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Open Access
Feature Article

Coping with chronic vulvovaginal candidiasis

Gayle Fischer
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Acute vulvovaginal candidiasis (VVC) is common and usually easily treated but some women develop chronic symptoms that do not respond to conventional anti-Candida treatment. Recently proposed diagnostic criteria may help clinicians identify women with chronic VVC. Evidence is mounting that it represents a hypersensitivity response to commensal Candida spp. It usually responds to long-term antifungal treatment.

Key Points

  • Vulvovaginal candidiasis (VVC) covers a disease spectrum, from a single episode to chronic disease with unremitting symptoms.
  • The concept of chronic VVC was recently described; it is a common cause of chronic nonerosive vulvovaginitis in women presenting at vulval disease clinics.
  • Evidence suggests chronic VVC is a hypersensitivity response to commensal Candida spp.
  • In healthy non-diabetic patients, chronic VVC, like acute VVC, occurs only in the presence of oestrogen.
  • Chronic VVC may be diagnosed based on clinical features and a history that satisfies specific criteria; diagnosis is supported by, but does not require, a positive swab result for Candida spp. at presentation.
  • Patients with chronic VVC respond well to oral antifungal therapy, which may be needed long term.