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Cited by 84Antifungal resistance and susceptibilityReproductive tract infections researchUrinary Tract Infections Management

Treatment of Vulvovaginal Candidiasis—An Overview of Guidelines and the Latest Treatment Methods

Open access
Satora, Małgorzata, Grunwald, Arkadiusz, Zaremba, Bartłomiej, Frankowska, Karolina, Żak, Klaudia, Tarkowski, Rafał, Kułak, Krzysztof·2023·Journal of Clinical Medicine
DOI 10.3390/jcm12165376PMC PMC10455317
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Abstract

Vulvovaginal candidiasis (VVC) is a common condition associated with discomfort in affected women. Due to the presence of different forms of the disease, diverse treatment regimens are developed; the newest ones include oteseconazole and ibrexafungerp. Here, we focus on the most up-to-date recommendations regarding VVC treatment, as well as novel treatment options. Topical and oral azoles are the drugs of choice in uncomplicated mycosis. The efficacy of probiotics and substances such as TOL-463 and chlorhexidine is indicated as satisfactory; however, there are no relevant guidelines. Although the majority of researchers agree that the treatment of non-albicans VVC should be long-lasting, the recommendations are inconsistent. Another clinical problem is the treatment of VVC with azole intolerance or resistance, for which literature proposes the use of several drugs including oteseconazole, ibrexafungerp, and voriconazole. The treatment schedules for recurrent VVC include mainly fluconazole; however, alternative options such as immunotherapeutic vaccine (NDV-3A) or designed antimicrobial peptides (dAMPs) were also described. We also focused on VVC affecting pregnant women, which is a substantial challenge in clinical practice, also due to the heterogeneous relevant guidelines. Thus far, few precise recommendations are available in the literature. Future studies should focus on atypical VVC forms to elucidate the inconsistent findings.

AI snapshot

Written from the paper’s full text.

TL;DR

This narrative review summarizes guidelines and newer treatments for vulvovaginal candidiasis (VVC), including azoles, oteseconazole, ibrexafungerp, and options for complicated, recurrent, and pregnancy-associated disease. It concludes that azoles remain first-line for uncomplicated VVC, while non-albicans, azole-resistant, and recurrent VVC remain challenging and require further trials of newer agents and vaccines.

Key findings

  • Uncomplicated VVC is mainly treated with topical or oral azoles; fluconazole remains first-line and improves quality of life in 96% of women, but approximately 50% of fluconazole-treated patients have recurrence after 6 months, and the 2021 CDC guidelines favor short-course topical azoles.
  • Newer agents include oteseconazole and ibrexafungerp: oral oteseconazole was as effective as fluconazole for an acute VVC episode, and its MIC against fluconazole-resistant *C. glabrata* was 64-fold lower than fluconazole; ibrexafungerp produced clinical cure in 50.5% vs 28.6% with placebo in acute VVC. Oteseconazole was FDA-approved in April 2022 for RVVC in women without reproductive potential, and ibrexafungerp in June 2021 for RVVC in women after menopause.
  • Non-albicans and azole-resistant VVC are difficult: resistant species are estimated to cause 25–45% of VVC, CDC suggests 600 mg vaginal boric acid once daily for 2 weeks for recurrence but notes fertility/embryotoxic concerns in reproductive-age women, and amphotericin B 50 mg vaginal suppositories for 14 days left 8 of 10 non-albicans patients without further infection.
  • In pregnancy, topical azoles are recommended; BASHH advises 500 mg clotrimazole pessary daily for 7 days in acute VVC and topical imidazole for 10–14 days plus 500 mg clotrimazole pessary weekly for maintenance in RVVC. A bee honey/yogurt mixture in 129 pregnant women gave greater clinical improvement and less local irritation than 100 mg tioconazole, and redcore lotion plus miconazole improved symptoms and fungal cultures in a meta-analysis with >60% pregnant participants.

Methods

  • Narrative review of studies selected from PubMed, Google Scholar, and Scopus from January 2013 to June 2023, using keywords such as “vulvovaginal candidiasis,” “recurrent vulvovaginal candidiasis,” “azole intolerance,” and “vulvovaginal candidiasis during pregnancy.”
  • Included original papers and case reports; excluded articles not in English, conference abstracts only, and duplicated papers.
  • Main analysis is a narrative synthesis of guidelines and treatment studies; no formal meta-analysis or quantitative pooling is described.

Limitations

  • The paper states that most reviewed studies were phase II or III clinical trials, making possible efficacy, other indications, and exact dosing difficult to assess; studies often excluded immunocompromised patients due to comorbidities, and larger multi-center studies with varied VVC etiologies are needed.
  • The paper also notes specific trial limitations: oteseconazole studies had few *C. glabrata* isolates (11.8% and 1.8%); the ibrexafungerp study had too few non-albicans strains; NDV-3A vaccine efficacy was assessed only by symptoms, without prolonged efficacy or quality-of-life assessment; and dequalinium chloride conclusions came from an unpublished drug utilization trial and a small sample.
  • Evident from the text: as a narrative review, no systematic risk-of-bias assessment or formal evidence grading is described, and the guidelines for non-albicans VVC and pregnancy are repeatedly characterized as inconsistent or heterogeneous.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3390/jcm12165376

Cites

80 of 80 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 111 cited sources checked · 0 supported · 0 flagged

  • Findingcitation

    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].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] Farr A. Effendy I. Frey Tirri B. Hof H. Mayser P. Petricevic L. Ruhnke M. Schaller M. Schaefer A.P.A. Sustr V. Guideline: Vulvovaginal Candidosis (AWMF 015/072, Level S2k) Mycoses 2021 64 583 602 10.1111/myc.13248 33529414 PMC8248160 source

      Not checked in the free run.

