stated in: § Clinical challenges in therapeutic management of RVVC · plain
- Premisecitation
In a post hoc analysis, NDV-3A significantly reduced the frequency of symptomatic VVC episodes in women younger than 40 years with RVVC.
“In a post hoc analysis, NDV-3A significantly reduced the frequency of symptomatic VVC episodes in women younger than 40 years with RVVC. 34”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [34] ClinicalTrials.gov. Phase 3 study of oral ibrexafungerp (SCY-078) vs. placebo in subjects with recurrent vulvovaginal candidiasis (VVC) (CANDLE), https://clinicaltrials.gov/ct2/show/NCT04029116
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- Premisecitation
Oteseconazole is a novel oral agent recently approved by the FDA for RVVC.
“Oteseconazole (previously VT-1161, Mycovia Pharmaceuticals, Inc., Durham, North Carolina) is a novel oral agent recently approved by the FDA for RVVC. 29”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [29] U.S. Food and Drug Administration. VIVJOA: digital oteseconazole prescribing information (PI), 2022, https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/215888s000lbl.pdf
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- Premisecitation
Because Candida is a common vaginal commensal that can be found in the absence of infection, its presence is not diagnostic in itself.
“Because Candida is a common vaginal commensal that can be found in the absence of infection, its presence is not diagnostic in itself. 6”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [6] Blostein F Levin-Sparenberg E Wagner J, et al. Recurrent vulvovaginal candidiasis. Ann Epidemiol 2017; 27(9): 575.e3–582.e3. 28927765 source
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- Premisecitation
Candida overgrowth can trigger a symptomatic infection.
“Candida overgrowth, however, can trigger a symptomatic infection. 3”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [3] Sobel JD. Recurrent vulvovaginal candidiasis. Am J Obstet Gynecol 2016; 214(1): 15– 21. 26164695 source
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- Premisecitation
Women infected with resistant strains may not achieve symptom remission because of the limited number of treatment options effective against azole-resistant Candida species.
“women infected with resistant strains may not achieve symptom remission because of the limited number of treatment options effective against azole-resistant Candida species. 13”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [13] Collins LM Moore R Sobel JD. Prognosis and long-term outcome of women with idiopathic recurrent vulvovaginal candidiasis caused by Candida albicans. J Low Genit Tract Dis 2020; 24(1): 48– 52. 31860575 source
Not checked in the free run.
- Premisecitation
Women with RVVC may require long-term maintenance therapy.
“however, women with recurrent vulvovaginal candidiasis may require long-term maintenance therapy.”
- Also stated in: § Clinical challenges in therapeutic management of RVVC · plain
“recommended treatments for acute VVC episodes in women with RVVC generally include 7–14 days of induction therapy with a topical or oral agent followed by weekly maintenance treatment for 6 months. 17”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [17] Pappas PG Kauffman CA Andes DR, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 62(4): e1–e50. PMC4725385 26679628 source
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- Also stated in: § Clinical challenges in therapeutic management of RVVC · plain
- Premisecitation
Recurrence can result from developed resistance to antifungal treatment, usually due to prolonged or repeated use of a single agent.
“Recurrence can also result from developed resistance to antifungal treatment, usually due to prolonged or repeated use of a single agent. 11”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [11] Sobel JD Sobel R. Current treatment options for vulvovaginal candidiasis caused by azole-resistant Candida species. Expert Opin Pharmacother 2018; 19(9): 971– 977. 29932786 source
Not checked in the free run.
- Premisecitation
Vulvovaginal candidiasis is a common infection associated most often with the overgrowth of Candida albicans.
“Vulvovaginal candidiasis is a common infection associated most often with the overgrowth of the fungal species Candida albicans.”
- Also stated in: § Introduction · boosted
“Candida albicans has been confirmed responsible in 85%−95% of VVC infections and in the majority of RVVC infections as well. 3”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [3] Sobel JD. Recurrent vulvovaginal candidiasis. Am J Obstet Gynecol 2016; 214(1): 15– 21. 26164695 source
Not checked in the free run.
- Also stated in: § Introduction · boosted
- Premisecitation
Candida overgrowth in the vaginal epithelium can be influenced by behavioral factors, such as sexual activity, use of sponge/intrauterine device, and oral contraceptives or hormone replacement therapy.
“Candida overgrowth in the vaginal epithelium can be influenced by behavioral factors, such as sexual activity, use of sponge/intrauterine device, and oral contraceptives or hormone replacement therapy. 3”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [3] Sobel JD. Recurrent vulvovaginal candidiasis. Am J Obstet Gynecol 2016; 214(1): 15– 21. 26164695 source
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- Premisecitation
Alterations in health status and immune protective defenses, including type 1 diabetes and HIV, have been shown to be potential contributing factors to RVVC.
“Alterations in health status and immune protective defenses, including type 1 diabetes and HIV, have also been shown to be potential contributing factors. 3”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [3] Sobel JD. Recurrent vulvovaginal candidiasis. Am J Obstet Gynecol 2016; 214(1): 15– 21. 26164695 source
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- Premisecitation
Women with a history of RVVC are more likely than women with VVC to be infected with less-common Candida species or with azole-resistant strains.
