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Recurrent vulvovaginal candidiasis

      Recurrent vulvovaginal candidiasis (RVVC) is a common cause of significant morbidity in women in all strata of society affecting millions of women worldwide. Previously, RVVC occurrence was limited by onset of menopause but the widespread use of hormone replacement therapy has extended the at-risk period. Candida albicans remains the dominant species responsible for RVVC, however optimal management of RVVC requires species determination and effective treatment measures are best if species-specific. Considerable progress has been made in understanding risk factors that determine susceptibility to RVVC, particularly genetic factors, as well as new insights into normal vaginal defense immune mechanisms and their aberrations in RVVC. While effective control of RVVC is achievable with the use of fluconazole maintenance suppressive therapy, cure of RVVC remains elusive especially in this era of fluconazole drug resistance. Vaccine development remains a critical challenge and need.

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        American Journal of Obstetrics & GynecologyVol. 216Issue 4
        • Preview
          In a recent review of recurrent vulvovaginal candidiasis, treatment options were described for women in whom no preventable triggering stimuli were forthcoming.1 A suppressive maintenance prophylactic regimen with fluconazole was recommended and indeed this regimen is widely used and appreciated worldwide. In the review, attention was directed at 1 such regimen consisting of the use of once weekly fluconazole (150 mg) for a period of 6 months.2 Other alternative regimens were also immediately referenced including a more personalized but similar regimen of Dr Donders et al,3 the text emphasizing that these maintenance regimens have documented therapeutic efficacy and safety.
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      • Comment on treatment for recurrent vulvovaginal candidiasis
        American Journal of Obstetrics & GynecologyVol. 216Issue 4
        • Preview
          With great interest we read the article “Recurrent vulvovaginal candidiasis” of Jack D. Sobel.1 The author presents oral and topical treatment strategies for recurrent vulvovaginal candidiasis. Therapy with oral fluconazole starts with an initial “induction therapy” and is followed by a maintenance phase, wherein the drug is given at certain intervals.2,3
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