Med. praxi. 2011;8(5):233-236

General principles of diagnosis and treatment of vulvovaginal candidiasis

doc.MUDr.Vít Unzeitig, CSc.1, MUDr.Michal Kliment, CSc.2, doc.MUDr.Jiří ©paček, Ph.D.3, MUDr.Vladimír Dvořák4, prof.MUDr.Miroslav Borovský, Ph.D.5
1 Gynekologicko-porodnická klinika MU a FN Brno, Centrum ambulantní gynekologie a primární péče Brno
2 Gynekologická ambulancia Gyn Gaal Pezinok
3 Gynekologicko-porodnická klinika UK a FN Hradec Králové
4 Centrum ambulantní gynekologie a primární péče Brno
5 Gynekologicko-porodnická klinika UK a FN Bratislava

It aims to help doctors provide rational diagnostic and therapeutic procedure in cases of uncomplicated and complicated vulvovaginal

candidiasis. The text provides recommendations based on generally accepted principles of evidence-based medicine for diagnostic tests,

medical schemes and health promotion principles needed for effective management of vulvovaginal candidiasis.

Keywords: vulvovaginal candidiasis, etiology, diagnosis, treatment

Published: June 1, 2011  Show citation

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Unzeitig V, Kliment M, ©paček J, Dvořák V, Borovský M. General principles of diagnosis and treatment of vulvovaginal candidiasis. Med. praxi. 2011;8(5):233-236.
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References

