{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T19:39:23Z","timestamp":1790192363406,"version":"4.1.0"},"reference-count":129,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Microbiol."],"abstract":"<jats:p>\n                    Vulvovaginal candidiasis (VVC), predominantly caused by\n                    <jats:italic>Candida albicans<\/jats:italic>\n                    , is one of the most common vaginal infections in women of reproductive age. Its clinical management has become increasingly complex due to the rising prevalence of non-\n                    <jats:italic>albicans Candida<\/jats:italic>\n                    infections, escalating azole resistance, and the challenge of biofilm formation. This review systematically summarizes recent advances in VVC research, with a focus on evolving epidemiology, innovations in diagnostics, current and emerging therapies, and an in-depth analysis of resistance mechanisms. Key molecular pathways underpinning antifungal resistance\u2014including biofilm development, efflux pump overexpression, target-site gene mutations, and alterations in transcriptional regulators\u2014are examined. The findings of this review support several actionable strategies for future practice. First, routine use of molecular diagnostics (PCR, MALDI-TOF MS) is essential for species identification and resistance detection, enabling a shift from empirical to precision-based therapy. Second, antifungal susceptibility testing should be interpreted with attention to vaginal pH conditions, and non-azole alternatives (boric acid, nystatin, ibrexafungerp, oteseconazole) should be prioritized when azole resistance is confirmed or suspected. Third, emerging approaches\u2014including biofilm-disrupting agents, probiotic microbiome modulation, and nanotechnology-enhanced drug delivery\u2014offer promising adjunctive and preventive strategies, particularly for recurrent VVC. By integrating these contemporary findings, this review provides a translational framework to optimize diagnosis, guide therapeutic decision-making, and inform future research priorities in VVC management. Notably, several novel agents\u2014including ibrexafungerp and oteseconazole\u2014have already received FDA approval and are entering clinical practice, with multiple ongoing trials evaluating boric acid, probiotics, and novel oral antifungals, underscoring the accelerating translation of mechanism-informed therapies into patient care.\n                  <\/jats:p>","DOI":"10.3389\/fmicb.2026.1811011","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T04:28:12Z","timestamp":1778819292000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Advances in vulvovaginal candidiasis research: a comprehensive review from epidemiology, diagnosis, treatment to resistance mechanisms"],"prefix":"10.3389","volume":"17","author":[{"given":"Weipei","family":"Zhu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liangsheng","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1555","DOI":"10.3390\/pharmaceutics16121555","article-title":"Fluconazole-Resistant vulvovaginal candidosis: An update on current management.","volume":"16","author":"Akinosoglou","year":"","journal-title":"Pharmaceutics"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2313","DOI":"10.3390\/diagnostics14202313","article-title":"Rapid molecular diagnostics in vulvovaginal candidosis.","volume":"14","author":"Akinosoglou","year":"","journal-title":"Diagnostics"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e0238428","DOI":"10.1371\/journal.pone.0238428","article-title":"Anti-biofilm activity of chlorhexidine digluconate against Candida albicans vaginal isolates.","volume":"15","author":"Alvendal","year":"2020","journal-title":"PLoS One"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e499","DOI":"10.1111\/j.1439-0507.2010.01965.x","article-title":"Epidemiological survey of vulvovaginal candidosis in Sfax. 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