  • Findingcitation

    Preclinical studies have shown that ibrexafungerp has the same or even higher in vitro activity compared with echinocandins in the treatment of VVC caused by treatment-resistant species.

    “As for ibrexafungerp, preclinical studies have shown that in the treatment of VVC caused by treatment-resistant species, it has the same or even higher in vitro activity compared to echinocandins [75].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [75] Gamal A. Chu S. McCormick T.S. Borroto-Esoda K. Angulo D. Ghannoum M.A. Ibrexafungerp, a Novel Oral Triterpenoid Antifungal in Development: Overview of Antifungal Activity Against Candida Glabrata Front. Cell. Infect. Microbiol. 2021 11 642358 10.3389/fcimb.2021.642358 33791244 PMC8006402

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  • Findingcitation

    Probiotics used alone have no effect on long-term improvement in cure rates.

    “However, probiotics used alone have no effect on long-term improvement in cure rates [77].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [77] Xie H.Y. Feng D. Wei D.M. Mei L. Chen H. Wang X. Fang F. Probiotics for Vulvovaginal Candidiasis in Non-Pregnant Women Cochrane Database Syst. Rev. 2017 11 CD010496 10.1002/14651858.CD010496.pub2 29168557 PMC6486023 source

      Not checked in the free run.

  • Findingcitation

    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”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] Farr A. Effendy I. Frey Tirri B. Hof H. Mayser P. Petricevic L. Ruhnke M. Schaller M. Schaefer A.P.A. Sustr V. Guideline: Vulvovaginal Candidosis (AWMF 015/072, Level S2k) Mycoses 2021 64 583 602 10.1111/myc.13248 33529414 PMC8248160 source

      Not checked in the free run.

  • Findingcitation

    In the same meta-analysis, the combined miconazole and redcore lotion group had lower levels of adverse effects.

    “Additionally, in the group treated with combined therapy, lower levels of adverse effects were observed [74].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [74] Lijuan D. Lu Y. Liping W. Yaya S. Xiaoyun L. Xiangrong L.I. Effectiveness of Redcore Lotion in Patients with Vulvovaginal Candidiasis: A Systematic Review and Meta-Analysis J. Tradit. Chin. Med. 2022 42 487 492 10.19852/j.cnki.jtcm.2022.04.001 35848964 PMC9924725 source

      Not checked in the free run.

  • May combine two claims. 36
  • Classified as probably not a substantial claim. 16
  • The quote only partly states this claim. 3

  • May combine two claims.

    Findingreasoning

    Patients with RVVC strongly responded to NDV-3A vaccination, indicating generation of an immune response against Candida.

    “It seems important that patients with RVVC strongly responded to NDV-3A vaccination, which indicates the generation of an immune response against Candida.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    Patients over 40 years of age did not respond as well to the NDV-3A vaccine as other patients, and the reason is unclear.

    “However, it also seems relevant to the results of this study that the patients over 40 years of age did not respond as well to the NDV-3A vaccine as the other patients, and the reason for this seems to be unclear.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Cultivation of Candida species takes approximately 48-72 h, which can lead to a delay in correct diagnosis and treatment.

    “However, cultivation of Candida species takes approximately 48–72 h, which can lead to a delay in the correct diagnosis and treatment of a patient.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Wiesenfeld H.C. Macio I. The Infrequent Use of Office-Based Diagnostic Tests for Vaginitis Am. J. Obstet. Gynecol. 1999 181 39 41 10.1016/S0002-9378(99)70433-3 10411793

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationnone given

    VVC affecting pregnant women is a substantial challenge in clinical practice due to heterogeneous relevant guidelines.

    “We also focused on VVC affecting pregnant women, which is a substantial challenge in clinical practice, also due to the heterogeneous relevant guidelines.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Premisecitation

    In a 2021 study of 40 women, treatment with Unilen® Microbio+ was more effective than topical clotrimazole alone (90% vs. 80%) for VVC.

    “Treatment with Unilen® Microbio+ has been shown to be more effective than topical treatment with clotrimazole alone (90% vs. 80%).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [40] Stabile G. Gentile R.M. Carlucci S. Restaino S. De Seta F. A New Therapy for Uncomplicated Vulvovaginal Candidiasis and Its Impact on Vaginal Flora Healthcare 2021 9 1555 10.3390/healthcare9111555 34828601 PMC8625853

      Not checked in the free run.

  • The quote only partly states this claim.

    Premisecitation

    In a 2021 study of 111 patients, the effectiveness of chlorhexidine in vaginal infections was higher than that of clotrimazole.