  1. Holland J, Young ML, Lee O, Chen S. Vulvovaginal carriage of yeasts other than Candida albicans. Sexually transmitted infections 2003; 79(3): 249-250. Go to original source... Go to PubMed...
  2. Sobel JD. Pathogenesis and epidemiology of vulvovaginal candidiasis. [Review] [60 refs]. Annals of the New York Academy of Sciences 1988; 544: 547-557. Go to original source... Go to PubMed...
  3. Singh S, Sobel J, Bhargava P, Boikov D, Vazquez J. Vaginitis due to Candida krusei: epidemiology, clinical aspects, and therapy. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America 2002; 35(9): 1066-1070. Go to original source... Go to PubMed...
  4. Schaaf VM, Perez-Stable EJ, Borchardt K. The limited value of symptoms and signs in the diagnosis of vaginal infections. [see comments]. Archives of Internal Medicine 1990; 150(9): 1929-1933. Go to original source...
  5. Ferris DG, Dekle C, Litaker MS. Women's use of over-thecounter antifungal medications for gynecologic symptoms. Journal of Family Practice 1996; 42(6): 595-600.
  6. Geiger AM, Foxman B, Sobel JD. Chronic vulvovaginal candidiasis: characteristics of women with Candida albicans, C glabrata and no candida. Genitourin-Med 1995; 71(5): 304-307. Go to original source... Go to PubMed...
  7. Lindner JG, Plantema FH, Hoogkamp K. Quantitative studies of the vaginal flora of healthy women and of obstetric and gynaecological patients. J-Med-Microbiol 1978; 11(3): 233-241. Go to original source... Go to PubMed...
  8. Odds FC. Candida and Candidosis; A review and bibliography. Second ed. London: Bailliere Tindall, 1988.
  9. Abbott J. Clinical and microscopic diagnosis of vaginal yeast infection: a prospective analysis. Annals of Emergency Medicine 1995; 25(5): 587-591. Go to original source... Go to PubMed...
  10. Bergman JJ, Berg AO, Schneeweiss R, Heidrich FE. Clinical comparison of microscopic and culture techniques in the diagnosis of Candida vaginitis. Journal of Family Practice 1984; 18(4): 549-552.
  11. Eckert LO, Hawes SE, Stevens CE, Koutsky LA, Eschenbach DA, Holmes KK. Vulvovaginal candidiasis: clinical manifestations, risk factors, management algorithm. Obstetrics & Gynecology 1998; 92(5): 757-765. Go to original source...
  12. Sonnex C, Lefort W. Microscopic features of vaginal candidiasis and their relation to symptomatology. Sexually transmitted infections 1999; 75(6): 417-419. Go to original source... Go to PubMed...
  13. Zdolsek B, Hellberg D, Froman G, Nilsson S, Mardh PA. Culture and wet smear microscopy in the diagnosis of lowsymptomatic vulvovaginal candidosis. European Journal of Obstetrics, Gynecology, & Reproductive Biology 1995; 58(1): 47-51. Go to original source... Go to PubMed...
  14. Emmerson J, Gunputrao A, Hawkswell J, Dexter A, Sykes R, Searle S, et al. Sampling for vaginal candidosis: how good is it? International journal of STD & AIDS 1994; 5(5): 356-358.
  15. Patel D, Gillespie B, Sobel J, Leaman D, Nyirjesy P, Weitz MV, et al. Risk factors for recurrent vulvovaginal candidiasis in women receiving maintenance antifungal therapy: results of a prospective cohort study. American journal of obstetrics and gynecology 2004; 190(3): 644-653. Go to original source... Go to PubMed...
  16. Elegbe IA, Elegbe I. Quantitative relationships of Candida albicans infections and dressing patterns in Nigerian women. American Journal of Public Health 1983; 73(4): 450-452. Go to original source... Go to PubMed...
  17. Watson MC, Grimshaw JM, Bond CM, Mollison J, Ludbrook A. Oral versus intra-vaginal imidazole and triazole anti-fungal agents for the treatment of uncomplicated vulvovaginal candidiasis (thrush): a systematic review. [Review] [27 refs]. BJOG: an International Journal of Obstetrics & Gynaecology 2002; 109(1): 85-95. Go to original source... Go to PubMed...
  18. Watson MC, Grimshaw JM, Bond CM, Mollison J, Ludbrook A. Oral versus intra-vaginal imidazole and triazole antifungal treatment of uncomplicated vulvovaginal candidiasis (thrush). [update of Cochrane Database Syst Rev. 2001; 1: CD002845; 11279767] [Review] [37 refs]. Cochrane Database of Systematic Reviews 2001; 4: CD002845. Go to original source...