“especially in women with a history of recurrent vulvovaginal candidiasis, who are more likely than women with vulvovaginal candidiasis to be infected with less-common Candida species or with azole-resistant strains.”
- Also stated in: § Diagnosis of RVVC · plain
“C. glabrata and other NAC species are reported in 10%−20% of women with RVVC. 15”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [15] Centers for Disease Control and Prevention. Vulvovaginal candidiasis (VVC), 2021, https://www.cdc.gov/std/treatment-guidelines/candidiasis.htm
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- Also stated in: § Diagnosis of RVVC · plain
- Premisecitation
Given increased accessibility of over-the-counter antifungal therapy, some strains of Candida that were previously susceptible have become resistant.
“Given the increased accessibility of over-the-counter (OTC) antifungal therapy, some strains of Candida that were previously susceptible have become resistant, 12”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [12] Makanjuola O Bongomin F Fayemiwo SA. An update on the roles of non-albicans Candida species in vulvovaginitis. J Fungi 2018; 4(4): 121. PMC6309050 30384449 source
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- Premisecitation
Women who reported having self-diagnosed an infection were less likely to report symptom relief compared with women who were diagnosed by a physician: 57% versus 84%.
“Women who reported having self-diagnosed an infection were less likely to report symptom relief compared with women who were diagnosed by a physician: 57% versus 84%, respectively. 19”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [19] Yano J Sobel JD Nyirjesy P, et al. Current patient perspectives of vulvovaginal candidiasis: incidence, symptoms, management and post-treatment outcomes. BMC Womens Health 2019; 19(1): 48. 30925872 PMC6441174 source
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- Premisecitation
Mycologic cure and symptom relief are achieved in 90% of women with uncomplicated acute VVC who complete their therapeutic regimen.
“Mycologic cure 16 and symptom relief are achieved in 90% of women with uncomplicated acute VVC who complete their therapeutic regimen. 15”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [15] Centers for Disease Control and Prevention. Vulvovaginal candidiasis (VVC), 2021, https://www.cdc.gov/std/treatment-guidelines/candidiasis.htm
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- Premisecitation
Fungal culture is considered as the reference standard for the diagnosis of VVC.
“Fungal culture is considered as the reference standard for the diagnosis of VVC”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [15] Centers for Disease Control and Prevention. Vulvovaginal candidiasis (VVC), 2021, https://www.cdc.gov/std/treatment-guidelines/candidiasis.htm
Not checked in the free run.
- Interpretationreasoning
Treatment of RVVC has inherent clinical challenges because of the complexity of its pathophysiology and the increasing number of NAC-species and azole-resistant infections.
“Treatment of RVVC has inherent clinical challenges because of the complexity of its pathophysiology and the increasing number of NAC-species and azole-resistant infections.”
Quote in the paperSubstantial claim - Premisecitation
Even in women who previously had a clinically diagnosed acute VVC infection, only one-third correctly self-diagnosed a subsequent VVC infection.
“Even in women who previously had a clinically diagnosed acute VVC infection, only one-third correctly self-diagnosed a subsequent VVC infection. 6”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [6] Blostein F Levin-Sparenberg E Wagner J, et al. Recurrent vulvovaginal candidiasis. Ann Epidemiol 2017; 27(9): 575.e3–582.e3. 28927765 source
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- Premisecitation
Widespread use of broad-spectrum antibiotics coupled with increased availability of OTC and prescription antimycotic medications has fueled the shift toward NAC species.
“Widespread use of broad-spectrum antibiotics coupled with increased availability of OTC and prescription antimycotic medications has fueled this shift. 12”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [12] Makanjuola O Bongomin F Fayemiwo SA. An update on the roles of non-albicans Candida species in vulvovaginitis. J Fungi 2018; 4(4): 121. PMC6309050 30384449 source
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- Premisecitation
The prevalence of infection with non-albicans Candida (NAC) species is increasing.
“the prevalence of infection with non-albicans Candida (NAC) species is increasing.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [12] Makanjuola O Bongomin F Fayemiwo SA. An update on the roles of non-albicans Candida species in vulvovaginitis. J Fungi 2018; 4(4): 121. PMC6309050 30384449 source
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- Premisecitation
Repeated use of fluconazole increases risk for the development of resistant strains.
“Repeated use of fluconazole also increases risk for the development of resistant strains.13,18,26”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [13] Collins LM Moore R Sobel JD. Prognosis and long-term outcome of women with idiopathic recurrent vulvovaginal candidiasis caused by Candida albicans. J Low Genit Tract Dis 2020; 24(1): 48– 52. 31860575 source
Not checked in the free run.
- cites [18] Marchaim D Lemanek L Bheemreddy S, et al. Fluconazole-resistant Candida albicans vulvovaginitis. Obstet Gynecol 2012; 120(6): 1407– 1414. 23168767 source
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- cites [26] Warrilow AG Hull CM Parker JE, et al. The clinical candidate VT-1161 is a highly potent inhibitor of Candida albicans CYP51 but fails to bind the human enzyme. Antimicrob Agents Chemother 2014; 58(12): 7121– 7127. 25224009 PMC4249504 source
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- Premisecitation
Alternative treatment options are limited because the current armamentarium of antifungal agents active against NAC strains is limited.