    “In this study, the effectiveness of chlorhexidine in vaginal infections was therefore higher than that of clotrimazole [42].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [42] Mirzaeei S. Zangeneh M. Veisi F. Parsa S. Hematti M. Chlorhexidine, clotrimazole, metronidazole and combination therapy in the treatment of vaginal infections J. Med. Life 2021 14 250 256 10.25122/jml-2019-0160 34104249 PMC8169144

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a 2019 study of 106 women, TOL-463 cured 92% of VVC patients with the insert and 81% with the gel.

    “The percentage of VVC patients cured with the insert was 92%, and the percentage of VVC patients cured with the gel was 81%.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [41] Marrazzo J.M. Dombrowski J.C. Wierzbicki M.R. Perlowski C. Pontius A. Dithmer D. Schwebke J. Safety and Efficacy of a Novel Vaginal Anti-Infective, TOL-463, in the Treatment of Bacterial Vaginosis and Vulvovaginal Candidiasis: A Randomized, Single-Blind, Phase 2, Controlled Trial Clin. Infect. Dis. 2019 68 803 809 10.1093/cid/ciy554 30184181 PMC6376090 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    For VVC with azole intolerance or resistance, literature proposes the use of oteseconazole, ibrexafungerp, and voriconazole.

    “Another clinical problem is the treatment of VVC with azole intolerance or resistance, for which literature proposes the use of several drugs including oteseconazole, ibrexafungerp, and voriconazole.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    The majority of researchers agree that treatment of non-albicans VVC should be long-lasting, but recommendations are inconsistent.

    “Although the majority of researchers agree that the treatment of non-albicans VVC should be long-lasting, the recommendations are inconsistent.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Recently, two new drugs, oteseconazole and ibrexafungerp, are characterized by higher efficacy in the treatment of VVC and less potential to cause side effects.

    “Recently, two new drugs characterized by higher efficacy in the treatment of VVC and less potential to cause side effects have appeared—oteseconazole and ibrexafungerp [13,14].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [13] Nishimoto A.T. Wiederhold N.P. Flowers S.A. Zhang Q. Kelly S.L. Morschhäuser J. Yates C.M. Hoekstra W.J. Schotzinger R.J. Garvey E.P. In Vitro Activities of the Novel Investigational Tetrazoles VT-1161 and VT-1598 Compared to the Triazole Antifungals against Azole-Resistant Strains and Clinical Isolates of Candida Albicans Antimicrob. Agents Chemother. 2019 63 e00341-19 10.1128/AAC.00341-19 30910896 PMC6535515 source

      Not checked in the free run.

    • cites [14] Larkin E.L. Long L. Isham N. Borroto-Esoda K. Barat S. Angulo D. Wring S. Ghannoum M. A Novel 1,3-Beta-d-Glucan Inhibitor, Ibrexafungerp (Formerly SCY-078), Shows Potent Activity in the Lower PH Environment of Vulvovaginitis Antimicrob. Agents Chemother. 2019 63 e02611-18 10.1128/AAC.02611-18 30885896 PMC6496072

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The American Society of Infectious Diseases recommends that patients should use topical and oral azoles concurrently.

    “Thus, the American Society of Infectious Diseases recommends that patients should use topical and oral azoles concurrently [38].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [38] Pappas 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. Clinical Practice Guidelines for the Management Candidiasis: 2009 Update by the Infectious Diseases Society of America Clin. Infect. Dis. 2009 48 503 535 10.1086/596757 19191635 PMC7294538 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Fluconazole remains the first-line treatment for VVC, improving quality of life in 96% of women.

    “Fluconazole remains the first line treatment for VVC, improving quality of life in 96% of women; however, even 63% of women have ongoing infections after completing maintenance therapy [8,9].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [8] Nguyen Y. Lee A. Fischer G. Quality of Life in Patients with Chronic Vulvovaginal Candidiasis: A before and after Study on the Impact of Oral Fluconazole Therapy Australas. J. Dermatol. 2017 58 e176 e181 10.1111/ajd.12487 27170259

      Not checked in the free run.

    • cites [9] Crouss T. Sobel J.D. Smith K. Nyirjesy P. Long-Term Outcomes of Women With Recurrent Vulvovaginal Candidiasis After a Course of Maintenance Antifungal Therapy J. Low. Genit. Tract Dis. 2018 22 382 386 10.1097/LGT.0000000000000413 29975334 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Uncomplicated VVC accounts for up to 90% of all cases of candidiasis.

    “Uncomplicated VVC accounts for up to 90% of all cases of candidiasis [33].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33] Workowski K.A. Bolan G.A. Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines, 2015 MMWR Recomm. Rep. Morb. Mortal. Wkly. Rep. Recomm. Rep. 2015 64 S759 S762 26602614

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The mainstay of treatment for most cases of uncomplicated VVC is azole antifungals, which inhibit the fungal enzyme CYP51 and prevent accumulation of fungitoxic sterols.

    “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].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [11] 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. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America Clin. Infect. Dis. 2016 62 e1 e50 10.1093/cid/civ933 26679628 PMC4725385 source

      Not checked in the free run.

    • cites [34] Sobel J.D. Wiesenfeld H.C. Martens M. Danna P. Hooton T.M. Rompalo A. Sperling M. Livengood C. Horowitz B. Von Thron J. Maintenance Fluconazole Therapy for Recurrent Vulvovaginal Candidiasis N. Engl. J. Med. 2004 351 876 883 10.1056/NEJMoa033114 15329425 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationnone given

    The efficacy of probiotics, TOL-463, and chlorhexidine is satisfactory, but there are no relevant guidelines for their use in VVC.