  19. Bisschop MP, Merkus JM, Scheygrond H, Van Cutsem J. Cotreatment of the male partner in vaginal candidosis: a double-blind randomized control study. British Journal of Obstetrics & Gynaecology 1986; 93(1): 79-81. Go to original source... Go to PubMed...
  20. Fong IW. The value of treating the sexual partners of women with recurrent vaginal candidiasis with ketoconazole. Genitourin-Med 1992; 68(3): 174-176. Go to original source... Go to PubMed...
  21. Sobel JD, Faro S, Force RW, Foxman B, Ledger WJ, Nyirjesy PR, et al. Vulvovaginal candidiasis: epidemiologic, diagnostic, and therapeutic considerations. [see comments.]. [Review] [29 refs]. American Journal of Obstetrics & Gynecology 1998; 178(2): 203-211. Go to original source... Go to PubMed...
  22. Nyirjesy P. Chronic vulvovaginal candidiasis. Am-FamPhysician 2001; 63(4): 697-702.
  23. Hurley R. Recurrent Candida infection. Clinics in Obstetrics & Gynaecology - Supplement 1981; 8(1): 209-214. Go to original source... Go to PubMed...
  24. Fidel PL Jr., Sobel JD. Immunopathogenesis of recurrent vulvovaginal candidiasis. [Review] [117 refs]. Clinical Microbiology Reviews 1996; 9(3): 335-348. Go to original source... Go to PubMed...
  25. El-Din SS, Reynolds MT, Ashbee HR, Barton RC, Evans EG. An investigation into the pathogenesis of vulvo-vaginal candidosis. Sexually transmitted infections 2001; 77(3): 179-183. Go to original source... Go to PubMed...
  26. Bauters T, Dhont M, Temmerman MI, Nelis H. Prevalence of vulvovaginal candidiasis and susceptibility to fluconazole in women. American journal of obstetrics and gynecology 2002; 187(3): 569-574. Go to original source... Go to PubMed...
  27. Neves NA CLLACACE. Successful treatment of refractory recurrent vaginal candidiasis with cetirizine plus fluconazole. Journal of Lower Genital Tract Disease 2005; 9(3): 167-170. Ref Type: Generic. Go to original source... Go to PubMed...
  28. Pirotta MV, Garland SM. Genital Candida species detected in samples from women in Melbourne, Australia, before and after treatment with antibiotics. Journal of clinical microbiology 2006; 44(9). Go to original source... Go to PubMed...
  29. Moraes PS. Recurrent vaginal candidiasis and allergic rhinitis: a common association. Annals of Allergy, Asthma, & Immunology 1998; 81(2): 165-169. Go to original source... Go to PubMed...
  30. Ledger WJ, Witkin SS. Vulvovaginal infections. London: Manson Publish., 2007: 128 p. Go to original source...
  31. Spacek J, Jilek P, Buchta V, Forstl M, Hronek M, Holeckova M. The serum levels of calcium, magnesium, iron and zinc in patients with recurrent vulvovaginal candidosis during attack, remission and in healthy controls. Mycoses 2005; 48(6): 391-395. Go to original source... Go to PubMed...
  32. Bohler K, Meisinger V, Klade H, Reinthaller A. Zinc levels of serum and cervicovaginal secretion in recurrent vulvovaginal candidiasis. Genitourin-Med 1994; 70(5): 308-310. Go to original source... Go to PubMed...
  33. Sobel J, Wiesenfeld H, Martens M, Danna P, Hooton T, Rompalo A, et al. Maintenance fluconazole therapy for recurrent vulvovaginal candidiasis. The New England journal of medicine 2004; 351(9): 876-883. Go to original source... Go to PubMed...
  34. Falagas ME, Betsi GI, Athanasiou S. Probiotics for prevention of recurrent vulvovaginal candidiasis: a review. The Journal of antimicrobial chemotherapy 2006; 58(2). Go to original source... Go to PubMed...
  35. Pirotta M, Gunn J, Chondros P, Grover S, O'Malley P, Hurley S, et al. Effect of lactobacillus in preventing post-antibiotic vulvovaginal candidiasis: a randomised controlled trial. BMJ (Clinical research ed) 2004; 329(7465).
  36. Kalliomaki M, Salminen S, Arvilommi H, Kero P, Koskinen P, Isolauri E. Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial. [see comments]. Lancet 2001; 357(9262): 1076-1079. Go to original source... Go to PubMed...
  37. Mardh PA, Rodrigues AG, Genc M, Novikova N, Martinez-de-Oliveira J, Guaschino S. Facts and myths on recurrent vulvovaginal candidosis - a review on epidemiology, clinical manifestations, diagnosis, pathogenesis and therapy. [Review] [189 refs]. International journal of STD & AIDS 2002; 13(8): 522-539. Go to original source... Go to PubMed...