“Alternative treatment options are limited because, as with azole-resistant strains, the current armamentarium of antifungal agents active against NAC strains is limited. 12”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [12] Makanjuola O Bongomin F Fayemiwo SA. An update on the roles of non-albicans Candida species in vulvovaginitis. J Fungi 2018; 4(4): 121. PMC6309050 30384449 source
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- Interpretationcitation
Treating azole-resistant vaginitis constitutes a major clinical challenge for providers, given the current paucity of alternative antimycotic agents.
“Treating azole-resistant vaginitis constitutes a major clinical challenge for providers, given the current paucity of alternative antimycotic agents. 11”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [11] Sobel JD Sobel R. Current treatment options for vulvovaginal candidiasis caused by azole-resistant Candida species. Expert Opin Pharmacother 2018; 19(9): 971– 977. 29932786 source
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- Premisecitation
Microscopy of vaginal discharge by wet preparation for the presence of budding yeasts, pseudohyphae, or hyphae is a commonly used, rapid method to confirm a suspected VVC infection.
“Microscopy of vaginal discharge by wet preparation (saline, 10% potassium hydroxide) for the presence of budding yeasts, pseudohyphae, or hyphae is a commonly used, rapid method to confirm a suspected VVC infection. 15”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [15] Centers for Disease Control and Prevention. Vulvovaginal candidiasis (VVC), 2021, https://www.cdc.gov/std/treatment-guidelines/candidiasis.htm
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- Premisecitation
Candida glabrata is the second-most prevalent Candida species in vulvovaginitis.
“Candida glabrata is the second-most prevalent Candida species in vulvovaginitis 8”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [8] Willems HME Ahmed SS Liu J, et al. Vulvovaginal candidiasis: a current understanding and burning questions. J Fungi 2020; 6(1): 27. PMC7151053 32106438 source
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- Premisecitation
Breakthrough infections are still relatively rare (usually <5% of patients).
“Although breakthrough infections are still relatively rare (usually < 5% of patients), in vitro susceptibility testing can be useful in selecting subsequent treatment.11,18”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [11] Sobel JD Sobel R. Current treatment options for vulvovaginal candidiasis caused by azole-resistant Candida species. Expert Opin Pharmacother 2018; 19(9): 971– 977. 29932786 source
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- cites [18] Marchaim D Lemanek L Bheemreddy S, et al. Fluconazole-resistant Candida albicans vulvovaginitis. Obstet Gynecol 2012; 120(6): 1407– 1414. 23168767 source
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- Premisecitation
An alternative maintenance regimen of 200 mg doses of fluconazole weekly for 2 months, then every 2 weeks for 4 months, followed by once-monthly 200 mg doses for another 6 months has also been assessed.
“An alternative maintenance regimen of 200 mg doses of fluconazole weekly for 2 months, then every 2 weeks for 4 months, followed by once-monthly 200 mg doses for another 6 months has also been assessed.22,23”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [22] Donders G Bellen G Byttebier G, et al. Individualized decreasing-dose maintenance fluconazole regimen for recurrent vulvovaginal candidiasis (ReCiDiF trial). Am J Obstet Gynecol 2008; 199(6): 613.e1–613.e9. 18976735 source
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- cites [23] Sherrard J Wilson J Donders G, et al. 2018 European (IUSTI/WHO) International Union against sexually transmitted infections (IUSTI) World Health Organisation (WHO) guideline on the management of vaginal discharge. Int J STD AIDS 2018; 29(13): 1258– 1272. 30049258 source
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- Premisecitation
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.
“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”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [21] Sobel JD Wiesenfeld HC Martens M, et al. Maintenance fluconazole therapy for recurrent vulvovaginal candidiasis. N Engl J Med 2004; 351(9): 876– 883. 15329425 source
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- Premisecitation
In vitro susceptibility testing can be useful in selecting subsequent treatment.
“in vitro susceptibility testing can be useful in selecting subsequent treatment.11,18”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [11] Sobel JD Sobel R. Current treatment options for vulvovaginal candidiasis caused by azole-resistant Candida species. Expert Opin Pharmacother 2018; 19(9): 971– 977. 29932786 source
Not checked in the free run.
- cites [18] Marchaim D Lemanek L Bheemreddy S, et al. Fluconazole-resistant Candida albicans vulvovaginitis. Obstet Gynecol 2012; 120(6): 1407– 1414. 23168767 source
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- Premisecitation
Topical azole antifungals, widely used to treat VVC, are used less commonly in RVVC.