    “The efficacy of probiotics and substances such as TOL-463 and chlorhexidine is indicated as satisfactory; however, there are no relevant guidelines.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    PCR testing for VVC has sensitivity 90.9% and specificity 94.1% for Candida, and for C. glabrata sensitivity 75.9% and specificity 99.7%.

    “For VVC, the sensitivity was 90.9% and the specificity was 94.1% for Candida, and for C. glabrata, the sensitivity and specificity were 75.9% and 99.7%, respectively [32].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] Gaydos C.A. Beqaj S. Schwebke J.R. Lebed J. Smith B. Davis T.E. Fife K.H. Nyirjesy P. Spurrell T. Furgerson D. Clinical Validation of a Test for the Diagnosis of Vaginitis Obstet. Gynecol. 2017 130 181 189 10.1097/AOG.0000000000002090 28594779 PMC5635603 source

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  • May combine two claims.

    Premisecitation

    In a study of 209 patients, VVC occurred in 17.7% based on symptoms and laboratory findings; clinical diagnosis sensitivity was 70.3% and specificity was 83.7%.

    “A study by Aniebue et al., conducted on 209 patients, found that only the clinical diagnosis of VVC is associated with a false positive rate. VVC occurred in 17.7% of patients based on symptoms and laboratory findings. Comparing the microbiological diagnosis to the clinical diagnosis, its sensitivity was 70.3% and the specificity was 83.7% [24].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [24] Aniebue U.U. Nwankwo T.O. Nwafor M.I. Vulvovaginal Candidiasis in Reproductive Age Women in Enugu Nigeria, Clinical versus Laboratory-Assisted Diagnosis Niger. J. Clin. Pract. 2018 21 1017 1022 10.4103/njcp.njcp_25_16 30074004

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    Treatment schedules for recurrent VVC mainly include fluconazole; alternative options include the immunotherapeutic vaccine NDV-3A and designed antimicrobial peptides (dAMPs).

    “The treatment schedules for recurrent VVC include mainly fluconazole; however, alternative options such as immunotherapeutic vaccine (NDV-3A) or designed antimicrobial peptides (dAMPs) were also described.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In the United States, RVVC is defined as three or more episodes of symptomatic VVC in less than one year.

    “In the United States, RVVC is defined as three or more episodes of symptomatic VVC in less than one year [59].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [59] Workowski K.A. Bachmann L.H. Chan P.A. Johnston C.M. Muzny C.A. Park I. Reno H. Zenilman J.M. Bolan G.A. Sexually Transmitted Infections Treatment Guidelines, 2021 MMWR Recomm. Rep. 2021 70 1 187 10.15585/mmwr.rr7004a1 PMC8344968 34292926

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    European guidelines and IDSA define RVVC as four or more symptomatic episodes of VVC during a one-year period.

    “On the other hand, European guidelines and guidelines from the Infectious Diseases Society of America define RVVC as four or more symptomatic episodes of VVC during a one-year period [47].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [47] Donders G. Sziller I.O. Paavonen J. Hay P. De Seta F. Bohbot J.M. Kotarski J. Vives J.A. Szabo B. Cepuliené R. Management of Recurrent Vulvovaginal Candidosis: Narrative Review of the Literature and European Expert Panel Opinion Front. Cell. Infect. Microbiol. 2022 12 934353 10.3389/fcimb.2022.934353 36159646 PMC9504472 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Treatment of non-albicans VVC is challenging because they are very often resistant to azoles and nearly 50% of affected women might present minimal or no symptoms.

    “Treatment of non-albicans species VVC is challenging because they are very often resistant to azoles and nearly 50% of affected women might present minimal or no symptoms [36].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [36] Sexually Transmitted Infections Treatment Guidelines. Vulvovaginal Candidiasis (VVC) 2021 Available online: https://www.cdc.gov/std/treatment-guidelines/candidiasis.htm (accessed on 22 July 2023)

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Hyperglycemia in vaginal cells is associated with increased fungal adhesion and binding and reduces neutrophil phagocytosis.

    “Possible reasons are connected with hyperglycemia in vaginal cells. It is associated with increased fungal adhesion and binding and also reduces the ability of neutrophils to perform effective phagocytosis of these cells [15,47].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [15] Yano J. Sobel J.D. Nyirjesy P. Sobel R. Williams V.L. Yu Q. Noverr M.C. Fidel P.L. Current Patient Perspectives of Vulvovaginal Candidiasis: Incidence, Symptoms, Management and Post-Treatment Outcomes BMC Womens Health 2019 19 48 10.1186/s12905-019-0748-8 30925872 PMC6441174 source

      Not checked in the free run.

    • cites [47] Donders G. Sziller I.O. Paavonen J. Hay P. De Seta F. Bohbot J.M. Kotarski J. Vives J.A. Szabo B. Cepuliené R. Management of Recurrent Vulvovaginal Candidosis: Narrative Review of the Literature and European Expert Panel Opinion Front. Cell. Infect. Microbiol. 2022 12 934353 10.3389/fcimb.2022.934353 36159646 PMC9504472 source

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  • May combine two claims.