  38. Ergin A, Arikan S. Comparison of microdilution and disc diffusion methods in assessing the in vitro activity of fluconazole and Melaleuca alternifolia tea tree oil against vaginal Candida isolates. Journal of chemotherapy (Florence Italy). 2002; 14(5): 465-472. Go to original source... Go to PubMed...
  39. Hammer KA, Carson CF, Riley TV. In-vitro activity of essential oils, in particular Melaleuca alternifolia (tea tree) oil and tea tree oil products, against Candida spp. J Antimicrob Chemother 1998; 42(5): 591-595. Go to original source... Go to PubMed...
  40. Hammer KA, Carson CF, Riley TV. Antifungal effects of Melaleuca alternifolia (tea tree) oil and its components on Candida albicans, Candida glabrata and Saccharomyces cerevisiae. J Antimicrob Chemother 2004; 53(6): 1081-1085. Go to original source... Go to PubMed...
  41. Crawford G, Sciacca J, James W. Tea tree oil: cutaneous effects of the extracted oil of Melaleuca alternifolia. Dermatitis: contact atopic occupational drug: official journal of the American Contact Dermatitis Society North American Contact Dermatitis Group 2004; 15(2): 59-66. Go to original source... Go to PubMed...
  42. Bohannon NJ. Treatment of vulvovaginal candidiasis in patients with diabetes. [Review] [62 refs]. Diabetes care 1998; 21(3): 451-456. Go to original source... Go to PubMed...
  43. Goswami D, Goswami R, Banerjee U, Dadhwal V, Miglani S, Lattif AA, et al. Pattern of Candida species isolated from patients with diabetes mellitus and vulvovaginal candidiasis and their response to single dose oral fluconazole therapy. The Journal of infection 2006; 52(2). Go to original source... Go to PubMed...
  44. Ray D, Goswami R, Banerjee U, Dadhwal V, Goswami D, Mandal P, et al. Prevalence of Candida glabrata and its response to boric acid vaginal suppositories in comparison with oral fluconazole in patients with diabetes and vulvovaginal candidiasis. Diabetes care 2007; 30(2).
  45. Duerr A, Heilig CM, Meikle SF, Cu US, Klein RS, Rompalo A, et al. Incident and persistent vulvovaginal candidiasis among human immunodeficiency virus-infected women: Risk factors and severity. Obstetrics and gynecology 2003; 101(3).
  46. Sobel J. Vulvovaginal candidiasis: a comparison of HIVpositive and -negative women. International journal of STD & AIDS 2002; 13(6): 358-362. Go to original source... Go to PubMed...
  47. Sobel J, Chaim W, Nagappan V, Leaman D. Treatment of vaginitis caused by Candida glabrata: use of topical boric acid and flucytosine. American journal of obstetrics and gynecology 2003; 189(5): 1297-1300. Go to original source... Go to PubMed...
  48. Koukalová D, Viktorínová M, Hamal P, Hájek V, Kudela M, Konečná l, Skřivánek A, Závodný P. Vakcinoterapie recidivujícich kvasinkovitých zánětů pochvy. Klin. Mikrobiol. Inf. lék, 1998; 4(10): 306-310.
  49. Koukalová D, Hamal P, Hájek V, Koďousek R. Vakcína k léčbě vleklých kvasinkovitých zánětů pochvy, Klin. Mikrobiol. Inf. Lék. 1998; 4(2): 59-62.
  50. Koukalová D, Bystroň J, Heřmanová Z, Viktorínová M, Hamal P, Hájek V. Imunologické vyąetření pacientek léčených vakcinou Kanvakol. Klin. mikrobiol. inf. lék, 2000; 6(5): 154-156.
  51. Koukalová D, Bystroň J, Heřmanová Z, Ordeltová M, Szotkowska J. Imunologický profil pacientek s recidivujícími mykotickými kolpitidami před a po vakcinoterapii, Alergie, 2001; 2: 117-119.
  52. Hopwood V, Crowley T, Horrocks CT, Milne JD, Taylor PK, Warnock DW. Vaginal candidosis: relation between yeast counts and symptoms and clinical signs in non-pregnant women. Genitourin-Med 1988; 64(5): 331-334. Go to original source... Go to PubMed...
  53. Odds FC, Webster CE, Riley VC, Fisk PG. Epidemiology of vaginal Candida infection: significance of numbers of vaginal yeasts and their biotypes. European Journal of Obstetrics, Gynecology & Reproductive Biology 1987; 25(1): 53-66. Go to original source... Go to PubMed...
  54. Odds FC, Webster CE, Mayuranathan P, Simmons PD. Candida concentrations in the vagina and their association with signs and symptoms of vaginal candidosis. Journal of Medical & Veterinary Mycology 1988; 26(5): 277-283. Go to original source... Go to PubMed...
  55. Priestley CJ, Jones BM, Dhar J, Goodwin L. What is normal vaginal flora? [see comments]. Genitourin-Med 1997; 73(1): 23-28. Go to original source... Go to PubMed...
