{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T13:31:43Z","timestamp":1793626303128,"version":"4.5.1"},"reference-count":167,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T00:00:00Z","timestamp":1762992000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>Symptomatic vulvovaginal candidiasis (VVC) affects around three-quarters of women at least once in their lifetime. Around 10% of these women will experience prolonged or recurrent vulvovaginal candidiasis (RVVC), which fails to respond, despite following recommended therapy. Most commonly prescribed therapy involves suppression therapy\u2014usually for two weeks\u2014which aims at eliminating symptoms by frequent administration of antifungals, followed by maintenance (weekly\/monthly) therapy for up to six months. However, following cessation of maintenance therapy, around 50% of these women experience relapse. The vaginal ecology of RVVC can be characterized, and it is thought that biofilms and\/or the development of antifungal resistance prevent adequate resolution. However, hypersensitivity may also confound management. This narrative review was performed to identify key studies that examine the management of VVC and the challenges of current prolonged antifungal therapy. It identifies gaps that show it remains important to investigate microbiological findings in RVVC and how these may inform rational choices in therapy in an era of rising antimicrobial resistance. Hope exists, as studies of the vaginal microbiome highlight that the type of microbiota may influence the level of inflammation and reduce symptomatology. Future research will continue to explore whether a personalized medicine approach can promote healthy vaginal ecology and prevent the debilitating long-term effects of RVVC.<\/jats:p>","DOI":"10.3390\/jof11110806","type":"journal-article","created":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T16:46:22Z","timestamp":1763138782000},"page":"806","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Perspectives on Vaginal Ecology and Management of Recurrent Vulvovaginal Candidiasis: A Narrative Review"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6206-9634","authenticated-orcid":false,"given":"Danilla","family":"Grando","sequence":"first","affiliation":[{"name":"School of Science, RMIT University, Melbourne, VIC 3000, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2816-6956","authenticated-orcid":false,"given":"Cathy J.","family":"Watson","sequence":"additional","affiliation":[{"name":"Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC 3053, Australia"},{"name":"Women\u2019s Health Clinics, The Royal Women\u2019s Hospital, Parkville, VIC 3052, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1961","DOI":"10.1016\/S0140-6736(07)60917-9","article-title":"Vulvovaginal Candidosis","volume":"369","author":"Sobel","year":"2007","journal-title":"Lancet"},{"key":"ref_2","unstructured":"MSHC (2025, June 04). Candidiasis (Vulvovaginal) Treatment Guidelines. Melbourne Sexual Health Centre Guidelines. Available online: https:\/\/www.mshc.org.au\/health-professionals\/treatment-guidelines\/candidiasis-vulvovaginal-treatment-guidelines."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1056\/NEJMoa033114","article-title":"Maintenance Fluconazole Therapy for Recurrent Vulvovaginal Candidiasis","volume":"351","author":"Sobel","year":"2004","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1080\/01674820601168176","article-title":"Perceived Stress in Women with Recurrent Vulvovaginal Candidiasis","volume":"28","author":"Kornfeld","year":"2007","journal-title":"J. Psychosom. Obstet. Gynaecol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1186\/1477-7525-11-169","article-title":"Subjective Health Status and Health-related Quality of Life Among Women with Recurrent Vulvovaginal Candidosis (RVVC) in Europe and the USA","volume":"11","author":"Guelfucci","year":"2013","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.ctim.2012.01.004","article-title":"Use of Complementary and Alternative Medicine in Recurrent Vulvovaginal Candidiasis-Results of a Practitioner Survey","volume":"20","author":"Watson","year":"2012","journal-title":"Complement. Ther. Med."},{"key":"ref_7","first-page":"36","article-title":"Vaginal and Oral Use of Probiotics as Adjunctive Therapy to Fluconazole in Patients with Vulvovaginal Candidiasis: A Clinical Trial on Iranian Women","volume":"7","author":"Vahedpoor","year":"2021","journal-title":"Curr. Med. Mycol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"S162","DOI":"10.1093\/cid\/ciab1057","article-title":"Vulvovaginal Candidiasis: A Review of the Evidence for the 2021 Centers for Disease Control and Prevention of Sexually Transmitted Infections Treatment Guidelines","volume":"74","author":"Nyirjesy","year":"2022","journal-title":"Clin. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e339","DOI":"10.1016\/S1473-3099(18)30103-8","article-title":"Global Burden of Recurrent Vulvovaginal Candidiasis: A Systematic Review","volume":"18","author":"Denning","year":"2018","journal-title":"Lancet Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1097\/LGT.0b013e318273e8cf","article-title":"Prevalence of Recurrent Vulvovaginal Candidiasis in 5 European Countries and the United States: Results from an Internet Panel Survey","volume":"17","author":"Foxman","year":"2013","journal-title":"J. Low. Genit. Tract. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Willems, H.M.E., Ahmed, S.S., Liu, J., Xu, Z., and Peters, B.M. (2020). Vulvovaginal Candidiasis: A Current Understanding and Burning Questions. J. Fungi, 6.","DOI":"10.3390\/jof6010027"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1566","DOI":"10.1093\/infdis\/170.6.1566","article-title":"Karyotyping of Candida albicans Isolates Obtained Longitudinally in Women with Recurrent Vulvovaginal Candidiasis","volume":"170","author":"Vazquez","year":"1994","journal-title":"J. Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Rodr\u00edguez-Cerdeira, C., Mart\u00ednez-Herrera, E., Carnero-Gregorio, M., L\u00f3pez-Barcenas, A., Fabbrocini, G., Fida, M., El-Samahy, M., and Gonz\u00e1lez-Cesp\u00f3n, J.L. (2020). Pathogenesis and Clinical Relevance of Candida Biofilms in Vulvovaginal Candidiasis. Front. Microbiol., 11.","DOI":"10.3389\/fmicb.2020.544480"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1097\/AOG.0b013e31827307b2","article-title":"Fluconazole-resistant Candida albicans Vulvovaginitis","volume":"120","author":"Marchaim","year":"2012","journal-title":"Obstet. Gynecol."