    Interpretationreasoning

    In most cases, VVC in HIV-positive patients is uncomplicated and should be treated according to general guidelines as uncomplicated VVC.

    “In most cases, VVC in these patients is uncomplicated and should be treated according to general guidelines as uncomplicated VVC.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Patients with diabetes mellitus and those at increased risk of developing it are at higher risk of VVC.

    “Both patients struggling with the disease and those with an increased risk of developing it are in the group at higher risk of VVC [26].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] Farr A. Effendy I. Frey Tirri B. Hof H. Mayser P. Petricevic L. Ruhnke M. Schaller M. Schaefer A.P.A. Sustr V. Guideline: Vulvovaginal Candidosis (AWMF 015/072, Level S2k) Mycoses 2021 64 583 602 10.1111/myc.13248 33529414 PMC8248160

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    dAMPs may become potential therapeutic agents for the treatment of RVVC because they show fungicidal activity and have a low predisposition to induce resistance.

    “Showing fungicidal activity, in contrast to fluconazole’s fungistatic effect, and having a low predisposition to induce resistance among microorganisms, dAMPs may become potential therapeutic agents for the treatment of RVVC.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    There is no evidence that HIV-positive women respond worse to therapies used in HIV-negative patients, and no proof that VVC predisposes to HIV infection.

    “As for HIV infection, there is no evidence that HIV-positive women respond worse to therapies used in HIV-negative patients, and there is no proof that VVC predisposes to HIV infection [48].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [48] Guideline Development Group Edwards A. Rautemaa-Richardson R. Owen C. Nathan B. Palmer B. Wood C. Ahmed H. Sameena Ahmad Patient Representatives; FitzGerald, M. British Association for Sexual Health and HIV National Guideline for the Management of Vulvovaginal Candidiasis (2019) Int. J. STD AIDS 2020 31 1124 1144 10.1177/0956462420943034 32883171

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  • May combine two claims.

    Premisecitation

    Oteseconazole is effective against C. albicans and C. glabrata.

    “A study has shown that oteseconazole is effective not only against C. albicans, but also against C. glabrata [54].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [54] 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. 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 7121 7127 10.1128/AAC.03707-14 25224009 PMC4249504

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationcitation

    To date, good-quality evidence on the efficacy of complementary and alternative treatments for RVVC is limited, so they are not recommended.

    “To date, good-quality evidence on the efficacy of complementary and alternative treatments for RVVC is limited, so they are not recommended [1,6].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [1] Nyirjesy P. Brookhart C. Lazenby G. Schwebke J. Sobel J.D. Vulvovaginal Candidiasis: A Review of the Evidence for the 2021 Centers for Disease Control and Prevention of Sexually Transmitted Infections Treatment Guidelines Clin. Infect. Dis. 2022 74 S162 S168 10.1093/cid/ciab1057 35416967 source

      Not checked in the free run.

    • cites [6] Cooke G. Watson C. Deckx L. Pirotta M. Smith J. Van Driel M.L. Treatment for Recurrent Vulvovaginal Candidiasis (Thrush) Cochrane Database Syst. Rev. 2022 2022 10.1002/14651858.CD009151 PMC8744138 35005777

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A single intramuscular dose of NDV-3A vaccine was safe, generated a rapid and robust immune response, and reduced the incidence of symptomatic RVVC episodes for up to 12 months in 188 women with RVVC.

    “A single intramuscular dose of the vaccine was safe; it generated a rapid and robust immune response and reduced the incidence of symptomatic RVVC episodes for up to 12 months in 188 women with RVVC [47].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [47] Donders G. Sziller I.O. Paavonen J. Hay P. De Seta F. Bohbot J.M. Kotarski J. Vives J.A. Szabo B. Cepuliené R. Management of Recurrent Vulvovaginal Candidosis: Narrative Review of the Literature and European Expert Panel Opinion Front. Cell. Infect. Microbiol. 2022 12 934353 10.3389/fcimb.2022.934353 36159646 PMC9504472 source

      Not checked in the free run.

  • May combine two claims. The quote only partly states this claim.

    Premisecitation

    In a 2022 study of 11 patients with refractory VVC, oral voriconazole was effective, with 8 patients cured after 2 weeks.

    “After 2 weeks of treatment with voriconazole, eight patients were cured.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [58] Morris G.C. Dean G. Soni S. Sundaram S. Fearnley N. Wilson J.D. Outcomes and Experiences of Using Oral Voriconazole with or without Concomitant Topical Agents to Treat Refractory Vulvovaginal Yeast Infections Int. J. STD AIDS 2022 33 1134 1141 10.1177/09564624221127356 36214529

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Diabetic patients are more likely to have non-albicans Candida infections, particularly C. glabrata, characterized by a less effective response to antimycotic therapy.

    “What is more, these patients are more likely to have non-albicans Candida species infections, particularly those caused by C. glabrata and characterized by a less effective response to antimycotic therapy [26].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] Farr A. Effendy I. Frey Tirri B. Hof H. Mayser P. Petricevic L. Ruhnke M. Schaller M. Schaefer A.P.A. Sustr V. Guideline: Vulvovaginal Candidosis (AWMF 015/072, Level S2k) Mycoses 2021 64 583 602 10.1111/myc.13248 33529414 PMC8248160

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Long-term treatment with fluconazole is associated with high costs and side effects, while about 50% of women experience recurrence a few months after the end of treatment.

