VULVOVAGINAL CANDIDIASIS: UPDATES ON DIAGNOSTIC AND TREATMENT APPROACHES

Abstract

Vulvovaginal candidiasis (VVC) is one of the most frequent gynecological infections, affecting approximately 70% of women at some point in their lives and representing the second leading cause of vaginitis. It is mainly caused by Candida albicans; however, non-albicans species, which are more resistant to azoles, have increased in prevalence in recent decades, making clinical management more challenging. Clinically, VVC manifests with intense pruritus, burning sensation, dyspareunia, and thick white vaginal discharge. Despite its typical presentation, these symptoms have low predictive value and may be confused with other forms of vulvovaginitis, highlighting the need for laboratory confirmation. Diagnosis should include direct microscopy and mycological culture (gold standard), especially in recurrent or refractory cases. Molecular methods, such as PCR, have stood out for their high sensitivity and specificity, particularly in detecting non-albicans species, although they still face limitations related to cost and availability. VVC can be classified as uncomplicated (mild, sporadic episodes, usually caused by C. albicans and with good therapeutic response) or complicated, which includes resistant species, severe symptoms, pregnancy, comorbidities, immunosuppression, and recurrent vulvovaginal candidiasis (RVVC), defined as ≥4 episodes within one year. Treatment of uncomplicated VVC may be carried out with topical antifungals or oral fluconazole, both showing similar cure rates. In recurrent cases, prolonged fluconazole therapy is recommended (induction followed by maintenance for six months). The emergence of azole resistance has stimulated the development of new antifungal agents, such as ibrexafungerp. Partner treatment is only indicated when symptoms are present. VVC negatively impacts quality of life, affecting self-esteem, sexuality, and mental health, reinforcing the importance of accurate diagnosis, professional guidance, and individualized management. The article concludes that laboratory and therapeutic updates are essential to reduce recurrences and improve treatment effectiveness.

DOI: https://doi.org/10.56238/edimpacto2025.087-026