},{"key":"ref_15","first-page":"44","article-title":"Chronic Vulvovaginal Candida Hypersensitivity: An Underrecognized and Undertreated Disorder by Allergists","volume":"6","author":"Bernstein","year":"2015","journal-title":"Allergy Rhinol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2939","DOI":"10.1128\/IAI.72.5.2939-2946.2004","article-title":"An Intravaginal Live Candida Challenge in Humans Leads to New Hypotheses for the Immunopathogenesis of Vulvovaginal Candidiasis","volume":"72","author":"Fidel","year":"2004","journal-title":"Infect. Immun."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/S0002-9378(98)80001-X","article-title":"Vulvovaginal Candidiasis: Epidemiologic, Diagnostic, and Therapeutic Considerations","volume":"178","author":"Sobel","year":"1998","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1007\/s11908-005-0048-3","article-title":"Advances in Diagnosing Vaginitis: Development of a New Algorithm","volume":"7","author":"Nyirjesy","year":"2005","journal-title":"Curr. Infect. Dis. Rep."},{"key":"ref_19","first-page":"0815","article-title":"Candidiasis (vulvovaginal)","volume":"16","year":"2015","journal-title":"BMJ Clin. Evid."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"4301","DOI":"10.2147\/IDR.S474304","article-title":"The Increasing Trend of Triazole-Resistant Candida from Vulvovaginal Candidiasis","volume":"17","author":"Li","year":"2024","journal-title":"Infect. Drug Resist."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"29","DOI":"10.3109\/13693780802713224","article-title":"Performance of Chromogenic Candida agar and CHROMagar Candida in Recovery and Presumptive Identification of Monofungal and Polyfungal Vaginal Isolates","volume":"48","author":"Ozcan","year":"2010","journal-title":"Med. Mycol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1136\/sextrans-2024-056186","article-title":"Increasing Rate of non-Candida albicans Yeasts and Fluconazole Resistance in Yeast Isolates from Women with Recurrent Vulvovaginal Candidiasis in Leeds, United Kingdom","volume":"101","author":"Ratner","year":"2025","journal-title":"Sex. Transm. Infect."},{"key":"ref_23","first-page":"595","article-title":"Women\u2019s Use of Over-the-counter Antifungal Medications for Gynecologic Symptoms","volume":"42","author":"Ferris","year":"1996","journal-title":"J. Fam. Pract."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1126\/science.aap7999","article-title":"Worldwide Emergence of Resistance to Antifungal Drugs Challenges Human Health and Food Security","volume":"360","author":"Fisher","year":"2018","journal-title":"Science"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1038\/s41579-019-0322-2","article-title":"Drug Resistance and Tolerance in Fungi","volume":"18","author":"Berman","year":"2020","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1080\/mmy.40.4.383.386","article-title":"High Rate of Vaginal Infections Caused by non-C. albicans Candida species Among Asymptomatic Women","volume":"40","author":"Dan","year":"2002","journal-title":"Med. Mycol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Navarathna, D.H., Lukey, J., Coppin, J.D., and Jinadatha, C. (2023). Diagnostic Performance of DNA Probe-based and PCR-based Molecular Vaginitis Testing. Microbiol. Spectr., 11.","DOI":"10.1128\/spectrum.01628-23"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Lillis, R.A., Parker, R.L., Ackerman, R., Ackerman, J., Young, S., Weissfeld, A., Trevino, E., Nachamkin, I., Crane, L., and Brown, J. (2023). Clinical Evaluation of a New Molecular Test for the Detection of Organisms Causing Vaginitis and Vaginosis. J. Clin. Microbiol., 61.","DOI":"10.1128\/jcm.01748-22"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1097\/OLQ.0000000000002197","article-title":"Prevalence and Accuracy of Empiric Treatment Among Patients With Vaginitis Symptoms in the United States","volume":"52","author":"Tse","year":"2025","journal-title":"Sex. Transm. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Amerson-Brown, M.H. (2025). From Microscopy to Molecular Diagnostics: Identifying the Complexities of Clinical Diagnostics for Vaginal Infections. Microbiol. Spectr., 13.","DOI":"10.1128\/spectrum.00251-25"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Morovati, H., Kord, M., Ahmadikia, K., Eslami, S., Hemmatzadeh, M., Kurdestani, K.M., Khademi, M., and Darabian, S. (2023). A Comprehensive Review of Identification Methods for Pathogenic Yeasts: Challenges and Approaches. Adv. Biomed. Res., 12.","DOI":"10.4103\/abr.abr_375_22"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1111\/myc.13119","article-title":"Comparison of Four Commercially Available Chromogenic Media to Identify Candida albicans and Other Medically Relevant Candida species","volume":"63","author":"Scharmann","year":"2020","journal-title":"Mycoses"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1590\/S0036-46652015000400002","article-title":"Comparison Between Four Usual Methods of Identification of Candida species","volume":"57","author":"Souza","year":"2015","journal-title":"Rev. Inst. Med. Trop. Sao Paulo"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1111\/1471-0528.12518","article-title":"The Effects of Oral Garlic on Vaginal Candida Colony Counts: A Randomised Placebo Controlled Double-blind Trial","volume":"121","author":"Watson","year":"2014","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Bitew, A., and Abebaw, Y. (2018). Vulvovaginal Candidiasis: Species Distribution of Candida and their Antifungal Susceptibility Pattern. BMC Womens Health, 18.","DOI":"10.1186\/s12905-018-0607-z"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1927","DOI":"10.1128\/JCM.02070-08","article-title":"Reliability of the Vitek 2 Yeast Susceptibility Test for Detection of in vitro Resistance to Fluconazole and Voriconazole in Clinical Isolates of Candida albicans and Candida glabrata","volume":"47","author":"Posteraro","year":"2009","journal-title":"J. Clin. Microbiol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Robert, M.G., Cornet, M., Hennebique, A., Rasamoelina, T., Caspar, Y., Pond\u00e9rand, L., Bidart, M., Durand, H., Jacquet, M., and Garnaud, C. (2021). MALDI-TOF MS in a Medical Mycology Laboratory: On Stage and Backstage. Microorganisms, 9.","DOI":"10.3390\/microorganisms9061283"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Teke, L., Bar\u0131\u015f, A., and Bayraktar, B. (2021). Comparative Evaluation of the Bruker Biotyper and Vitek MS Matrix-assisted Laser Desorption Ionization-time of Flight Mass Spectrometry (MALDI-TOF MS) systems for Non-albicans Candida and Uncommon Yeast Isolates. J. Microbiol. Methods, 185.","DOI":"10.1016\/j.mimet.2021.106232"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"104802","DOI":"10.1016\/j.micpath.2021.104802","article-title":"Vulvovaginal Candidiasis in Iran: A Systematic Review and Meta-analysis on the Epidemiology, Clinical Manifestations, Demographic Characteristics, Risk Factors, Etiologic Agents and Laboratory Diagnosis","volume":"154","author":"Sasani","year":"2021","journal-title":"Microb. Pathog."