    “Long-term treatment with fluconazole is associated with high costs and side effects, while about 50% of women experience a recurrence of symptoms a few months after the end of treatment [61].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [61] Lírio J. Giraldo P.C. Amaral R.L. Sarmento A.C.A. Costa A.P.F. Gonçalves A.K. Antifungal (Oral and Vaginal) Therapy for Recurrent Vulvovaginal Candidiasis: A Systematic Review Protocol BMJ Open 2019 9 e027489 10.1136/bmjopen-2018-027489 PMC6537984 31122991

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Boric acid can impair fertility and might be embryotoxic, so it is not recommended for women of reproductive age.

    “Nevertheless, it should be taken into account that the application of boric acid can impair fertility and might be embryotoxic; therefore, it is not recommended for women of reproductive age [26].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] Farr A. Effendy I. Frey Tirri B. Hof H. Mayser P. Petricevic L. Ruhnke M. Schaller M. Schaefer A.P.A. Sustr V. Guideline: Vulvovaginal Candidosis (AWMF 015/072, Level S2k) Mycoses 2021 64 583 602 10.1111/myc.13248 33529414 PMC8248160

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    For C. glabrata infection, German guidelines from 2021 suggest local administration of nystatin or ciclopiroxolamine may be considered.

    “Currently, in the case of the C. glabrata infection, according to German guidelines from 2021, the local administration of nystatin or ciclopiroxolamine may be considered [26].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] Farr A. Effendy I. Frey Tirri B. Hof H. Mayser P. Petricevic L. Ruhnke M. Schaller M. Schaefer A.P.A. Sustr V. Guideline: Vulvovaginal Candidosis (AWMF 015/072, Level S2k) Mycoses 2021 64 583 602 10.1111/myc.13248 33529414 PMC8248160

      Not checked in the free run.

  • May combine two claims.

    Study design and conductcitation

    The efficacy of the NDV-3A vaccine was evaluated only according to symptoms, and a prolonged efficacy evaluation was missing.

    “Despite the promising results, the efficacy of the vaccine was evaluated only according to symptoms, and a prolonged efficacy evaluation was missing.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [65] 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. A Fungal Immunotherapeutic Vaccine (NDV-3A) for Treatment of Recurrent Vulvovaginal Candidiasis—A Phase 2 Randomized, Double-Blind, Placebo-Controlled Trial Clin. Infect. Dis. 2018 66 1928 1936 10.1093/cid/ciy185 29697768 PMC5982716

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Studies show that oteseconazole and ibrexafungerp are effective against treatment-resistant Candida species and provide a shorter treatment time than fluconazole.

    “Studies show that these drugs are effective against treatment-resistant Candida species and provide a shorter treatment time than the use of fluconazole.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [63] Sobel J.D. Nyirjesy P. Oteseconazole: An Advance in Treatment of Recurrent Vulvovaginal Candidiasis Future Microbiol. 2021 16 1453 1461 10.2217/fmb-2021-0173 34783586

      Not checked in the free run.

    • cites [75] Gamal A. Chu S. McCormick T.S. Borroto-Esoda K. Angulo D. Ghannoum M.A. Ibrexafungerp, a Novel Oral Triterpenoid Antifungal in Development: Overview of Antifungal Activity Against Candida Glabrata Front. Cell. Infect. Microbiol. 2021 11 642358 10.3389/fcimb.2021.642358 33791244 PMC8006402

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    The German guidelines highlight the reasonableness of local clotrimazole in the first pregnancy trimester to avoid oral azole administration and potential fetal malformations.

    “The authors especially highlight the reasonableness of such management in the first pregnancy trimester to avoid oral azole administration and the following potential fetal malformations [26].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] Farr A. Effendy I. Frey Tirri B. Hof H. Mayser P. Petricevic L. Ruhnke M. Schaller M. Schaefer A.P.A. Sustr V. Guideline: Vulvovaginal Candidosis (AWMF 015/072, Level S2k) Mycoses 2021 64 583 602 10.1111/myc.13248 33529414 PMC8248160

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    For acute VVC in pregnant women, the British Association for Sexual Health and HIV indicates as an alternative a 7-day therapy with clotrimazole 200 mg or 5 mg of 10% clotrimazole in cream.

    “Moreover, as an alternative, they indicate a 7-day therapy regimen with the use of clotrimazole at a reduced dose (200 mg) or 5 mg of 10% clotrimazole in cream.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [48] Guideline Development Group Edwards A. Rautemaa-Richardson R. Owen C. Nathan B. Palmer B. Wood C. Ahmed H. Sameena Ahmad Patient Representatives; FitzGerald, M. British Association for Sexual Health and HIV National Guideline for the Management of Vulvovaginal Candidiasis (2019) Int. J. STD AIDS 2020 31 1124 1144 10.1177/0956462420943034 32883171

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In general, the use of locally administered azoles is recommended for VVC in pregnant women.

    “In general, the use of locally administered azoles is recommended [26,36,48].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [26] Farr A. Effendy I. Frey Tirri B. Hof H. Mayser P. Petricevic L. Ruhnke M. Schaller M. Schaefer A.P.A. Sustr V. Guideline: Vulvovaginal Candidosis (AWMF 015/072, Level S2k) Mycoses 2021 64 583 602 10.1111/myc.13248 33529414 PMC8248160

      Not checked in the free run.