“Topical azole antifungals, widely used to treat VVC, are used less commonly in RVVC.17,20”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [17] Pappas PG Kauffman CA Andes DR, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 62(4): e1–e50. PMC4725385 26679628 source
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- cites [20] Sobel JD. Factors involved in patient choice of oral or vaginal treatment for vulvovaginal candidiasis. Patient Prefer Adherence 2013; 8: 31– 34. 24368881 PMC3869914 source
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- Premisecitation
Studies have shown that women often base self-diagnosis on nonspecific symptoms and without a full understanding of the variety of vaginal conditions that can cause similar symptoms.
“Studies have shown, however, that women often base self-diagnosis on nonspecific symptoms and without a full understanding of the variety of vaginal conditions that can cause similar symptoms. 6”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [6] Blostein F Levin-Sparenberg E Wagner J, et al. Recurrent vulvovaginal candidiasis. Ann Epidemiol 2017; 27(9): 575.e3–582.e3. 28927765 source
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- Premisecitation
C. glabrata and other NAC species are reported in 10%−20% of women with RVVC.
“C. glabrata and other NAC species are reported in 10%−20% of women with RVVC. 15”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [15] Centers for Disease Control and Prevention. Vulvovaginal candidiasis (VVC), 2021, https://www.cdc.gov/std/treatment-guidelines/candidiasis.htm
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- Interpretationreasoning
Treatment of NAC-species RVVC can also be clinically challenging.
“Treatment of NAC-species RVVC can also be clinically challenging.”
Quote in the paperSubstantial claim - Premisecitation
A 2017 Cochrane review of randomized controlled trials using probiotics in addition to conventional antifungal treatment regimens for VVC in nonpregnant women showed increased short-term clinical and mycological cure rates and a reduced short-term relapse rate.
“A 2017 Cochrane review of randomized controlled trials (RCTs) using probiotics in addition to conventional antifungal treatment regimens for VVC in nonpregnant women showed increased short-term clinical and mycological cure rates and a reduced short-term relapse rate. 28”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [28] Xie HY Feng D Wei DM, et al. Probiotics for vulvovaginal candidiasis in non-pregnant women. Cochrane Database Syst Rev 2017; 11: CD010496. PMC6486023 29168557
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- May combine two claims. 18
- Classified as probably not a substantial claim. 9
May combine two claims.
PremisecitationVVC can co-occur with other vaginal infections such as bacterial vaginosis, which generally presents with elevated pH.
“bearing in mind that VVC can co-occur with other vaginal infections such as bacterial vaginosis, which generally presents with elevated pH.1,3”
Quote in the paperNot a substantial claim0 of 2 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationA Phase 3 study is underway to evaluate the efficacy of oral ibrexafungerp in preventing recurrent VVC episodes in participants with RVVC.
“A Phase 3 study (NCT04029116) is underway to evaluate the efficacy of oral ibrexafungerp in preventing recurrent VVC episodes in participants with RVVC. 34”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [34] ClinicalTrials.gov. Phase 3 study of oral ibrexafungerp (SCY-078) vs. placebo in subjects with recurrent vulvovaginal candidiasis (VVC) (CANDLE), https://clinicaltrials.gov/ct2/show/NCT04029116
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe estimated annual economic impact of RVVC in the United States in 2010 from lost work hours was US$1 billion.
“the estimated annual economic impact of RVVC in the United States in 2010 from lost work hours was US$1 billion.2,4,8”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [2] Denning DW Kneale M Sobel JD, et al. Global burden of recurrent vulvovaginal candidiasis: a systematic review. Lancet Infect Dis 2018; 18(11): e339–e347. 30078662 source
Not checked in the free run.
- cites [4] Foxman B Muraglia R Dietz JP, et al. Prevalence of recurrent vulvovaginal candidiasis in 5 European countries and the United States: results from an internet panel survey. J Low Genit Tract Dis 2013; 17(3): 340– 345. 23486072 source
Not checked in the free run.
- cites [8] Willems HME Ahmed SS Liu J, et al. Vulvovaginal candidiasis: a current understanding and burning questions. J Fungi 2020; 6(1): 27. PMC7151053 32106438 source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationIn the United States, the total annual insurer and out-of-pocket costs for outpatient VVC treatment was estimated at US$368 million for 2017.
“In the United States, the total annual insurer and out-of-pocket costs for outpatient VVC treatment was estimated at US$368 million for 2017 7”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [7] Benedict K Jackson BR Chiller T, et al. Estimation of direct healthcare costs of fungal diseases in the United States. Clin Infect Dis 2019; 68(11): 1791– 1797. 30204844 PMC6409199 source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationThe worldwide annual prevalence of RVVC was estimated at 138 million women in 2018, and this number is projected to increase to nearly 158 million women by 2030.
“a large systematic review in 2018 estimated the worldwide annual prevalence of RVVC at 138 million women, and this number is projected to increase to nearly 158 million women by 2030. 2”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [2] Denning DW Kneale M Sobel JD, et al. Global burden of recurrent vulvovaginal candidiasis: a systematic review. Lancet Infect Dis 2018; 18(11): e339–e347. 30078662 source
Not checked in the free run.
May combine two claims.
PremisecitationIbrexafungerp is an oral 1,3-β-D-glucan synthase inhibitor that is FDA approved to treat acute VVC.