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"905","DOI":"10.3109\/1040841X.2015.1091805","article-title":"Vulvovaginal Candidiasis: Epidemiology, Microbiology and Risk Factors","volume":"42","author":"Ferreira","year":"2016","journal-title":"Crit. Rev. Microbiol."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Aboagye, G., Waikhom, S., Asiamah, E.A., Tettey, C.O., Mbroh, H., Smith, C., Osei, G.Y., Asafo Adjei, K., and Asmah, R.H. (2025). Antifungal Susceptibility Profiles of Candida and non-albicans Species Isolated from Pregnant Women: Implications for Emerging Antimicrobial Resistance in Maternal Health. Microbiol. Spectr., 2.","DOI":"10.1128\/spectrum.00787-25"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e70026","DOI":"10.1111\/myc.70026","article-title":"Epidemiology of Vulvovaginal Candidiasis in Greece: A 2-Year Single-Centre Study","volume":"68","author":"Kroustali","year":"2025","journal-title":"Mycoses"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e470","DOI":"10.1016\/S2666-5247(23)00067-8","article-title":"Worldwide Emergence of Fluconazole-resistant Candida parapsilosis: Current Framework and Future Research Roadmap","volume":"4","author":"Daneshnia","year":"2023","journal-title":"Lancet Microbe"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e146","DOI":"10.1017\/S0950268823001346","article-title":"Fluconazole and Echinocandin Resistance of Candida species in Invasive Candidiasis at a University Hospital During pre-COVID-19 and the COVID-19 Outbreak","volume":"151","author":"Szekely","year":"2023","journal-title":"Epidemiol. Infect."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"myac029","DOI":"10.1093\/mmy\/myac029","article-title":"Vulvovaginal Candidiasis and Asymptomatic Vaginal Colonization in Portugal: Epidemiology, Risk Factors and Antifungal Pattern","volume":"60","author":"Fernandes","year":"2022","journal-title":"Med. Mycol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"myad025","DOI":"10.1093\/mmy\/myad025","article-title":"Species and Antifungal Susceptibility Profile of Agents Causing Vulvovaginal Candidiasis in a Military Population: A Cross-sectional Study","volume":"61","author":"Trajano","year":"2023","journal-title":"Med. Mycol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1007\/s11046-024-00904-8","article-title":"Integrating Clinical and Microbiological Expertise to Improve Vaginal Candidiasis Management","volume":"189","author":"Karakoyun","year":"2024","journal-title":"Mycopathologia"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Anh, D.N., Hung, D.N., Tien, T.V., Dinh, V.N., Son, V.T., Luong, N.V., Van, N.T., Quynh, N.T.N., Van Tuan, N., and Tuan, L.Q. (2021). Prevalence, Species Distribution and Antifungal Susceptibility of Candida albicans Causing Vaginal Discharge Among Symptomatic Non-pregnant Women of Reproductive Age at a Tertiary Care Hospital, Vietnam. BMC Infect. Dis., 21.","DOI":"10.1186\/s12879-021-06192-7"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"101354","DOI":"10.1016\/j.mycmed.2022.101354","article-title":"High Diversity of Yeast Species and Strains Responsible for Vulvovaginal Candidiasis in South-East Gabon","volume":"33","author":"Bignoumba","year":"2023","journal-title":"J. Mycol. Med."},{"key":"ref_50","first-page":"576","article-title":"MALDI-TOF Mass Spectrometry Identification and Antifungal Susceptibility Testing of Yeasts Causing Vulvovaginal Candidiasis (VVC) in Tebessa (Northeastern Algeria)","volume":"81","author":"Benhadj","year":"2024","journal-title":"Ann. Biol. Clin."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"613.e1","DOI":"10.1016\/j.ajog.2008.06.029","article-title":"Individualized Decreasing-dose Maintenance Fluconazole Regimen for Recurrent Vulvovaginal Candidiasis (ReCiDiF trial)","volume":"199","author":"Donders","year":"2008","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Sobel, J.D., and Vempati, Y.S. (2024). Bacterial Vaginosis and Vulvovaginal Candidiasis Pathophysiologic Interrelationship. Microorganisms, 12.","DOI":"10.3390\/microorganisms12010108"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"e188","DOI":"10.1111\/ajd.12497","article-title":"Management of Chronic Vulvovaginal Candidiasis: A Long Term Retrospective Study","volume":"58","author":"Nguyen","year":"2017","journal-title":"Australas. J. Dermatol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1093\/cid\/civ1194","article-title":"Executive Summary: Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America","volume":"62","author":"Pappas","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"104471","DOI":"10.1016\/j.micpath.2020.104471","article-title":"Recurrent Vulvovaginal Candida spp Isolates Phenotypically Express Less Virulence Traits","volume":"148","author":"Rolo","year":"2020","journal-title":"Microb. Pathog."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Desai, J.V. (2018). Candida albicans Hyphae: From Growth Initiation to Invasion. J. Fungi, 4.","DOI":"10.3390\/jof4010010"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1080\/21505594.2015.1012981","article-title":"Candida albicans-epithelial Interactions and Pathogenicity Mechanisms: Scratching the Surface","volume":"6","author":"Moyes","year":"2015","journal-title":"Virulence"},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Camilli, G., Griffiths, J.S., Ho, J., Richardson, J.P., and Naglik, J.R. (2020). Some Like it Hot: Candida Activation of Inflammasomes. PLoS Pathog., 16.","DOI":"10.1371\/journal.ppat.1008975"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"R568","DOI":"10.1016\/j.cub.2016.02.019","article-title":"Pyroptosis","volume":"26","author":"Lamkanfi","year":"2016","journal-title":"Curr. Biol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1650","DOI":"10.1128\/IAI.00001-10","article-title":"Contribution of Candida albicans Cell Wall Components to Recognition by and Escape from Murine Macrophages","volume":"78","author":"McKenzie","year":"2010","journal-title":"Infect. Immun."