    • cites [36] Sexually Transmitted Infections Treatment Guidelines. Vulvovaginal Candidiasis (VVC) 2021 Available online: https://www.cdc.gov/std/treatment-guidelines/candidiasis.htm (accessed on 22 July 2023)

      Not checked in the free run.

    • cites [48] Guideline Development Group Edwards A. Rautemaa-Richardson R. Owen C. Nathan B. Palmer B. Wood C. Ahmed H. Sameena Ahmad Patient Representatives; FitzGerald, M. British Association for Sexual Health and HIV National Guideline for the Management of Vulvovaginal Candidiasis (2019) Int. J. STD AIDS 2020 31 1124 1144 10.1177/0956462420943034 32883171

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    In pregnant individuals, boric acid as a substitute for azole-based therapy may be associated with an increased risk of various congenital malformations and should be avoided.

    “Several national and international guidelines recommend the application of boric acid as a substitute for azole-based therapy in non-pregnant women; however, in pregnant individuals, such a treatment regimen may be associated with an increased risk of various congenital malformations, and thus it seems that it should be avoided [71].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [71] Mittelstaedt R. Kretz A. Levine M. Handa V.L. Ghanem K.G. Sobel J.D. Powell A. Tuddenham S. Data on Safety of Intravaginal Boric Acid Use in Pregnant and Nonpregnant Women: A Narrative Review Sex. Transm. Dis. 2021 48 e241 e247 10.1097/OLQ.0000000000001562 34561373 PMC10100571

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    For acute VVC in pregnant women, the British Association for Sexual Health and HIV recommends 500 mg clotrimazole in pessary daily for 7 days.

    “In case of acute VVC, the authors recommend the use of 500 mg of clotrimazole in pessary daily for 7 days.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [48] Guideline Development Group Edwards A. Rautemaa-Richardson R. Owen C. Nathan B. Palmer B. Wood C. Ahmed H. Sameena Ahmad Patient Representatives; FitzGerald, M. British Association for Sexual Health and HIV National Guideline for the Management of Vulvovaginal Candidiasis (2019) Int. J. STD AIDS 2020 31 1124 1144 10.1177/0956462420943034 32883171

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The CDC guideline included a limited statement recommending topical azoles for 7 days, with no other detailed recommendations established.

    “The guidelines developed by the Centers for Disease Control and Prevention included a limited statement recommending the use of topical azoles for 7 days, and no other detailed recommendations were established [36].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [36] Sexually Transmitted Infections Treatment Guidelines. Vulvovaginal Candidiasis (VVC) 2021 Available online: https://www.cdc.gov/std/treatment-guidelines/candidiasis.htm (accessed on 22 July 2023)

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    For acute VVC in pregnant women, the British Association for Sexual Health and HIV lists other options: 150 mg econazole pessary, miconazole cream (5 g of 2% daily for 7 days), or miconazole capsules (1200 or 400 mg daily for 7 days).

    “Additionally, other treatment options include the use of 150 mg of econazole in pessary, as well as miconazole in cream (5 g of 2% agent, daily for 7 days) or in capsules (1200 or 400 mg daily for 7 days).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [48] Guideline Development Group Edwards A. Rautemaa-Richardson R. Owen C. Nathan B. Palmer B. Wood C. Ahmed H. Sameena Ahmad Patient Representatives; FitzGerald, M. British Association for Sexual Health and HIV National Guideline for the Management of Vulvovaginal Candidiasis (2019) Int. J. STD AIDS 2020 31 1124 1144 10.1177/0956462420943034 32883171

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Oral fluconazole is the treatment of first choice in patients with uncomplicated VVC, but it seems ineffective against VVC caused by species other than C. albicans.

    “Although oral fluconazole is the treatment of first choice in patients with uncomplicated VVC, it still seems to be ineffective against VVC caused by species other than C. albicans [50].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [50] Nasrollahi Omran A. Vakili L. Jafarpur M. The Determination of Vaginal Candidiasis InWomen Referred to Shahid Rajaei Hospital in Tonekabon (2009–2010) mljgoums 2011 5 1 7

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    During pregnancy, the incidence of VVC significantly increases compared with non-pregnant women, although exact statistics are missing.

    “It is estimated that during pregnancy the incidence of VVC significantly increases in comparison to that in non-pregnant women; however, the exact statistics are missing [67].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [67] He C. Lin Z. Robb S. Ezeamama A. Serum Vitamin D Levels and Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis Nutrients 2015 7 4555 4577 10.3390/nu7064555 26061015 PMC4488802

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A meta-analysis found that fluconazole therapy did not significantly increase the risk of various congenital malformations, but suggested further investigation of a potential association between heart defects and fluconazole exposure.

    “Although the results of meta-analysis regarding the occurrence of complications resulting from fluconazole therapy indicated that such a treatment regimen did not significantly increase the risk of various congenital malformations, they suggested the need for further investigation of a potential association between heart defects and fluconazole exposure [70].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [70] Alsaad A.M.S. Kaplan Y.C. Koren G. Exposure to Fluconazole and Risk of Congenital Malformations in the Offspring: A Systematic Review and Meta-Analysis Reprod. Toxicol. 2015 52 78 82 10.1016/j.reprotox.2015.02.009 25724389

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    For RVVC in pregnant women, guidelines recommend topical imidazole for 10-14 days and 500 mg clotrimazole pessary once a week for maintenance.

