{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:16:30Z","timestamp":1787015790380,"version":"build-2736575974"},"reference-count":161,"publisher":"Wiley","issue":"S1","license":[{"start":{"date-parts":[[2015,2,24]],"date-time":"2015-02-24T00:00:00Z","timestamp":1424736000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Mycoses"],"published-print":{"date-parts":[[2015,3]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>\n                    The oestrogenised vagina is colonised by\n                    <jats:italic>Candida<\/jats:italic>\n                    species in at least 20% of women; in late pregnancy and in immunosuppressed patients, this increases to at least 30%. In most cases,\n                    <jats:italic>Candida albicans<\/jats:italic>\n                    is involved. Host factors, particularly local defence mechanisms, gene polymorphisms, allergies, serum glucose levels, antibiotics, psycho\u2010social stress and oestrogens influence the risk of candidal vulvovaginitis. Non\u2010\n                    <jats:italic>albicans<\/jats:italic>\n                    species, particularly\n                    <jats:italic>Candida glabrata<\/jats:italic>\n                    , and in rare cases also\n                    <jats:italic>Saccharomyces cerevisiae<\/jats:italic>\n                    , cause less than 10% of all cases of vulvovaginitis with some regional variation; these are generally associated with milder signs and symptoms than normally seen with a\n                    <jats:italic>C. albicans<\/jats:italic>\n                    \u2010associated vaginitis. Typical symptoms include premenstrual itching, burning, redness and odourless discharge. Although itching and redness of the introitus and vagina are typical symptoms, only 35\u201340% of women reporting genital itching in fact suffer from vulvovaginal candidosis. Medical history, clinical examination and microscopic examination of vaginal content using 400\u00d7 optical magnification, or preferably phase contrast microscopy, are essential for diagnosis. In clinically and microscopically unclear cases and in chronically recurring cases, a fungal culture for pathogen determination should be performed. In the event of non\u2010\n                    <jats:italic>C. albicans<\/jats:italic>\n                    species, the minimum inhibitory concentration (\n                    <jats:styled-content style=\"fixed-case\">MIC<\/jats:styled-content>\n                    ) should also be determined. Chronic mucocutaneous candidosis, a rarer disorder which can occur in both sexes, has other causes and requires different diagnostic and treatment measures. Treatment with all antimycotic agents on the market (polyenes such as nystatin; imidazoles such as clotrimazole; and many others including ciclopirox olamine) is easy to administer in acute cases and is successful in more than 80% of cases. All vaginal preparations of polyenes, imidazoles and ciclopirox olamine and oral triazoles (fluconazole, itraconazole) are equally effective (Table\u00a0\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"#myc12292-tbl-0004\"\/>\n                    ); however, oral triazoles should not be administered during pregnancy according to the manufacturers.\n                    <jats:italic>C. glabrata<\/jats:italic>\n                    is not sufficiently sensitive to the usual dosages of antimycotic agents approved for gynaecological use. In other countries, vaginal suppositories of boric acid (600\u00a0mg, 1\u20132 times daily for 14\u00a0days) or flucytosine are recommended. Boric acid treatment is not allowed in Germany and flucytosine is not available. Eight hundred\u2010milligram oral fluconazole per day for 2\u20133\u00a0weeks is therefore recommended in Germany. Due to the clinical persistence of\n                    <jats:italic>C. glabrata<\/jats:italic>\n                    despite treatment with high\u2010dose fluconazole, oral posaconazole and, more recently, echinocandins such as micafungin are under discussion; echinocandins are very expensive, are not approved for this indication and are not supported by clinical evidence of their efficacy. In cases of vulvovaginal candidosis, resistance to\n                    <jats:italic>C. albicans<\/jats:italic>\n                    does not play a significant role in the use of polyenes or azoles.\n                    <jats:italic>Candida krusei<\/jats:italic>\n                    is resistant to the triazoles, fluconazole and itraconazole. For this reason, local imidazole, ciclopirox olamine or nystatin should be used. There are no studies to support this recommendation, however. Side effects, toxicity, embryotoxicity and allergies are not clinically significant. Vaginal treatment with clotrimazole in the first trimester of a pregnancy reduces the rate of premature births. Although it is not necessary to treat a vaginal colonisation of\n                    <jats:italic>Candida<\/jats:italic>\n                    in healthy women, vaginal administration of antimycotics is often recommended in the third trimester of pregnancy in Germany to reduce the rate of oral thrush and napkin dermatitis in healthy full\u2010term newborns. Chronic recurrent vulvovaginal candidosis continues to be treated in intervals using suppressive therapy as long as immunological treatments are not available. The relapse rate associated with weekly or monthly oral fluconazole treatment over 6\u00a0months is approximately 50% after the conclusion of suppressive therapy according to current studies. Good results have been achieved with a fluconazole regimen using an initial 200\u00a0mg fluconazole per day on 3 days in the first week and a dosage\u2010reduced maintenance therapy with 200\u00a0mg once a month for 1 year when the patient is free of symptoms and fungal infection (Table\u00a0\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"#myc12292-tbl-0005\"\/>\n                    ). Future studies should include\n                    <jats:italic>Candida<\/jats:italic>\n                    autovaccination, antibodies to\n                    <jats:italic>Candida<\/jats:italic>\n                    virulence factors and other immunological experiments. Probiotics with appropriate lactobacillus strains should also be examined in future studies on the basis of encouraging initial results. Because of the high rate of false indications,\n                    <jats:styled-content style=\"fixed-case\">OTC<\/jats:styled-content>\n                    treatment (self\u2010treatment by the patient) should be discouraged.\n                  <\/jats:p>","DOI":"10.1111\/myc.12292","type":"journal-article","created":{"date-parts":[[2015,2,24]],"date-time":"2015-02-24T10:16:30Z","timestamp":1424772990000},"page":"1-15","source":"Crossref","is-referenced-by-count":95,"title":["Guideline: Vulvovaginal Candidosis (AWMF 015\/072), S2k (excluding chronic mucocutaneous candidosis)"],"prefix":"10.1111","volume":"58","author":[{"given":"Werner","family":"Mendling","sequence":"first","affiliation":[{"name":"Deutsches Zentrum f\u00fcr Infektionen in Gyn\u00e4kologie und Geburtshilfe Vogelsangstrasse 106 42109 Wuppertal 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