},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Wickramasinghe, D.N., Lyon, C.M., Lee, S., Hepworth, O.W., Priest, E.L., Maufrais, C., Ryan, A.P., Permal, E., Sullivan, D., and McManus, B.A. (2024). Variations in Candidalysin Amino Acid Sequence Influence Toxicity and Host Responses. mBio, 15.","DOI":"10.1128\/mbio.03351-23"},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"T\u00f3th, A., Zajta, E., Csonka, K., V\u00e1gv\u00f6lgyi, C., Netea, M.G., and G\u00e1cser, A. (2017). Specific Pathways Mediating Inflammasome Activation by Candida parapsilosis. Sci. Rep., 7.","DOI":"10.1038\/srep43129"},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Konwar, A., Mathur, K., Pandey, S., Bhorali, K., Thakur, A., and Puria, R. (2025). Insights into the Evolution of Candidalysin and Recent Developments. Arch. Microbiol., 207.","DOI":"10.1007\/s00203-025-04414-z"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1038\/ni.2987","article-title":"Neutrophils Sense Microbe Size and Selectively Release Neutrophil Extracellular Traps in Response to Large Pathogens","volume":"15","author":"Branzk","year":"2014","journal-title":"Nat. Immunol."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Pan, Y., Sun, Y., Chen, L., Cheng, Y., Jin, P., Zhang, W., Zheng, L., Liu, J., Zhou, T., and Xu, Z. (2023). Candida Causes Recurrent Vulvovaginal Candidiasis by Forming Morphologically Disparate Biofilms on the Human Vaginal Epithelium. Biofilm, 6.","DOI":"10.1016\/j.bioflm.2023.100162"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1128\/EC.00262-13","article-title":"Immune Evasion, Stress Resistance, and Efficient Nutrient Acquisition are Crucial for Intracellular Survival of Candida glabrata Within Macrophages","volume":"13","author":"Seider","year":"2014","journal-title":"Eukaryot. Cell"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"555","DOI":"10.4161\/viru.28509","article-title":"Secreted Candida parapsilosis Lipase Modulates the Immune Response of Primary Human Macrophages","volume":"5","author":"Csonka","year":"2014","journal-title":"Virulence"},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Kulig, K., Karnas, E., Woznicka, O., Kuleta, P., Zuba-Surma, E., Pyza, E., Osyczka, A., Kozik, A., Rapala-Kozik, M., and Karkowska-Kuleta, J. (2022). Insight into the Properties and Immunoregulatory Effect of Extracellular Vesicles Produced by Candida glabrata, Candida parapsilosis, and Candida tropicalis Biofilms. Front. Cell Infect. Microbiol., 12.","DOI":"10.3389\/fcimb.2022.879237"},{"key":"ref_69","first-page":"10-17912","article-title":"Simplified J774A.1 Macrophage Assay for Fungal Pathogenicity Demonstrates Non-clinical Nakaseomyces glabratus Strains Survive Better than Lab Strains","volume":"22","author":"Pezak","year":"2024","journal-title":"MicroPubl. Biol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"e00645","DOI":"10.1128\/IAI.00645-17","article-title":"Candidalysin Drives Epithelial Signaling, Neutrophil Recruitment, and Immunopathology at the Vaginal Mucosa","volume":"86","author":"Richardson","year":"2018","journal-title":"Infect. Immun."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"e00527","DOI":"10.1128\/IAI.00527-18","article-title":"Comparative Analysis of the Capacity of the Candida Species to Elicit Vaginal Immunopathology","volume":"86","author":"Willems","year":"2018","journal-title":"Infect. Immun."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1038\/nri3897","article-title":"Immune Defence Against Candida Fungal Infections","volume":"15","author":"Netea","year":"2015","journal-title":"Nat. Rev. Immunol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.semcdb.2018.02.026","article-title":"Candida Innate Immunity at the Mucosa","volume":"89","author":"Richardson","year":"2019","journal-title":"Semin. Cell Dev. Biol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"e00684","DOI":"10.1128\/IAI.00684-17","article-title":"Novel Mechanism behind the Immunopathogenesis of Vulvovaginal Candidiasis: \u201cNeutrophil Anergy\u201d","volume":"86","author":"Yano","year":"2018","journal-title":"Infect. Immun."},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Rosati, D., Bruno, M., Jaeger, M., Ten Oever, J., and Netea, M.G. (2020). Recurrent Vulvovaginal Candidiasis: An Immunological Perspective. Microorganisms, 8.","DOI":"10.3390\/microorganisms8020144"},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Rodrigues, C.F., Rodrigues, M.E., and Henriques, M. (2019). Candida sp. Infections in Patients with Diabetes Mellitus. J. Clin. Med., 8.","DOI":"10.3390\/jcm8010076"},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"Peters, B.M., Yano, J., Noverr, M.C., and Fidel, P.L. (2014). Candida Vaginitis: When Opportunism Knocks, the Host Responds. PLoS Pathog., 10.","DOI":"10.1371\/journal.ppat.1003965"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"3334","DOI":"10.2741\/2929","article-title":"Protective and Pathologic Immune Responses against Candida albicans Infection","volume":"13","author":"Ashman","year":"2008","journal-title":"Front. Biosci."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"5790","DOI":"10.1128\/IAI.70.10.5790-5799.2002","article-title":"Candida-specific Antibodies During Experimental Vaginal Candidiasis in Mice","volume":"70","author":"Wozniak","year":"2002","journal-title":"Infect. Immun."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1155\/S1064744901000369","article-title":"Differentiation Between Women with Vulvovaginal Symptoms who are Positive or Negative for Candida species by Culture","volume":"9","author":"Linhares","year":"2001","journal-title":"Infect. Dis. Obstet. Gynecol."},{"key":"ref_81","first-page":"499","article-title":"Chronic Monilial Vaginitis","volume":"29","author":"Hosen","year":"1971","journal-title":"Ann. Allergy"},{"key":"ref_82","first-page":"266","article-title":"Allergy in Chronic Monilial Vaginitis","volume":"29","author":"Kudelko","year":"1971","journal-title":"Ann. Allergy"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1016\/0091-6749(88)90909-8","article-title":"A Localized Vaginal Allergic Response in Women with Recurrent Vaginitis","volume":"81","author":"Witkin","year":"1988","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"273","DOI":"10.4103\/0366-6999.198927","article-title":"Lactobacillus crispatus Modulates Vaginal Epithelial Cell Innate Response to Candida albicans","volume":"130","author":"Niu","year":"2017","journal-title":"Chin. Med. J."