“Ibrexafungerp (formerly SCY-078; SCYNEXIS Inc., Jersey City, New Jersey) is an oral 1,3-β-D-glucan synthase inhibitor 32 that is FDA approved to treat acute VVC. 33”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [32] Gamal A Chu S McCormick TS, et al. Ibrexafungerp, a novel oral triterpenoid antifungal in development: overview of antifungal activity against Candida glabrata. Front Cell Infect Microbiol 2021; 11: 642358. 33791244 PMC8006402 source
Not checked in the free run.
- cites [33] U.S. Food and Drug Administration. BREXAFEMME: digital ibrexafungerp prescribing information (PI), 2021, https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/214900s000lbl.pdf
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationOnly about 9% of women with VVC are estimated to have RVVC.
“Although only 9% of women with VVC are estimated to have RVVC,2,4”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [2] Denning DW Kneale M Sobel JD, et al. Global burden of recurrent vulvovaginal candidiasis: a systematic review. Lancet Infect Dis 2018; 18(11): e339–e347. 30078662 source
Not checked in the free run.
- cites [4] Foxman B Muraglia R Dietz JP, et al. Prevalence of recurrent vulvovaginal candidiasis in 5 European countries and the United States: results from an internet panel survey. J Low Genit Tract Dis 2013; 17(3): 340– 345. 23486072 source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationRVVC can significantly impact quality of life, causing both physical and psychological symptoms.
“Recurrent vulvovaginal candidiasis can significantly impact quality of life, causing both physical and psychological symptoms”
- Also stated in: § Burden of RVVC · plain
“women with RVVC report significantly reduced quality of life 2 and debilitating negative psychosocial effects. 5”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [2] Denning DW Kneale M Sobel JD, et al. Global burden of recurrent vulvovaginal candidiasis: a systematic review. Lancet Infect Dis 2018; 18(11): e339–e347. 30078662 source
Not checked in the free run.
- cites [5] Fukazawa EI Witkin SS Robial R, et al. Influence of recurrent vulvovaginal candidiasis on quality of life issues. Arch Gynecol Obstet 2019; 300(3): 647– 650. 31270690 source
Not checked in the free run.
- Also stated in: § Burden of RVVC · plain
May combine two claims.
PremisecitationAcute VVC infections are often diagnosed symptomatically by clinicians or self-diagnosed by patients.
“Acute vulvovaginal candidiasis infections are often diagnosed symptomatically by clinicians or self-diagnosed by patients themselves”
- Also stated in: § Self-diagnosis of VVC and RVVC · hedged
“women who have symptoms associated with VVC may skip consultation with a doctor and instead self-diagnose and self-treat with OTC preparations. 3”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [3] Sobel JD. Recurrent vulvovaginal candidiasis. Am J Obstet Gynecol 2016; 214(1): 15– 21. 26164695 source
Not checked in the free run.
- Also stated in: § Self-diagnosis of VVC and RVVC · hedged
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationUp to 75% of women will have at least one episode of VVC in their lifetime, most often during their reproductive years.
“Up to 75% of women will have at least one episode of VVC in their lifetime, most often during their reproductive years.1,2”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [1] Sobel J. Vulvovaginal candidosis. Lancet 2007; 369(9577): 1961– 1971. 17560449 source
Not checked in the free run.
- cites [2] Denning DW Kneale M Sobel JD, et al. Global burden of recurrent vulvovaginal candidiasis: a systematic review. Lancet Infect Dis 2018; 18(11): e339–e347. 30078662 source
Not checked in the free run.
May combine two claims.
PremisecitationVaginal pH is usually normal in VVC; elevated pH suggests an alternate diagnosis.
“vaginal pH is usually normal in VVC. Elevated pH suggests an alternate diagnosis, 3”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [3] Sobel JD. Recurrent vulvovaginal candidiasis. Am J Obstet Gynecol 2016; 214(1): 15– 21. 26164695 source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationWomen with RVVC may have a genetic-based hyperinflammatory response to Candida colonization and invasion.
“Women with RVVC may also have a genetic-based hyperinflammatory response to Candida colonization and invasion, though more research is needed in this area. 9”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [9] Rosati D Bruno M Jaeger M, et al. Recurrent vulvovaginal candidiasis: an immunological perspective. Microorganisms 2020; 8(2): 144. PMC7074770 31972980 source
Not checked in the free run.
May combine two claims.
PremisecitationDevelopment of azole-resistant infection may be suspected in women who do not respond to standard treatment regimens or who experience breakthrough symptoms despite compliant long-term fluconazole maintenance therapy.
“Development of azole-resistant infection may be suspected in women who do not respond to standard treatment regimens or who experience breakthrough symptoms despite compliant long-term fluconazole maintenance therapy. 11”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [11] Sobel JD Sobel R. Current treatment options for vulvovaginal candidiasis caused by azole-resistant Candida species. Expert Opin Pharmacother 2018; 19(9): 971– 977. 29932786 source
Not checked in the free run.
May combine two claims.
PremisecitationMaintenance therapy for RVVC is rarely curative; it is intended to suppress rather than eradicate the causative yeast.
