Recurrent vulvovaginal candidiasis rarely cured, but managed with long term fluconazole
August 03 2020
A continuing need for suppressive fluconazole was seen in the majority of women with recurrent vulvovaginal candidiasis (rVVC).
Dr Laura Collins and colleagues from Wayne State University in Detroit followed up 147 women, typically in their mid 30’s, who took weekly suppressive fluconazole for 6 months. They found that 73% continued fluconazole beyond 6 months. The reasons given by women included culture-confirmed rVVC (55%) or suspected but not confirmed rVVC (17%) and patient preference (10%). These women continued to take fluconazole for a median of 3 years and often a lot longer. The relief that these women get from fluconazole is substantial.
In a third of these patients, a questionnaire was returned and this found that 94% had found benefit from maintenance fluconazole and equally 81% had suffered a relapse on stopping it.
An estimate of the prevalence of rVVC was published in 2018 and excluding post-menopausal women on hormone replacement therapy, 138 million are estimated to be affected at any one time and ~370 million over their lifetime. Collins’ report probably is focused on that proportion who do not spontaneously resolve over 1-2 years (the majority).
In 191 women, Collins found fluconazole resistance in 6.8% of Candida albicans strains cultured during or after fluconazole maintenance therapy. Resistance was not linked with any particular patient characteristic or time – occurring as early as 2 months of therapy or as late as 17 years.
- Read the paper: Collins et al (2020) Prognosis and Long-Term Outcome of Women With Idiopathic Recurrent Vulvovaginal Candidiasis Caused by Candida albicans