{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T16:14:12Z","timestamp":1788970452127,"version":"build-2803163510"},"reference-count":65,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"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) is usually attributed to\n                    <jats:italic>Candida albicans<\/jats:italic>\n                    (\n                    <jats:italic>C. albicans<\/jats:italic>\n                    ), but non-\n                    <jats:italic>albicans Candida<\/jats:italic>\n                    species and rare yeasts are increasingly encountered in recurrent, complicated, or treatment-refractory disease. Their clinical significance is not uniform: some isolates represent causative infection, whereas others reflect colonization, mixed vaginitis, or detection without causality. This Mini Review addresses three linked clinical and biological questions. First, pathogen attribution should move from detection to causative diagnosis. Recurrent or refractory symptoms warrant structured reassessment during an active episode, integrating clinical examination, vaginal pH and microscopy, fungal culture with species-level identification, exclusion of competing diagnoses, and susceptibility testing when indicated. Second, persistence differs from the\n                    <jats:italic>C. albicans<\/jats:italic>\n                    paradigm and may involve niche adaptation, epithelial association, biofilm-associated tolerance, stress survival, and species-dependent relationships between susceptibility phenotypes and persistence-associated traits. Third, management should be species-informed and susceptibility-aware:\n                    <jats:italic>Nakaseomyces glabratus<\/jats:italic>\n                    (formerly\n                    <jats:italic>Candida glabrata<\/jats:italic>\n                    ) and\n                    <jats:italic>Candida krusei\/Pichia kudriavzevii<\/jats:italic>\n                    require different salvage-treatment logic, whereas evidence for uncommon\n                    <jats:italic>Candida<\/jats:italic>\n                    species and rare yeasts remains limited and case-based. New antifungals have promising activity, but current trials do not establish species-specific efficacy in non-\n                    <jats:italic>albicans<\/jats:italic>\n                    VVC. Probiotics and microbiome-directed interventions should remain investigational adjuncts evaluated in strain-defined, species-stratified trials rather than substitutes for antifungal therapy. We further identify limitations in the evidence base and priorities for vaginally relevant epithelial, immune-cell, and polymicrobial models. Integrating causative attribution with resistance, tolerance, and persistence biology may reduce both undertreatment of clinically attributable infection and overtreatment of colonization or noninfectious vulvovaginal disease.\n                  <\/jats:p>","DOI":"10.3389\/fmicb.2026.1944046","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T15:36:31Z","timestamp":1788968191000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Non-albicans Candida and rare yeasts in vulvovaginal candidiasis: pathogen attribution, antifungal resistance, persistence, and species-informed management"],"prefix":"10.3389","volume":"17","author":[{"given":"Ziyi","family":"Yan","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yali","family":"Cui","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Department of Laboratory Medicine, West China Second University Hospital (Tianfu), Sichuan University (Sichuan Provincial Children\u2019s Hospital)","place":["Meishan, China"]},{"name":"Department of Laboratory Medicine, Meishan Women and Children\u2019s Hospital, Alliance Hospital of West China Second University Hospital, Sichuan University","place":["Meishan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingying","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Department of Laboratory Medicine, Women and Children\u2019s Hospital of Tibet Autonomous Region","place":["Lhasa, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xue","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Chengdu Hi-Tech Zone Hospital for Women and Children (Chengdu Hi-Tech Zone Hospital for Maternal and Child Healthcare)","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng","family":"Liao","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Chengdu Hi-Tech Zone Hospital for Women and Children (Chengdu Hi-Tech Zone Hospital for Maternal and Child Healthcare)","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingxin","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linghan","family":"Kuang","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Department of Laboratory Medicine, Chengdu Hi-Tech Zone Hospital for Women and Children (Chengdu Hi-Tech Zone Hospital for Maternal and Child Healthcare)","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongmei","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1016\/j.tjog.2024.03.004","article-title":"The role of probiotics as adjunct treatment in the prevention and management of gynecological infections: An updated meta-analysis of 35 RCT studies.","volume":"63","author":"Abavisani","year":"2024","journal-title":"Taiwan J. 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