“Maintenance therapy for RVVC is rarely curative; it is intended to suppress rather than eradicate the causative yeast. 24”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [24] Sobel J. Management of recurrent vulvovaginal candidiasis: unresolved issues. Curr Infect Dis Rep 2006; 8: 481– 486. 17064642 source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationCommercial tests, such as PCR, are increasingly being utilized, as they often have faster turnaround than culture.
“Commercial tests, such as PCR, are increasingly being utilized, as they often have faster turnaround than culture 16”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [16] The American College of Obstetricians and Gynecologists. Vaginitis in nonpregnant patients, Number 215, 2020, https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2020/01/vaginitis-in-nonpregnant-patients
Not checked in the free run.
May combine two claims.
PremisecitationRisk factors for infection with C. glabrata include having type 2 diabetes, being postmenopausal, and being older.
“risk factors for infection with C. glabrata include having type 2 diabetes, being postmenopausal, and being older.1,3”
Quote in the paperNot a substantial claim0 of 2 sources checkedMay combine two claims.
PremisecitationSymptoms of C. albicans and NAC infections are generally not clinically distinguishable, but diagnostic and treatment considerations differ.
“Symptoms of C. albicans and NAC infections are generally not clinically distinguishable, 1 but diagnostic and treatment considerations differ. 8”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [1] Sobel J. Vulvovaginal candidosis. Lancet 2007; 369(9577): 1961– 1971. 17560449 source
Not checked in the free run.
- cites [8] Willems HME Ahmed SS Liu J, et al. Vulvovaginal candidiasis: a current understanding and burning questions. J Fungi 2020; 6(1): 27. PMC7151053 32106438 source
Not checked in the free run.
May combine two claims.
PremisecitationTreatment failure on standard recommended regimens is common, as some NAC strains are inherently resistant to the azole drug class, have acquired resistance mechanisms, or have low susceptibility to commonly used antifungal agents.
“Treatment failure on standard recommended regimens is common, as some NAC strains are inherently resistant to the azole drug class, have acquired resistance mechanisms, 8 or have low susceptibility to commonly used antifungal agents, 27”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [8] Willems HME Ahmed SS Liu J, et al. Vulvovaginal candidiasis: a current understanding and burning questions. J Fungi 2020; 6(1): 27. PMC7151053 32106438 source
Not checked in the free run.
- cites [27] Mintz JD Martens M. Prevalence of non-albicans Candida infections in women with recurrent vulvovaginal symptomatology. Adv Infect Dis 2013; 3(4): 238– 242.
Not checked in the free run.
May combine two claims.
PremisecitationNAC species have been reported to be causative in approximately 10% of VVC cases, with some studies citing up to 45% of VVC cases.
“NAC species have been reported to be causative in approximately 10% of cases, with some studies citing up to 45% of VVC cases. 12”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [12] Makanjuola O Bongomin F Fayemiwo SA. An update on the roles of non-albicans Candida species in vulvovaginitis. J Fungi 2018; 4(4): 121. PMC6309050 30384449 source
Not checked in the free run.
May combine two claims.
PremisecitationLimitations of microscopy include low (40%−70%) sensitivity and less ability to identify certain species, such as C. glabrata, because they do not form hyphae or pseudohyphae.
“Limitations of microscopy include low (40%−70%) sensitivity 3 and less ability to identify certain species, such as C. glabrata, because they do not form hyphae or pseudohyphae. 15”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [3] Sobel JD. Recurrent vulvovaginal candidiasis. Am J Obstet Gynecol 2016; 214(1): 15– 21. 26164695 source
Not checked in the free run.
- cites [15] Centers for Disease Control and Prevention. Vulvovaginal candidiasis (VVC), 2021, https://www.cdc.gov/std/treatment-guidelines/candidiasis.htm
Not checked in the free run.
May combine two claims.
PremisecitationThe treatment regimen for RVVC is dependent on causative yeast(s)/Candida species present, and azole susceptibility of cultured strains.
“The treatment regimen is dependent on causative yeast(s)/Candida species present, and azole susceptibility of cultured strains. 17”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [17] Pappas PG Kauffman CA Andes DR, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 62(4): e1–e50. PMC4725385 26679628 source
Not checked in the free run.
May combine two claims.
PremisecitationAlthough symptom resolution is achieved in ~90% of women with RVVC who undergo at least 6 months of maintenance therapy, up to 50% will have a recurrence after the termination of maintenance therapy.
“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”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [16] The American College of Obstetricians and Gynecologists. Vaginitis in nonpregnant patients, Number 215, 2020, https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2020/01/vaginitis-in-nonpregnant-patients
Not checked in the free run.
- cites [21] Sobel JD Wiesenfeld HC Martens M, et al. Maintenance fluconazole therapy for recurrent vulvovaginal candidiasis. N Engl J Med 2004; 351(9): 876– 883. 15329425 source
Not checked in the free run.
