Treatment Considerations in Vulvovaginal Candidiasis

In 1990, more than 13 million American women received prescriptions for treating vaginitis-the most common reason for visiting the gynecologist. (1) Vaginitis caused by yeast species accounts for approximately 40% of these cases, second only to bacterial vaginosis (45%). (2,3) The incidence of vulvovaginal candidiasis (VVC) has increased dramatically in the past decade. In the United Kingdom, the incidence rose from 118 to 200 per 100,000 between 1975 and 1984, (4) and in the United States the number of prescriptions written to treat this condition doubled between 1980 and 1990. Up to 75% of women experience vaginal candidiasis in their lifetime (5)-approximately 40% to 50% of whom have a recurrence. (6) Fewer than 5% of women have chronic recurrences, however. (7) Topical azoles remain the first line of VVC treatment, achieving mycologic and clinical cures with minimal systemic effects in 85% to 90% of episodic infections. Oral agents may be more convenient, but confer some risk of side effects and drug interactions. In addition, the proportion of nonalbican Candida infections caused by resistant strains may be on the rise.