Materiały źródłowe

• #1 Vulvovaginal Candidiasis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/candidiasis.htm

  VVC usually is caused by Candida albicans but can occasionally be caused by other Candida species or yeasts. […] Approximately 10%20% of women will have complicated VVC, requiring special diagnostic and therapeutic considerations. […] A diagnosis of Candida vaginitis is clinically indicated by the presence of external dysuria and vulvar pruritus, pain, swelling, and redness. […] The diagnosis can be made in a woman who has signs and symptoms of vaginitis when either a wet preparation (saline, 10% KOH) of vaginal discharge demonstrates budding yeasts, hyphae, or pseudohyphae, or a culture or other test yields a positive result for a yeast species. […] Use of 10% KOH in wet preparations improves the visualization of yeast and mycelia by disrupting cellular material that might obscure the yeast or pseudohyphae.

• #2 Vaginal yeast infection Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/vaginal-yeast-infection

  Vaginal yeast infection is an infection of the vagina. It is most often due to the fungus Candida albicans. […] Medicines to treat vaginal yeast infections are available as creams, ointments, vaginal tablets or suppositories and oral tablets. Most can be bought without needing to see your provider. If you do need to see your provider, you may wish to ask them about the use of boric acid for yeast infections. […] Treating yourself at home is probably OK if: Your symptoms are mild and you do not have pelvic pain or a fever, This is not your first yeast infection and you have not had many yeast infections in the past, You are

• #3 Yeast infection (vaginal) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/yeast-infection/symptoms-causes/syc-20378999

  Medicines can treat vaginal yeast infections. Yeast infections that happen four times or more a year may need a longer treatment course and a plan to prevent them. […] Make an appointment with your healthcare professional if: […] Your symptoms don’t go away after you treat them with antifungal vaginal creams or suppositories that you can get without a prescription. […] Candida albicans is the most common type of fungus to cause yeast infections. When other types of candida fungus cause yeast infections, they can be harder to treat.

• #4 Vaginal Yeast Infection: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/5019-vaginal-yeast-infection

  An overgrowth of the fungus candida causes a vaginal yeast infection. Treatment includes antifungal medication. […] Antifungal medications treat most vaginal yeast infections. The specific medication depends on the severity of the infection. Your healthcare provider will prescribe the best treatment based on your symptoms and condition. […] Antifungal medications work by fighting yeast overgrowth in your body. Medications are either oral (usually given in one dose of fluconazole by mouth) or topical (used daily for up to seven days). […] Your healthcare provider will give you information about each form of medication and directions on how to use each one properly. […] If youre taking medication for a yeast infection, you shouldnt have sex until youre finished with treatment. […] Sometimes you can treat a vaginal yeast infection with over-the-counter medicines.

• #5 Yeast infection (vaginal) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/yeast-infection/diagnosis-treatment/drc-20379004

  To diagnose a yeast infection, your healthcare professional may: […] Treatment for yeast infections depends on how bad the infections are and how often they happen. […] If you have mild to moderate symptoms and don’t get infections often, treatment options include: […] Short-course vaginal therapy. Using an antifungal medicine for 3 to 7 days most often clears a yeast infection. Antifungal medicines come in the form of creams, ointments, tablets and small objects you put into your vagina, called suppositories. […] One dose of medicine taken by mouth. Your healthcare professional might prescribe one dose of fluconazole (Diflucan). […] The U.S. Food and Drug Administration recently approved two medicines to treat vaginal yeast infections. One is oteseconazole (Vivjoa), taken by mouth.

• #6 Vulvovaginal Candidiasis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/candidiasis.htm

  Examination of a wet mount with KOH preparation should be performed for all women with symptoms or signs of VVC, and women with a positive result should be treated. […] Short-course topical formulations (i.e., single dose and regimens of 13 days) effectively treat uncomplicated VVC. Treatment with azoles results in relief of symptoms and negative cultures in 80%90% of patients who complete therapy. […] Recommended Regimens for Vulvovaginal Candidiasis include Clotrimazole 1% cream, Clotrimazole 2% cream, Miconazole 2% cream, Miconazole 4% cream, Miconazole 100 mg vaginal suppository, Miconazole 200 mg vaginal suppository, Miconazole 1,200 mg vaginal suppository, Tioconazole 6.5% ointment, Butoconazole 2% cream, Terconazole 0.4% cream, Terconazole 0.8% cream, Terconazole 80 mg vaginal suppository, and Fluconazole 150 mg orally in a single dose.

