Recurrent Vulvovaginal Candidiasis: An Immunological Perspective
Open accessAbstract
Vulvovaginal candidiasis (VVC) is a widespread vaginal infection primarily caused by Candida albicans. VVC affects up to 75% of women of childbearing age once in their life, and up to 9% of women in different populations experience more than three episodes per year, which is defined as recurrent vulvovaginal candidiasis (RVVC). RVVC results in diminished quality of life as well as increased associated healthcare costs. For a long time, VVC has been considered the outcome of inadequate host defenses against Candida colonization, as in the case of primary immunodeficiencies associated with persistent fungal infections and insufficient clearance. Intensive research in recent decades has led to a new hypothesis that points toward a local mucosal overreaction of the immune system rather than a defective host response to Candida colonization. This review provides an overview of the current understanding of the host immune response in VVC pathogenesis and suggests that a tightly regulated fungus–host–microbiota interplay might exert a protective role against recurrent Candida infections.
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Women 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”
From Clinical challenges in diagnosis and treatment of recurrent vulvovaginal candidiasis (2022) · cites this paper as [9]
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”
From Clinical challenges in diagnosis and treatment of recurrent vulvovaginal candidiasis (2022) · cites this paper as [9]
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”
From Clinical challenges in diagnosis and treatment of recurrent vulvovaginal candidiasis (2022) · cites this paper as [9]
Predisposing factors are absent in 20%-30% of patients with RVVC.
“Predisposing factors are absent in 20%–30% of patients with RVVC (Rosati et al., 2020).”
From Management of recurrent vulvovaginal candidosis: Narrative review of the literature and European expert panel opinion (2022) · cites this paper as Rosati et al., 2020
RVVC is considered a multifactorial disorder, the symptoms of which are governed by the interaction between Candida (species and virulence factors), the Lactobacilli population, the microenvironment (estrogen, inflammatory status, and oxidative stress), and the host (genetic factors, immune status, and behavioral factors).
“RVVC is considered a multifactorial disorder, the symptoms of which are governed by the interaction between Candida (species and virulence factors), the Lactobacilli population, the microenvironment (estrogen, inflammatory status, and oxidative stress), and the host (genetic factors, immune status, and behavioral factors).”
From Management of recurrent vulvovaginal candidosis: Narrative review of the literature and European expert panel opinion (2022) · cites this paper as Rosati et al., 2020
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References 126 · Cited by 206
- Authors
- Rosati, D., Bruno, M., Jaeger, M., ten Oever, J., & Netea, M. G.
- Affiliations
- Radboud University Nijmegen (NL)
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- University of Bonn (DE)
- Corresponding author
- Netea, Mihai G.
- Venue
- Microorganisms
- Publisher
- MDPI AG
- Published
- 2020-01-21
- Volume
- 8
- Issue
- 2
- Pages
- 144
- ISSN
- 2076-2607 (ISSN-L)
- PMC
- PMC7074770
- OpenAlex
- W3001155492
- Cited by
- 206
- References
- 126
- Citations by year
- 2026: 23 · 2025: 38 · 2024: 29 · 2023: 46 · 2022: 33 · 2021: 26 · 2020: 10 · 2019: 1
- FWCI
- 1.36
- Type
- journal article
- Language
- en
- Open access
- gold
- dx.doi.org
- Licence
- Locations
- Microorganisms (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Radboud Repository (Radboud University) (submittedVersion, other-oa)
- Funders
- European Commission (812969, 833247)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Keywords
- recurrent vulvovaginal candidiasis, Candida albicans, host immune response, primary immunodeficiency, fungal colonization, host-microbiota interactions, quality of life
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