{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:40:21Z","timestamp":1787316021937,"version":"build-2736575974"},"reference-count":107,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T00:00:00Z","timestamp":1771545600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Consejer\u00eda de Educaci\u00f3n, Universidades e Investigaci\u00f3n of the Gobierno Vasco-Eusko Jaularitza","award":["GIC21\/24 IT1607\u201322"],"award-info":[{"award-number":["GIC21\/24 IT1607\u201322"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>Vulvovaginal candidiasis (VVC) represents a widespread gynaecological challenge, affecting approximately 75% of women at some point during their reproductive years, with a significant subset progressing to recurrent forms (RVVC). Classical azoles and polyenes remain the cornerstone of therapy. However, their clinical utility is undermined by the rise of azole-resistant non-Candida albicans species, the capacity of Candida to form biofilms, and a complex variety of host-related factors that complicate disease expression and therapeutic response. This narrative review provides a critical up-to-date examination of the therapeutic landscape, integrating current diagnostic algorithms with pharmacological strategies for both acute, recalcitrant and recurrent VVCs. We assess the efficacy and safety of established antifungal agents alongside the breakthrough introduction of novel drug classes, with a particular interest in the oral triterpenoid ibrexafungerp and the tetrazole oteseconazole, which offer new mechanisms of action for cases that fail to respond to standard regimens. Furthermore, we address the management of a special clinical scenarios, including pregnancy and lactation, and explore promising emerging innovative approaches such as mucoadhesive formulations, immunomodulatory approaches, and alternative non-antifungal therapies. Ultimately, this review aims to support clinical decision-making by balancing the accessibility and user-friendliness of conventional treatments with the targeted precision offered by modern antifungal agents.<\/jats:p>","DOI":"10.3390\/jof12020152","type":"journal-article","created":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T10:32:37Z","timestamp":1771583557000},"page":"152","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Therapeutic Tools for Vulvovaginal Candidiasis: Current and Emerging Antifungal Agents"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0438-2248","authenticated-orcid":false,"given":"Guillermo","family":"Quind\u00f3s","sequence":"first","affiliation":[{"name":"Department of Immunology, Microbiology and Parasitology, Faculty of Medicine and Nursing, University of the Basque Country (UPV\/EHU), 48080 Bilbao, Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria Biobizkaia, 48903 Barakaldo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7109-7570","authenticated-orcid":false,"given":"Iker","family":"De-la-Pinta","sequence":"additional","affiliation":[{"name":"Department of Immunology, Microbiology and Parasitology, Faculty of Medicine and Nursing, University of the Basque Country (UPV\/EHU), 48080 Bilbao, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0924-3696","authenticated-orcid":false,"given":"Cristina","family":"Marcos-Arias","sequence":"additional","affiliation":[{"name":"Department of Immunology, Microbiology and Parasitology, Faculty of Medicine and Nursing, University of the Basque Country (UPV\/EHU), 48080 Bilbao, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8738-0901","authenticated-orcid":false,"given":"Nerea","family":"Jauregizar","sequence":"additional","affiliation":[{"name":"Instituto de Investigaci\u00f3n Sanitaria Biobizkaia, 48903 Barakaldo, Spain"},{"name":"Department of Pharmacology, Faculty of Medicine and Nursing, University of the Basque Country (UPV\/EHU), 48080 Bilbao, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3472-984X","authenticated-orcid":false,"given":"Elena","family":"Sevillano","sequence":"additional","affiliation":[{"name":"Department of Immunology, Microbiology and Parasitology, Faculty of Medicine and Nursing, University of the Basque Country (UPV\/EHU), 48080 Bilbao, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucila","family":"Madariaga","sequence":"additional","affiliation":[{"name":"Department of Immunology, Microbiology and Parasitology, Faculty of Medicine and Nursing, University of the Basque Country (UPV\/EHU), 48080 Bilbao, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9043-9265","authenticated-orcid":false,"given":"Elena","family":"Eraso","sequence":"additional","affiliation":[{"name":"Department of Immunology, Microbiology and Parasitology, Faculty of Medicine and Nursing, University of the Basque Country (UPV\/EHU), 48080 Bilbao, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,20]]},"reference":[{"key":"ref_1","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_2","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1055\/a-1345-8793","article-title":"Vulvovaginal Candidosis (Excluding Mucocutaneous Candidosis): Guideline of the German (DGGG), Austrian (OEGGG) and Swiss (SGGG) Society of Gynecology and Obstetrics (S2k-Level, AWMF Registry Number 015\/072, September 2020)","volume":"81","author":"Farr","year":"2021","journal-title":"Geburtshilfe Frauenheilkd"},{"key":"ref_3","first-page":"65","article-title":"Vulvovaginal candidiasis: An old disease with new challenges","volume":"34","author":"Miro","year":"2017","journal-title":"Rev. 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