    “In turn, in the case of the presence of RVVC, the guidelines recommend only the following management: topical imidazole for 10–14 days and 500 mg clotrimazole in pessary once a week for maintenance [48].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [48] Guideline Development Group Edwards A. Rautemaa-Richardson R. Owen C. Nathan B. Palmer B. Wood C. Ahmed H. Sameena Ahmad Patient Representatives; FitzGerald, M. British Association for Sexual Health and HIV National Guideline for the Management of Vulvovaginal Candidiasis (2019) Int. J. STD AIDS 2020 31 1124 1144 10.1177/0956462420943034 32883171

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The British Association for Sexual Health and HIV guideline listed several treatment schemes for VVC in pregnancy and distinguished management for acute and recurrent VVC among pregnant women.

    “Contrastingly, the British Association for Sexual Health and HIV listed several treatment schemes which can be applied, and the distinct management for acute and recurrent VVC among pregnant women was distinguished.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [48] Guideline Development Group Edwards A. Rautemaa-Richardson R. Owen C. Nathan B. Palmer B. Wood C. Ahmed H. Sameena Ahmad Patient Representatives; FitzGerald, M. British Association for Sexual Health and HIV National Guideline for the Management of Vulvovaginal Candidiasis (2019) Int. J. STD AIDS 2020 31 1124 1144 10.1177/0956462420943034 32883171

      Not checked in the free run.

  • May combine two claims.

    Study design and conductnone given

    The reviewed studies often did not take into account patients who were immunocompromised due to comorbidities, which can lead to a poorer assessment of the effectiveness of a given drug.

    “Secondly, studies often did not take into account patients who were immunocompromised due to comorbidities, which can lead to a poorer assessment of the effectiveness of a given drug.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    Most of the studies reviewed in this article were phase II or III clinical trials, which makes it difficult to assess possible efficacy, other indications, or the exact dosing regimen.

    “Firstly, it cannot be overlooked that most of the studies concerned phase II or III clinical trials, which makes it difficult to assess possible efficacy, other indications, or the exact dosing regimen.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    A review of the current literature concluded that there is a great need for the treatment of VVC infections, especially those caused by yeasts other than C. albicans.

    “A review of the current literature concluded that there is a great need for the treatment of VVC infections, especially those caused by yeasts other than C. albicans.”
    Quote in the paperNot a substantial claim
51 of 51

  • The paper relies on this without support.

    There are no officially approved vaccines or immunological therapies that can be used in antifungal treatment for VVC.

    “Despite the fact that many drugs for VVV are available on the market, there are still no officially approved vaccines or immunological therapies that can be used in antifungal treatment.”

  • The paper relies on this without support.

    VVC is a significant problem that affects the quality and comfort of everyday functioning and may contribute to deterioration of patients’ daily functioning.

    “VVC is still a significant problem that affects the quality and comfort of everyday functioning of patients.”
    “Treatment of VVC should be individualized, as this condition may contribute to the deterioration of patients’ daily functioning.”

  • The paper relies on this without support.

    Both oral and topical use of fluconazole may be associated with side effects in patients.

    “As both the oral and topical use of fluconazole may be associated with side effects in patients, new drugs are being studied, including oteseconazole and ibrexafungerp.”
3 of 3

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.

  • Honey-and-yogurt mixture changes from comparator to combination

    Minor

    The pregnancy study is described as comparing a honey-and-yogurt mixture against tioconazole. The discussion instead describes a mixture of honey and yogurt with thioconazole as a treatment product.

  • The stated publication-date range excludes cited studies

    Minor

    The methods say cited studies were selected from January 2013 to June 2023, but the paper cites and discusses a study published in 2005.

  • Bacterial-vaginosis patients appear in a treatment group not listed for them

    Minor

    The treatment description assigns patients with bacterial vaginosis to chlorhexidine gel or metronidazole tablets, but the results report 16 such patients in the clotrimazole-gel group.

3 of 3

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Authors
Satora, M., Grunwald, A., Zaremba, B., Frankowska, K., Żak, K., Tarkowski, R., & Kułak, K.
Affiliations
Medical University of Lublin (PL)
Corresponding author
Satora, Małgorzata
ORCID
Venue
Journal of Clinical Medicine
Publisher
MDPI AG
Published
2023-08-18
Volume
12
Issue
16
Pages
5376
ISSN
2077-0383 (ISSN-L)
DOI
10.3390/jcm12165376
PMC
PMC10455317
OpenAlex
W4385978652
Semantic Scholar
7397929886e4be783a7d58c91a42c7841e789816
Cited by
84
References
78
Citations by year
2026: 29 · 2025: 36 · 2024: 18 · 2023: 1
FWCI
3.98
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Clinical Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • 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 › Epidemiology › Urinary Tract Infections Management
Keywords
vaginal candidiasis, antifungal therapy, oteseconazole, ibrexafungerp, probiotics, chlorhexidine, voriconazole, recurrent vulvovaginal candidiasis, fluconazole, antimicrobial peptides, treatment guidelines

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.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

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