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1111\/j.1600-0897.2011.01093.x","article-title":"Identification of Immune Cells by Flow Cytometry in Vaginal Lavages from Women with Vulvovaginitis and Normal Microflora","volume":"67","author":"Giraldo","year":"2012","journal-title":"Am. J. Reprod. Immunol."},{"key":"ref_86","doi-asserted-by":"crossref","unstructured":"Ricchi, F., Kenno, S., Pedretti, N., Brenna, G., De Seta, F., Ardizzoni, A., and Pericolini, E. (2025). Cutibacterium acnes Lysate Improves Cellular Response against Candida albicans, Escherichia coli and Gardnerella vaginalis in an in vitro Model of Vaginal Infection. Front. Cell. Infect. Microbiol., 15.","DOI":"10.3389\/fcimb.2025.1578831"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"4675","DOI":"10.1128\/IAI.00083-07","article-title":"Anticandidal Immunity and Vaginitis: Novel Opportunities for Immune Intervention","volume":"75","author":"Cassone","year":"2007","journal-title":"Infect. Immun."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1038\/s41541-025-01171-4","article-title":"Protective Efficacy of the Pan-fungal Vaccine NXT-2 Against Vulvovaginal Candidiasis in a Murine Model","volume":"10","author":"Wychrij","year":"2025","journal-title":"npj Vaccines"},{"key":"ref_89","doi-asserted-by":"crossref","unstructured":"Ahmadifar, F., Balali, E., Khadivi, R., Hashemi, M., and Jebali, A. (2025). The Evaluation of a Novel Multi-epitope Vaccine Against Human Papillomavirus and Candida albicans. J. Genet. Eng. Biotechnol., 23.","DOI":"10.1016\/j.jgeb.2025.100489"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1038\/s41541-025-01183-0","article-title":"Pre-clinical Evaluation of a Divalent Liposomal Vaccine to Control Invasive Candidiasis","volume":"10","author":"Pacheco","year":"2025","journal-title":"npj Vaccines"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"4490","DOI":"10.1016\/j.vaccine.2012.04.069","article-title":"A Virosomal Vaccine Against Candidal Vaginitis: Immunogenicity, Efficacy and Safety Profile in Animal Models","volume":"30","author":"Amacker","year":"2012","journal-title":"Vaccine"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"1928","DOI":"10.1093\/cid\/ciy185","article-title":"A Fungal Immunotherapeutic Vaccine (NDV-3A) for Treatment of Recurrent Vulvovaginal Candidiasis-A Phase 2 Randomized, Double-Blind, Placebo-Controlled Trial","volume":"66","author":"Edwards","year":"2018","journal-title":"Clin. Infect. Dis."},{"key":"ref_93","doi-asserted-by":"crossref","unstructured":"Khan, M.A., Khan, A., Alnuqaydan, A.M., Albutti, A., Alharbi, B.F., and Owais, M. (2025). Targeting Azole-Resistant Candida albicans: Tetrapeptide Tuftsin-Modified Liposomal Vaccine Induces Superior Immune Protection. Vaccines, 13.","DOI":"10.3390\/vaccines13060630"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"123312","DOI":"10.1016\/j.lfs.2024.123312","article-title":"Efficacy of Lipid Nanoparticles-based Vaccine to Protect Against Vulvovaginal Candidiasis (VVC): Implications for Women\u2019s Reproductive Health","volume":"361","author":"Khan","year":"2025","journal-title":"Life Sci."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1007\/s11046-020-00445-w","article-title":"Candida Biofilms: An Update on Developmental Mechanisms and Therapeutic Challenges","volume":"185","author":"Rossoni","year":"2020","journal-title":"Mycopathologia"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/j.micinf.2016.01.002","article-title":"Candida albicans Biofilms: Development, Regulation, and Molecular Mechanisms","volume":"18","author":"Gulati","year":"2016","journal-title":"Microbes Infect."},{"key":"ref_97","doi-asserted-by":"crossref","unstructured":"Hu, T., Meng, Y., Zhao, C., Sheng, D., Yang, S., Dai, J., Wei, T., Zhang, Y., Zhao, G., and Liu, Y. (2025). Genome-scale Metabolic Modelling Reveals Specific Vaginal Lactobacillus Strains and Their Metabolites as Key Inhibitors of Candida albicans. Microbiol. Spectr., 13.","DOI":"10.1128\/spectrum.02984-24"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"471.e1","DOI":"10.1016\/j.ajog.2019.10.008","article-title":"Associations Between the Vaginal Microbiome and Candida Colonization in Women of Reproductive Age","volume":"222","author":"Tortelli","year":"2020","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_99","doi-asserted-by":"crossref","unstructured":"Parolin, C., Croatti, V., Giordani, B., and Vitali, B. (2022). Vaginal Lactobacillus Impair Candida Dimorphic Switching and Biofilm Formation. Microorganisms, 10.","DOI":"10.3390\/microorganisms10102091"},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"2573","DOI":"10.1093\/jac\/dkr358","article-title":"Sodium Butyrate Inhibits Pathogenic Yeast Growth and Enhances the Functions of Macrophages","volume":"66","author":"Nguyen","year":"2011","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_101","doi-asserted-by":"crossref","unstructured":"Said, M.M., Watson, C., and Grando, D. (2020). Garlic Alters the Expression of Putative Virulence Factor Genes SIR2 and ECE1 in Vulvovaginal C. albicans Isolates. Sci. Rep., 10.","DOI":"10.1038\/s41598-020-60178-0"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"881","DOI":"10.3201\/eid0809.020063","article-title":"Biofilms: Microbial Life on Surfaces","volume":"8","author":"Donlan","year":"2002","journal-title":"Emerg. Infect. Dis."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"e0062221","DOI":"10.1128\/msystems.00622-21","article-title":"Recurrent Vulvovaginal Candidiasis: A Dynamic Interkingdom Biofilm Disease of Candida and Lactobacillus","volume":"6","author":"McKloud","year":"2021","journal-title":"mSystems"},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"6235","DOI":"10.1038\/s41467-021-26525-z","article-title":"Coordination of Fungal Biofilm Development by Extracellular Vesicle Cargo","volume":"12","author":"Zarnowski","year":"2021","journal-title":"Nat. Commun."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"4680","DOI":"10.1073\/pnas.1002611107","article-title":"Vaginal Microbiome of Reproductive-age Women","volume":"108","author":"Ravel","year":"2011","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/s12934-023-02053-x","article-title":"Exopolysaccharides from Vaginal Lactobacilli Modulate Microbial Biofilms","volume":"22","author":"Giordani","year":"2023","journal-title":"Microb. Cell Fact."