Management of chronic vulvovaginal candidiasis: A long term retrospective study

Background: Chronic vulvovaginal candidiasis (CVVC) is described by a vulvovaginitis that is chronic in nature, and is associated with the presence of Candida in the vagina.(Fischer 2012, Hong, Dixit et al. 2013) Limited data is available on the treatment for CVVC and the subsequent long-term outcomes of treatment regimes for CVVC. This retrospective case series aims to explore the long-term outcomes of a regimen used in the treatment of CVVC.
Methods: Retrospective case series conducted over 1 year from data obtained from a private vulvar dermatology outpatient clinic. Data from 200 patients satisfying presumptive or diagnostic criteria for CVVC were collected from a database, including drugs, doses, induction and maintenance treatment regimes, results and adverse effects.
Results: Data for 200 patients with CVVC was collected from the private outpatient dermatology clinic database. All patients achieved a clinical response to an oral induction daily fluconazole regime within 12 weeks. 96.5% of patients remained on oral fluconazole for maintenance treatment and the other 3.5% changed to other antifungals due to adverse effects. 98.0% of the study cohort remains on treatment with an oral antifungal for symptom suppression with the longest follow up duration of eight years.
Conclusion: An effective dosing regime for this subset of women with CVVC was an induction regime of oral fluconazole commencing with 50-100mg daily for 12 weeks followed by a maintenance dose of fluconazole 50mg, ranging between an ongoing requirement of 50mg daily to 50mg as needed. Adverse effects in this cohort were minimal.
1. Fischer, G. (2012). "Chronic vulvovaginal candidiasis: What we know and what we have yet to learn." Australasian Journal of Dermatology 53(4): 247-254.
2. Hong, E., S. Dixit, P. L. Fidel, J. Bradford and G. Fischer (2013). "Vulvovaginal Candidiasis as a Chronic Disease: Diagnostic Criteria and Definition." J Low Genit Tract Dis.

Dr. Yvonne Nguyen

1) Dermatology Department, Royal Prince Alfred Hospital 2) Discipline of Dermatology, Sydney Medical

Yvonne Nguyen is currently a dermatology research registrar at the Royal Prince Alfred Hospital after having previously completed her internship and residency at the Royal North Shore Hospital. She received Bachelor of Pharmacy (Hons), MBBS and MPhil (Medicine) degrees from The University of Sydney. Her main research experience is in the area of Chronic Vulvovaginal Candidiasis, which she undertook in fulfilment of her Master of Philosophy (Medicine) degree from The University of Sydney.