  56. Cotch MF, Hillier SL, Gibbs RS, Eschenbach DA. Epidemiology and outcomes associated with moderate to heavy Candida colonization during pregnancy. Vaginal Infections and Prematurity Study Group. American Journal of Obstetrics & Gynecology 1998; 178(2): 374-380. Go to original source... Go to PubMed...
  57. Young GL, Jewell D. Topical treatment for vaginal candidiasis (thrush. in pregnancy) [update of Cochrane Database Syst Rev. 2000; 2: CD000225; 10796183]. [Review] [33 refs]. Cochrane Database of Systematic Reviews 2001; 4: CD000225.
  58. Spinillo A, Pizzoli G, Colonna L, Nicola S, De Seta F, Guaschino S. Epidemiologic characteristics of women with idiopathic recurrent vulvovaginal candidiasis. Obstetrics & Gynecology 1993; 81(5 Pt 1): 721-727.
  59. Dennerstein GJ. Depo-Provera in the treatment of recurrent vulvovaginal candidiasis. Journal of Reproductive Medicine 1986; 31(9): 801-803.
  60. Reef SE, Levine WC, McNeil MM, Fisher-Hoch S, Holmberg SD, Duerr A, et al. Treatment options for vulvovaginal candidiasis, 1993. [Review] [97 refs]. Clinical Infectious Diseases 1995; 20(Suppl. 1): S80-S90.
  61. Sobel JD. Recurrent vulvovaginal candidiasis. A prospective study of the efficacy of maintenance ketoconazole therapy. New England Journal of Medicine 1986; 315(23): 1455-1458. Go to original source... Go to PubMed...
  62. Sobel JD. Treatment of recurrent vulvovaginal candidiasis with maintenance fluconazole. International Journal of Gynaecology & Obstetrics 1992; 37: 17-34.
  63. White DJ, Vanthuyne A, Wood PM, Ayres JG. Zafirlukast for severe recurrent vulvovaginal candidiasis: an open label pilot study. Sexually transmitted infections 2004; 80(3).
  64. Sobel JD, Kapernick PS, Zervos M, Reed BD, Hooton T, Soper D, et al. Treatment of complicated Candida vaginitis: comparison of single and sequential doses of fluconazole. American Journal of Obstetrics & Gynecology 2001; 185(2): 363-369. Go to original source... Go to PubMed...
  65. Sobel JD, Brooker D, Stein GE, Thomason JL, Wermeling DP, Bradley B, et al. Single oral dose fluconazole compared with conventional Klotrimazole topical therapy of Candida vaginitis. Fluconazole Vaginitis Study Group. American Journal of Obstetrics & Gynecology 1995; 172(4 Pt 1): 1263-1268. Go to original source... Go to PubMed...
  66. Phillips A. Treatment of non-albicans Candida vaginitis with amphotericin B vaginal suppositories. American journal of obstetrics and gynecology 2005; 192(6): 2009-2012. Go to original source... Go to PubMed...
  67. Sobel JD, Chaim W. Treatment of Torulopsis glabrata vaginitis: retrospective review of boric acid therapy. Clinical Infectious Diseases 1997; 24(4): 649-652. Go to original source... Go to PubMed...
  68. Guaschino S, De Seta F, Sartore A, Ricci G, De Santo D, Piccoli M, et al. Efficacy of maintenance therapy with topical boric acid in comparison with oral itraconazole in the treatment of recurrent vulvovaginal candidiasis. American Journal of Obstetrics & Gynecology 2001; 184(4): 598-602. Go to original source... Go to PubMed...
  69. Acs NB. Teratogenic effects of vaginal boric acid treatment during pregnancy. International Journal of Gynaecology and Obstetrics: 2006; 93(1): 55-56. Go to original source... Go to PubMed...
  70. White DJ, Habib AR, Vanthuyne A, Langford S, Symonds M. Combined topical flucytosine and amphotericin B for refractory vaginal Candida glabrata infections. Sexually transmitted infections 2001; 77(3): 212-213. Go to original source... Go to PubMed...
  71. European guidelines on cardiovascular disease prevention in clinical practice: executive summary European Heart Journal 2007; 28: 2375-2414, doi: 10.1093/eurheartj/ehm316.
  72. Viktorínová M, Koukalová D. Mikrobiální koľní testy u pacientek s chronickou vaginální kandidózou, Čes.-slov. Dermatol., 2000; 75(4): 147-151.
  73. Koukalová D, Viktorínová M. Perorální vakcinoterapie v dermatologii. Epidemiol, Mikrobiol. Imunol., 1995; 44(1): 36-43. Go to original source... Go to PubMed...
  74. Koukalová D, Koďousek R, Hájek V, Kolář M. Experimental nonspecific immunostimulation by the Propionibacterium acnes vaccine, Acta Univ. Palacki Olomuc., Fac. Med., 1992; 133: 19-23. Go to PubMed...




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