- cites [22] Donders G Bellen G Byttebier G, et al. Individualized decreasing-dose maintenance fluconazole regimen for recurrent vulvovaginal candidiasis (ReCiDiF trial). Am J Obstet Gynecol 2008; 199(6): 613.e1–613.e9. 18976735 source
Not checked in the free run.
May combine two claims.
PremisecitationTrials of women with RVVC were not included in the 2017 Cochrane meta-analysis, and the evidence level was considered low/very low.
“Trials of women with RVVC were not included in this meta-analysis, however, and the evidence level was considered low/very low. 28”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [28] Xie HY Feng D Wei DM, et al. Probiotics for vulvovaginal candidiasis in non-pregnant women. Cochrane Database Syst Rev 2017; 11: CD010496. PMC6486023 29168557
Not checked in the free run.
May combine two claims.
PremisecitationLong-term use of fluconazole has risks, including an FDA pregnancy warning.
“Long-term use of fluconazole has risks, including an FDA pregnancy warning. 25”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [25] U.S. Food and Drug Administration. FDA Drug Safety Communication: use of long-term, high-dose Diflucan (fluconazole) during pregnancy may be associated with birth defects in infants, https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communicationuse-long-term-high-dose-diflucan-fluconazole-during-pregnancy-may-be
Not checked in the free run.
The paper relies on this without support.
There are currently no FDA-approved treatments for RVVC.
“There are currently no US Food and Drug Administration–approved treatments for recurrent vulvovaginal candidiasis”
“As there are no FDA-approved medications for RVVC”
The paper relies on this without support.
Probiotics are not currently recommended in any US-based treatment recommendations or guidelines.
“Probiotics are not currently recommended in any US-based treatment recommendations or guidelines.”
The paper relies on this without support.
Due to differences in diagnostic and management guidelines for RVVC internationally, this review focused on US-based guidelines and US FDA-approved treatments.
“Due to differences in diagnostic and management guidelines for RVVC internationally, this review focused on US-based guidelines and US FDA-approved treatments.”
The paper relies on this without support.
Many PCR tests are not FDA approved.
“however, many PCR tests are not US Food and Drug Administration (FDA) approved.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Conflicting statements on FDA-approved RVVC treatments
MajorThe treatment section says there are no FDA-approved medications for RVVC, but the treatment-innovations section says oteseconazole has been approved by the FDA for RVVC.
“As there are no FDA-approved medications for RVVC, recommended treatments for acute VVC episodes in women with RVVC generally include 7–14 days of induction therapy with a topical or oral agent followed by weekly maintenance treatment for 6 months.”
“Oteseconazole (previously VT-1161, Mycovia Pharmaceuticals, Inc., Durham, North Carolina) is a novel oral agent recently approved by the FDA for RVVC.”
Cites
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 · see citing works
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/civ1194 · Cited by 1,298 · see citing works
Sobel, J. D. (2007) · The Lancet · doi:10.1016/s0140-6736(07)60917-9 · Cited by 1,270 · see citing works
<i>Candida</i> Infections of the Genitourinary Tract
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Vulvovaginal candidiasis: Epidemiology, microbiology and risk factors
Gonçalves, B., Ferreira, C., Alves, C. T., Henriques, M., Azeredo, J., & Silva, S. (2016) · Critical Reviews in Microbiology · doi:10.3109/1040841x.2015.1091805 · Cited by 669 · see citing works
Global burden of recurrent vulvovaginal candidiasis: a systematic review
Denning, D. W., Kneale, M., Sobel, J. D., & Rautemaa-Richardson, R. (2018) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(18)30103-8 · Cited by 639 · see citing works
Recurrent vulvovaginal candidiasis
Sobel, J. D. (2016) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2015.06.067 · Cited by 502 · see citing works
Maintenance Fluconazole Therapy for Recurrent Vulvovaginal Candidiasis
Sobel, J. D., Wiesenfeld, H. C., Martens, M., Danna, P., Hooton, T. M., Rompalo, A., Sperling, M., Livengood, C., Horowitz, B., Von Thron, J., et al. (2004) · New England Journal of Medicine · doi:10.1056/nejmoa033114 · Cited by 487 · see citing works
Self-citationEstimation of Direct Healthcare Costs of Fungal Diseases in the United States
Benedict, K., Jackson, B. R., Chiller, T., & Beer, K. D. (2019) · Clinical Infectious Diseases · doi:10.1093/cid/ciy776 · Cited by 438 · see citing works
Vulvovaginal Candidiasis: A Current Understanding and Burning Questions
Willems, H. M. E., Ahmed, S. S., Liu, J., Xu, Z., & Peters, B. M. (2020) · Journal of Fungi · doi:10.3390/jof6010027 · Cited by 357 · see citing works