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"727","DOI":"10.3349\/ymj.2023.0490","article-title":"Effects of Lactiplantibacillus plantarum LM1215 on Candida albicans and Gardnerella vaginalis","volume":"65","author":"Bae","year":"2024","journal-title":"Yonsei Med. J."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1097\/OLQ.0000000000001063","article-title":"Clinicians\u2019 Use of Intravaginal Boric Acid Maintenance Therapy for Recurrent Vulvovaginal Candidiasis and Bacterial Vaginosis","volume":"46","author":"Powell","year":"2019","journal-title":"Sex. Transm. Dis."},{"key":"ref_109","first-page":"325","article-title":"Antifungal Mechanisms Supporting Boric acid Therapy of Candida vaginitis","volume":"63","author":"Schmidt","year":"2009","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"113666","DOI":"10.1016\/j.jconrel.2025.113666","article-title":"A \u201cThree-in-one\u201d Thermosensitive Gel System that Enhances Mucus and Biofilm penetration for the Treatment of Vulvovaginal Candidiasis","volume":"382","author":"Wang","year":"2025","journal-title":"J. Control. Release"},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"1580","DOI":"10.1099\/jmm.0.044578-0","article-title":"Premenstrual Vaginal Colonization of Candida and Symptoms of Vaginitis","volume":"61","author":"Watson","year":"2012","journal-title":"J. Med. Microbiol."},{"key":"ref_112","unstructured":"CDC (2025, June 04). Sexually Transmitted Infections Treatment. Vulvovaginal Candidiasis (VVC), Available online: https:\/\/www.cdc.gov\/std\/treatment-guidelines\/candidiasis.htm."},{"key":"ref_113","unstructured":"ASHM (2025, June 04). The Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM). Australian STI Management Guidelines for Use in Primary Care. Candidiasis. Available online: https:\/\/sti.guidelines.org.au\/sexually-transmissible-infections\/candidiasis\/."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1111\/myc.13248","article-title":"Guideline: Vulvovaginal Candidosis (AWMF 015\/072, level S2k)","volume":"64","author":"Farr","year":"2021","journal-title":"Mycoses"},{"key":"ref_115","doi-asserted-by":"crossref","unstructured":"Donders, G., Sziller, I.O., Paavonen, J., Hay, P., de Seta, F., Bohbot, J.M., Kotarski, J., Vives, J.A., Szabo, B., and Cepulien\u00e9, R. (2022). Management of Recurrent Vulvovaginal Candidosis: Narrative Review of the Literature and European Expert Panel Opinion. Front. Cell. Infect. Microbiol., 12.","DOI":"10.3389\/fcimb.2022.934353"},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1080\/14787210.2025.2516554","article-title":"The Future of Non-invasive Azole Antifungal Treatment Options for the Management of Vulvovaginal Candidiasis","volume":"23","author":"Quindos","year":"2025","journal-title":"Expert Rev. Anti Infect. Ther."},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/S1701-2163(15)30316-9","article-title":"Vulvovaginitis: Screening for and Management of Trichomoniasis, Vulvovaginal Candidiasis, and Bacterial Vaginosis","volume":"37","author":"Yudin","year":"2015","journal-title":"J. Obstet. Gynaecol. Can."},{"key":"ref_118","doi-asserted-by":"crossref","unstructured":"Day, T., and Sobel, J.D. (2025). Genital Cutaneous Candidiasis versus Chronic Recurrent Vulvovaginal Candidiasis: Distinct Diseases, Different Populations. Clin. Microbiol. Rev., 38.","DOI":"10.1128\/cmr.00020-25"},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/S0190-9622(99)70055-1","article-title":"Drug Interactions with Itraconazole, Fluconazole, and Terbinafine and their Management","volume":"41","author":"Gupta","year":"1999","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_120","first-page":"374","article-title":"The Value of Chronic Suppressive Therapy with Itraconazole versus Clotrimazole in Women with Recurrent Vulvovaginal Candidiasis","volume":"68","author":"Fong","year":"1992","journal-title":"Genitourin. Med."},{"key":"ref_121","first-page":"CD002845","article-title":"Oral versus Intra-vaginal Imidazole and Triazole Anti-fungal Treatment of Uncomplicated Vulvovaginal Candidiasis (Thrush)","volume":"8","author":"Denison","year":"2020","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_122","first-page":"CD009151","article-title":"Treatment for Recurrent Vulvovaginal Candidiasis (Thrush)","volume":"1","author":"Cooke","year":"2022","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1080\/14656566.2018.1476490","article-title":"Current Treatment Options for Vulvovaginal Candidiasis Caused by Azole-resistant Candida species","volume":"19","author":"Sobel","year":"2018","journal-title":"Expert Opin. Pharmacother."},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1093\/cid\/ciad002","article-title":"New Antifungals for Vulvovaginal Candidiasis: What is their Role?","volume":"76","author":"Sobel","year":"2023","journal-title":"Clin. Infect. Dis."},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1016\/j.cmi.2024.03.006","article-title":"New Treatment Options for Critically Important WHO Fungal Priority Pathogens","volume":"31","author":"Kriegl","year":"2025","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_126","unstructured":"(2025, June 04). A Phase 11b\/111 Study of prof-001 for the Treatment of Recurrent Vulvovaginal Candidiasis (RVVC). Available online: https:\/\/ctv.veeva.com\/study\/a-phase-iib-iii-study-of-prof-001-for-the-treatment-of-patients-with-recurrent-vulvovaginal-candidia."},{"key":"ref_127","doi-asserted-by":"crossref","unstructured":"Chayachinda, C., Thamkhantho, M., Rekhawasin, T., and Klerdklinhom, C. (2024). Sertaconazole 300 mg versus Clotrimazole 500 mg Vaginal Suppository for Treating Pregnant Women with Acute Vaginal Candidiasis: A Double-blinded, Randomized Trial. BMC Pregnancy Childbirth, 24.","DOI":"10.1186\/s12884-024-06440-z"},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1007\/s12281-021-00415-9","article-title":"Vulvovaginal Candidiasis: Epidemiology and Risk Factors, Pathogenesis, Resistance, and New Therapeutic Options","volume":"15","author":"Silva","year":"2021","journal-title":"Curr. Fungal Infect. Rep."