• #7 Patient education: Vaginal yeast infection (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/vaginal-yeast-infection-beyond-the-basics/print

  VAGINAL YEAST INFECTION TREATMENT […] Treatment may include a pill that you take by mouth or a vaginal treatment. […] Vaginal treatment—Treatment for a vaginal yeast infection often includes a vaginal cream or tablet. You apply the cream or tablet inside the vagina at bedtime with an applicator. There are prescription and nonprescription treatments, so ask your doctor or nurse which to use. One, three, and seven-day treatments are equally effective. The length of treatment depends on how severe your infection is. […] Oral treatment—A prescription pill called fluconazole (sample brand name: Diflucan) is another option for treating yeast infections. Most women only need one dose, although women with more complicated infections (such as those with underlying medical problems, recurrent yeast infections, or severe signs and symptoms) may require a second dose 72 hours (three days) after the first dose.

• #8 Vaginal yeast infection (thrush): Learn More – Vaginal yeast infections (thrush): What can help? – InformedHealth.org – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK543219/

  Vaginal infections are often caused by an overgrowth of yeast (a type of fungus). Also known as thrush, yeast infections in the vagina usually go away after a short course of treatment with antifungal medication. It is not clear whether home remedies help. […] Vaginal yeast infections are treated with antifungal drugs (antimycotics). The symptoms usually go away after a short course of treatment with these medications when used locally in and around the vagina. […] Antifungal drugs kill or reduce the growth of fungi (including yeast). The following medications are often used to treat vaginal yeast infections: clotrimazole, nystatin, ciclopirox, fluconazole. […] Simple infections clear up after a few days of locally applied treatment (vaginal suppositories or creams). Depending on the drug used, the treatment takes one, three or six days.

• #9 Vaginal yeast infection (thrush): Learn More – Vaginal yeast infections (thrush): What can help? – InformedHealth.org – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK543219/

  Research has shown that medications like fluconazole tablets work somewhat better than creams or vaginal suppositories do. But all of the treatments are equally good at relieving symptoms such as itching or burning. […] If you have a complicated vaginal yeast infection, its a good idea to talk to your doctor. He or she may recommend using a treatment over a longer period of time. […] When treating complicated vaginal yeast infections, an initial treatment is typically followed by maintenance treatment. […] This is usually followed by maintenance treatment, where you take one antifungal tablet per week over a period of six months. […] There are vaginal suppositories or capsules that contain live lactic acid bacteria (probiotics). These products are designed to protect and restore the natural balance in the vagina. They may help to fight a yeast infection when used in addition to antifungal drugs.

• #10 Patient education: Vaginal yeast infection (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/vaginal-yeast-infection-beyond-the-basics/print

  Side effects of fluconazole are mild and infrequent, but may include stomach upset, headache, and rash. Fluconazole interacts with a number of medications; ask your doctor, nurse, or pharmacist if you have concerns. Fluconazole is not recommended during pregnancy due to the potential risk of harm to the developing baby. […] When will I feel better?—Most yeast infections go away within a few days of starting treatment. However, you may continue to feel itchy and irritated, even after the infection is gone. If you do not get better within a few days after finishing treatment, call your doctor or nurse for advice. […] TREATMENT OF RECURRENT VAGINAL YEAST INFECTIONS […] Women with persistent symptoms are usually given a longer course of treatment for infections. This might involve several doses of fluconazole taken a few days apart, followed by weekly doses for the next six months or longer. While long-term treatment plans may prevent recurrent vaginal yeast infections, symptoms may still recur when treatment is stopped.

• #11 Yeast infection (vaginal) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/yeast-infection/diagnosis-treatment/drc-20379004

  The other medicine is ibrexafungerp (Brexafemme). […] Treatment for yeast infections that have severe symptoms or that happen often might include: […] Long-course vaginal therapy. You use an antifungal medicine daily for up to two weeks. […] More than one dose of medicine taken by mouth. […] Boric acid therapy. A capsule that has boric acid is put into your vagina. […] No alternative medicine therapies have been proved to treat vaginal yeast infections. […] Talk to your healthcare professional about what alternative therapies for vaginal yeast infection may be safe for you. […] If you’ve been treated for a yeast infection in the past, your healthcare professional may prescribe a treatment over the phone without seeing you. […] Don’t use tampons or douche before your appointment. […] Some questions to ask about vaginal yeast infections include: […] Be sure to ask all the questions you have.