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Yano, J., Sobel, J. D., Nyirjesy, P., Sobel, R., Williams, V. L., Yu, Q., Noverr, M. C., & Fidel, P. L. (2019) · BMC Women's Health · doi:10.1186/s12905-019-0748-8 · Cited by 270 · see citing works
Foxman, B., Muraglia, R., Dietz, J.-P., Sobel, J. D., & Wagner, J. (2013) · Journal of Lower Genital Tract Disease · doi:10.1097/lgt.0b013e318273e8cf · Cited by 261 · see citing works
Edwards, J. E., Schwartz, M. M., Schmidt, C. S., Sobel, J. D., Nyirjesy, P., Schodel, F., Marchus, E., Lizakowski, M., DeMontigny, E. A., Hoeg, J., et al. (2018) · Clinical Infectious Diseases · doi:10.1093/cid/ciy185 · Cited by 213 · see citing works
Recurrent Vulvovaginal Candidiasis: An Immunological Perspective
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Fluconazole-Resistant Candida albicans Vulvovaginitis
Marchaim, D., Lemanek, L., Bheemreddy, S., Kaye, K. S., & Sobel, J. D. (2012) · Obstetrics & Gynecology · doi:10.1097/aog.0b013e31827307b2 · Cited by 195 · see citing works
An Update on the Roles of Non-albicans Candida Species in Vulvovaginitis
Makanjuola, O., Bongomin, F., & Fayemiwo, S. (2018) · Journal of Fungi · doi:10.3390/jof4040121 · Cited by 182 · see citing works
Recurrent vulvovaginal candidiasis
Blostein, F., Levin-Sparenberg, E., Wagner, J., & Foxman, B. (2017) · Annals of Epidemiology · doi:10.1016/j.annepidem.2017.08.010 · Cited by 180 · see citing works
Warrilow, A. G. S., Hull, C. M., Parker, J. E., Garvey, E. P., Hoekstra, W. J., Moore, W. R., Schotzinger, R. J., Kelly, D. E., & Kelly, S. L. (2014) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.03707-14 · Cited by 173 · see citing works
Current treatment options for vulvovaginal candidiasis caused by azole-resistant Candida species
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Probiotics for vulvovaginal candidiasis in non-pregnant women
Xie, H. Y., Feng, D., Wei, D. M., Mei, L., Chen, H., Wang, X., & Fang, F. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010496.pub2 · Cited by 129 · see citing works
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Oteseconazole: An Advance in Treatment of Recurrent Vulvovaginal Candidiasis
Sobel, J. D., & Nyirjesy, P. (2021) · Future Microbiology · doi:10.2217/fmb-2021-0173 · Cited by 78 · see citing works
Influence of recurrent vulvovaginal candidiasis on quality of life issues
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Gamal, A., Chu, S., McCormick, T. S., Borroto-Esoda, K., Angulo, D., & Ghannoum, M. A. (2021) · Frontiers in Cellular and Infection Microbiology · doi:10.3389/fcimb.2021.642358 · Cited by 58 · see citing works
Collins, L. M., Moore, R., & Sobel, J. D. (2020) · Journal of Lower Genital Tract Disease · doi:10.1097/lgt.0000000000000496 · Cited by 55 · see citing works
Efficacy and Safety of Oteseconazole in Recurrent Vulvovaginal Candidiasis
Sobel, J. D., Donders, G., Degenhardt, T., Person, K., Curelop, S., Ghannoum, M., & Brand, S. R. (2022) · NEJM Evidence · doi:10.1056/evidoa2100055 · Cited by 55 · see citing works
Factors involved in patient choice of oral or vaginal treatment for vulvovaginal candidiasis
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Management of recurrent vulvovaginal candidiasis: Unresolved issues
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Flagged first, then by citations
Research works printed but not linked: 3
- The American College of Obstetricians and Gynecologists. Vaginitis in nonpregnant patients, Number 215, 2020, https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2020/01/vaginitis-in-nonpregnant-patients
- Mintz JD, 2013, Adv Infect Dis, 3, 238
- Xie HY, 2017, Cochrane Database Syst Rev, 11
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Sorted by citations
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Microbial Pathogens Linked to Vaginal Microbiome Dysbiosis and Therapeutic Tools for Their Treatment
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- Authors
- Neal, C. M., & Martens, M. G.
- Affiliations
- Indiana University School of Medicine (US)
- Department of Obstetrics and Gynecology, Mohawk Valley Health System, Utica, NY, USA
- Corresponding author
- Martens, Mark G
- Venue
- SAGE Open Medicine
- Publisher
- SAGE Publications
- Published
- 2022-01
- Volume
- 10
- Pages
- 20503121221115201-20503121221115201
- ISSN
- 2050-3121 (ISSN-L)
- PMC
- PMC9465564
- OpenAlex
- W4295903887
- Semantic Scholar
- 8338b65685c0f5cd6b227015cb1b2532a6cdade9
- Cited by
- 56
- References
- 29
- Citations by year
- 2026: 14 · 2025: 26 · 2024: 10 · 2023: 6
- FWCI
- 1.61
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- SAGE Open Medicine (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- IUScholarWorks (Indiana University) (submittedVersion, cc-by-nc)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
- Health Sciences › Medicine › Epidemiology › Urinary Tract Infections Management
- Keywords
- recurrent vulvovaginal candidiasis, Candida albicans, Candida species, azole resistance, misdiagnosis, fungal culture, microscopy, maintenance therapy, fluconazole, quality of life, financial burden, antifungal therapy
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