},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"657.e1","DOI":"10.1016\/j.ajog.2015.11.022","article-title":"National Birth Defects Prevention Study. Fluconazole use and Birth Defects in the National Birth Defects Prevention Study","volume":"214","author":"Howley","year":"2016","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"e5741","DOI":"10.1002\/pds.5741","article-title":"National Birth Defects Prevention Study. Antifungal Medication Use During Pregnancy and the Risk of Selected Major Birth Defects in the National Birth Defects Prevention Study, 1997\u20132011","volume":"33","author":"Papadopoulos","year":"2024","journal-title":"Pharmacoepidemiol. Drug Saf."},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1056\/NEJMoa1301066","article-title":"Use of Oral Fluconazole During Pregnancy and the Risk of Birth Defects","volume":"369","author":"Pasternak","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_132","doi-asserted-by":"crossref","unstructured":"Nachum, Z., Suleiman, A., Colodner, R., Battino, S., Wattad, M., Kuzmin, O., and Yefet, E. (2025). Oral Probiotics to Prevent Recurrent Vulvovaginal Infections During Pregnancy-Multicenter Double-Blind, Randomized, Placebo-Controlled Trial. Nutrients, 17.","DOI":"10.3390\/nu17030460"},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s40199-024-00546-7","article-title":"Development of Amphotericin B Inclusion Complex Formulation in Dissolvable Microarray Patches for Intravaginal Delivery","volume":"33","author":"Burhanuddin","year":"2024","journal-title":"Daru"},{"key":"ref_134","doi-asserted-by":"crossref","first-page":"e11489","DOI":"10.1016\/j.heliyon.2022.e11489","article-title":"Development and Characterization of Amphotericin B Nanoemulsion-loaded Mucoadhesive Gel for Treatment of Vulvovaginal Candidiasis","volume":"8","author":"Patil","year":"2022","journal-title":"Heliyon"},{"key":"ref_135","doi-asserted-by":"crossref","first-page":"e280","DOI":"10.1016\/S1473-3099(24)00749-7","article-title":"Global Guideline for the Diagnosis and Management of Candidiasis: An Initiative of the ECMM in Cooperation with ISHAM and ASM","volume":"25","author":"Cornely","year":"2025","journal-title":"Lancet Infect. Dis."},{"key":"ref_136","doi-asserted-by":"crossref","first-page":"387070","DOI":"10.1155\/2014\/387070","article-title":"Determinants of Symptomatic Vulvovaginal Candidiasis Among Human Immunodeficiency Virus Type 1 Infected Women in Rural KwaZulu-Natal, South Africa","volume":"2014","author":"Apalata","year":"2014","journal-title":"Infect. Dis. Obstet. Gynecol."},{"key":"ref_137","doi-asserted-by":"crossref","unstructured":"Mbatudde, N., Nalumaga, P.P., Bazira, J., and Kabanda, T. (2025). Symptomatic Vulvovaginal Candidiasis and Antifungal Resistance in HIV-1 Positive Women at Mbarara City Health Centre IV. Sci. Rep., 15.","DOI":"10.1038\/s41598-025-09215-4"},{"key":"ref_138","first-page":"347","article-title":"Vaginal Candidiasis, Predisposing Factors, Symptoms and Treatment","volume":"2","year":"2024","journal-title":"SCT Proc. Interdiscip. Insights Innov."},{"key":"ref_139","doi-asserted-by":"crossref","unstructured":"Zeng, Z., Li, P., Lu, J., Li, X., Li, M., Wu, Y., Zheng, M., Cao, Y., Liao, Q., and Ge, Z. (2024). A Non-antibiotic Antimicrobial Drug, a Biological Bacteriostatic Agent, is useful for Treating Aerobic Vaginitis, Bacterial Vaginosis, and Vulvovaginal Candidiasis. Front. Microbiol., 15.","DOI":"10.3389\/fmicb.2024.1341878"},{"key":"ref_140","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.ijgo.2005.01.033","article-title":"Propolis Solution for the Treatment of Chronic Vaginitis","volume":"89","author":"Imhof","year":"2005","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_141","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1002\/ptr.5802","article-title":"Effectiveness of Ageratina pichinchensis Extract in Patients with Vulvovaginal Candidiasis. A Randomized, Double-blind, and Controlled Pilot Study","volume":"31","author":"Zamilpa","year":"2017","journal-title":"Phytother. Res."},{"key":"ref_142","doi-asserted-by":"crossref","first-page":"567","DOI":"10.11622\/smedj.2015153","article-title":"Comparison of the Therapeutic Effects of Garcin\u00ae and Fluconazole on Candida Vaginitis","volume":"56","author":"Ebrahimy","year":"2015","journal-title":"Singapore Med. J."},{"key":"ref_143","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1080\/08998280.2022.2121575","article-title":"Dietary Supplements and Bleeding","volume":"35","author":"Hatfield","year":"2022","journal-title":"Bayl. Univ. Med. Cent. Proc."},{"key":"ref_144","first-page":"919","article-title":"Colonization of Candida albicans in Vagina, Rectum, and Mouth","volume":"16","author":"Bertholf","year":"1983","journal-title":"J. Fam. Pract."},{"key":"ref_145","doi-asserted-by":"crossref","first-page":"2287618","DOI":"10.1080\/19490976.2023.2287618","article-title":"Unveiling Candida albicans Intestinal Carriage in Healthy Volunteers: The role of Micro- and Mycobiota, Diet, Host Genetics and Immune Response","volume":"15","author":"Delavy","year":"2023","journal-title":"Gut Microbes"},{"key":"ref_146","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1016\/j.tim.2024.04.004","article-title":"Bacteria-derived Short-chain Fatty Acids as Potential Regulators of Fungal Commensalism and Pathogenesis","volume":"32","author":"McCrory","year":"2024","journal-title":"Trends Microbiol."},{"key":"ref_147","doi-asserted-by":"crossref","unstructured":"Cronin, P., Joyce, S.A., O\u2019Toole, P.W., and O\u2019Connor, E.M. (2021). Dietary Fibre Modulates the Gut Microbiota. Nutrients, 13.","DOI":"10.3390\/nu13051655"},{"key":"ref_148","doi-asserted-by":"crossref","unstructured":"Djusse, M.E., Prinelli, F., Camboni, T., Ceccarani, C., Consolandi, C., Conti, S., Dall\u2019Asta, M., Danesi, F., Laghi, L., and Curatolo, F.M. (2025). Dietary Habits and Vaginal Environment: Can a Beneficial Impact be Expected?. Front. Cell. Infect. Microbiol., 15.","DOI":"10.3389\/fcimb.2025.1582283"},{"key":"ref_149","doi-asserted-by":"crossref","unstructured":"Smith, B.C., McAndrew, T., Chen, Z., Harari, A., Barris, D.M., Viswanathan, S., Rodriguez, A.C., Castle, P., Herrero, R., and Schiffman, M. (2012). The Cervical Microbiome over 7 Years and a Comparison of Methodologies for its Characterization. