Feature Article

Coping with chronic vulvovaginal candidiasis

Gayle Fischer


An updated version is available in the linked supplement


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.