Vulvovaginalcandidose

Vulvovaginal candidiasis (VVC) is one of the most frequent infections of the female genital tract and the leading reason for consultations in gynecological outpatient offices. It is mostly triggered by Candida albicans. Approximately 70–75% of women experience at least 1 episode during their lifetime. The pathogenesis of VVC is complex and is based on an imbalance between Candida as the pathogen and the lack of defense mechanisms of the patient. Risk factors that promote colonization or the transformation from asymptomatic colonization to symptomatic infection include hormonal changes, a genetic predisposition, the use of antibiotics, hyperglycemia and certain lifestyle factors. The most frequent symptoms of VVC are itching, vaginal discharge, dyspareunia and dysuria, although these symptoms are often nonspecific and can mimic other diseases of the genital tract. The diagnostics require a thorough medical history, clinical examination, and microscopic examination of the vaginal discharge. For recurrent infections cultures are useful to identify the underlying Candida species. The treatment of acute VVC involves local antifungal agents, such as imidazoles or alternatively nystatin, while the treatment of recurrent VVC requires long-term treatment with fluconazole. During pregnancy topical imidazoles are the preferred treatment option. Alternative treatment methods, such as dequalinium chloride also show promising results. Adjunctive measures, such as the use of probiotics, could help to reduce recurrence rates. This article provides a comprehensive overview of the pathogenesis, risk factors, symptoms, diagnostics and treatment of VVC.