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0040425"},{"key":"ref_150","doi-asserted-by":"crossref","unstructured":"Kim, M.J., Lee, S., Kwon, M.Y., and Kim, M. (2022). Clinical Significance of Composition and Functional Diversity of the Vaginal Microbiome in Recurrent Vaginitis. Front. Microbiol., 13.","DOI":"10.3389\/fmicb.2022.851670"},{"key":"ref_151","doi-asserted-by":"crossref","unstructured":"Jepsen, I.E., Saxtorph, M.H., Englund, A.L.M., Petersen, K.B., Wissing, M.L.M., Hviid, T.V.F., and Macklon, N. (2022). Probiotic Treatment with Specific Lactobacilli does not Improve an Unfavorable Vaginal Microbiota Prior to Fertility Treatment\u2014A Randomized, Double-blinded, Placebo-controlled Trial. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.1057022"},{"key":"ref_152","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1093\/humrep\/dez065","article-title":"The Vaginal Microbiome as a Predictor for Outcome of in Vitro Fertilization with or without Intracytoplasmic Sperm Injection: A Prospective Study","volume":"34","author":"Koedooder","year":"2019","journal-title":"Hum. Reprod."},{"key":"ref_153","doi-asserted-by":"crossref","unstructured":"Perez, M., Armengol, E., Del Casale, A., Campedelli, I., Aldea-Perona, A., P\u00e9rez Otero, M., Rodriguez-Palmero, M., Espadaler-Mazo, J., and Huedo, P. (2025). Lactobacillus gasseri CECT 30648 Shows Probiotic Characteristics and Colonizes the Vagina of Healthy Women after Oral Administration. Microbiol. Spectr., 13.","DOI":"10.1128\/spectrum.00211-25"},{"key":"ref_154","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1038\/s41564-022-01083-2","article-title":"Towards a Deeper Understanding of the Vaginal Microbiota","volume":"7","author":"France","year":"2022","journal-title":"Nat. Microbiol."},{"key":"ref_155","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1136\/sextrans-2017-053133","article-title":"Lactobacillus iners-dominated Vaginal Microbiota is Associated with Increased Susceptibility to Chlamydia trachomatis Infection in Dutch Women: A case-control Study","volume":"94","author":"Ma","year":"2018","journal-title":"Sex. Transm. Infect."},{"key":"ref_156","doi-asserted-by":"crossref","unstructured":"Armstrong, E., Hemmerling, A., Miller, S., Huibner, S., Kulikova, M., Crawford, E., Casta\u00f1eda, G.R., Coburn, B., Cohen, C.R., and Kaul, R. (2024). Vaginal Lactobacillus crispatus Persistence Following Application of a Live Biotherapeutic Product: Colonization Phenotypes and Genital Immune Impact. Microbiome, 12.","DOI":"10.1186\/s40168-024-01828-7"},{"key":"ref_157","doi-asserted-by":"crossref","first-page":"1906","DOI":"10.1056\/NEJMoa1915254","article-title":"Randomized Trial of Lactin-V to Prevent Recurrence of Bacterial Vaginosis","volume":"382","author":"Cohen","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_158","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.immuni.2016.12.013","article-title":"Lactobacillus-Deficient Cervicovaginal Bacterial Communities Are Associated with Increased HIV Acquisition in Young South African Women","volume":"46","author":"Gosmann","year":"2017","journal-title":"Immunity"},{"key":"ref_159","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1056\/NEJMoa1205037","article-title":"Duodenal Infusion of Donor Feces for Recurrent Clostridium difficile","volume":"368","author":"Vrieze","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_160","doi-asserted-by":"crossref","first-page":"7786","DOI":"10.1038\/s41467-025-62752-4","article-title":"Long-term Health Outcomes in Adolescents with Obesity Treated with Faecal Microbiota Transplantation: 4-year Follow-up","volume":"16","author":"Wilson","year":"2025","journal-title":"Nat. Commun."},{"key":"ref_161","doi-asserted-by":"crossref","first-page":"1500","DOI":"10.1038\/s41591-019-0600-6","article-title":"Vaginal Microbiome Transplantation in Women with Intractable Bacterial Vaginosis","volume":"25","author":"Cohen","year":"2019","journal-title":"Nat. Med."},{"key":"ref_162","doi-asserted-by":"crossref","first-page":"102070","DOI":"10.1016\/j.eclinm.2023.102070","article-title":"Antibiotic-free Vaginal Microbiota Transplant with Donor Engraftment, Dysbiosis Resolution and Live Birth After Recurrent Pregnancy Loss: A Proof of Concept Case Study","volume":"61","author":"Vomstein","year":"2023","journal-title":"eClinicalMedicine"},{"key":"ref_163","doi-asserted-by":"crossref","first-page":"11446","DOI":"10.18632\/aging.206032","article-title":"Effectiveness of Vaginal Probiotics Lactobacillus crispatus chen-01 in Women with High-risk HPV infection: A Prospective Controlled Pilot Study","volume":"16","author":"Liu","year":"2024","journal-title":"Aging"},{"key":"ref_164","doi-asserted-by":"crossref","unstructured":"So, K.A., Yang, E.J., Kim, N.R., Hong, S.R., Lee, J.H., Hwang, C.S., Shim, S.H., Lee, S.J., and Kim, T.J. (2020). Changes of Vaginal Microbiota During Cervical Carcinogenesis in Women with Human Papillomavirus Infection. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0238705"},{"key":"ref_165","doi-asserted-by":"crossref","first-page":"101037","DOI":"10.1016\/j.lanmic.2024.101037","article-title":"Effect of the Vaginal Live Biotherapeutic LACTIN-V (Lactobacillus crispatus CTV-05) on Vaginal Microbiota and Genital Tract Inflammation Among Women at High Risk of HIV Acquisition in South Africa: A Phase 2, Randomised, Placebo-controlled Trial","volume":"6","author":"Hemmerling","year":"2025","journal-title":"Lancet Microbe"},{"key":"ref_166","doi-asserted-by":"crossref","first-page":"e0017025","DOI":"10.1128\/iai.00170-25","article-title":"Modulation of Group B Streptococcus Infection and Vaginal Cell Inflammatory signaling in vitro by Lactobacillus crispatus-loaded Electrospun Fibers","volume":"93","author":"Kyser","year":"2025","journal-title":"Infect. Immun."},{"key":"ref_167","doi-asserted-by":"crossref","unstructured":"Ravel, J., Simmons, S., Jaswa, E.G., Gottfried, S., Greene, M., Kellogg-Spadt, S., Gevers, D., and Harper, D.M. (2025). Impact of a Multi-strain L. crispatus-based Vaginal Synbiotic on the Vaginal Microbiome: A Randomized Placebo-controlled Trial. npj Biofilm. Microbiomes, 11.","DOI":"10.1038\/s41522-025-00788-6"}],"container-title":["Journal of Fungi"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2309-608X\/11\/11\/806\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T17:09:25Z","timestamp":1763140165000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2309-608X\/11\/11\/806"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,13]]},"references-count":167,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["jof11110806"],"URL":"https:\/\/doi.org\/10.3390\/jof11110806","relation":{},"ISSN":["2309-608X"],"issn-type":[{"value":"2309-608X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,13]]}}}