• #12 Treatment of Vulvovaginal Candidiasis—An Overview of Guidelines and the Latest Treatment Methods

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10455317/

  Oteseconazole, approved by FDA, is a new oral azole drug that has the same CYP51 selectivity as other drugs in this class, but it does not bind to and inhibit human CYP51 without causing many side effects. The mechanism of action of oteseconazole is shown in Figure 1. Oteseconazole, similar to triazoles, inhibits the fungal lanosterol 14-demethylase and, as a result, inhibits ergosterol biosynthesis. Nevertheless, in contrast to triazoles, oteseconazole has not three, but four nitrogen atoms in a five-member ring. This results in greater selectivity for fungal enzymes. A study has shown that oteseconazole is effective not only against C. albicans, but also against C. glabrata. In a 2022 multicenter, randomized, double-blind phase III study, participants were randomized to receive either oteseconazole or fluconazole. The study showed that oral oteseconazole 600 mg on day 1 (4 150 mg) and 450 mg on day 2 (3 150 mg) was as effective as fluconazole in the treatment of an acute episode of VVC, followed by oteseconazole 150 mg once daily weekly for the first 11 weeks of the maintenance phase. A phase IIa study by Brand et al., conducted on 55 participants, comparing oteseconazole to fluconazole showed no statistical difference between the groups treated with these drugs. The doses of oteseconazole were 300 mg daily for 3 days, 600 mg daily for 3 days, and 600 mg twice daily for 3 days, and the dose of fluconazole was 150 mg once daily for 3 days. The minimal inhibitory concentration (MIC) of oteseconazole against fluconazole-resistant C. glabrata was 64-fold lower than the MIC of fluconazole. Another sensitivity study, which was conducted on 219 patients, showed that the effects of oteseconazole on fungal isolates ranged from 0.0005 to 0.25 g/mL compared to fluconazole, which ranged from 0.06 to 32 g/m2. The limitation of both studies is the small number of participants from whom C. glabrata was isolated—11.8% and 1.8% of patients, respectively.

• #13 Treatment of Vulvovaginal Candidiasis—An Overview of Guidelines and the Latest Treatment Methods

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10455317/

  Ibrexafungerp, a triterpenoid antifungal medicine, reduces the number of (1,3)-D-glucan polymers, which weakens the fungal cell wall and leads to the death of the fungal cell. When treated with ibrexafungerp, there is not as much potential for cytochrome P450 interactions (increased with azoles) as the target only exists in the fungal cell wall. In addition, most side effects are mild and mainly affect the gastrointestinal tract. In a 2022 study, Schwebke et al. evaluated the effectiveness of treating patients with acute VVC with ibrexafungerp compared to a placebo group. Out of 188 patients included in the research sample, only 11 women in mycological examination showed the presence of Candida glabrata. The study actually showed an improvement in clinical cure rates compared to the placebo group (50.5% vs. 28.6%). However, it is limited by too few patients with strains other than C. albicans. Therefore, more research should be conducted on the efficacy of ibrexafungerp in VVC in patients with azole-resistant strains.

• #14 Vulvovaginal Candidiasis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/candidiasis.htm

  Severe VVC (i.e., extensive vulvar erythema, edema, excoriation, and fissure formation) is associated with lower clinical response rates among patients treated with short courses of topical or oral therapy. […] Either 714 days of topical azole or 150 mg of fluconazole in two sequential oral doses (second dose 72 hours after initial dose) is recommended. […] The optimal treatment of nonalbicans VVC remains unknown; however, a longer duration of therapy (714 days) with a nonfluconazole azole regimen (oral or topical) is recommended. […] If recurrence occurs, 600 mg of boric acid in a gelatin capsule administered vaginally once daily for 3 weeks is indicated. […] Women with underlying immunodeficiency, those with poorly controlled diabetes or other immunocompromising conditions (e.g., HIV), and those receiving immunosuppression therapy (e.g., corticosteroid treatment) might not respond as well to short-term therapies. […] Only topical azole therapies, applied for 7 days, are recommended for use among pregnant women.

• #15 Yeast infections: Causes, symptoms, and treatment

  https://www.medicalnewstoday.com/articles/151172

  Treatment includes short-course medication for uncomplicated cases or a longer course for complicated cases. […] The fastest way to get rid of a yeast infection is to contact a doctor. They can provide a timely and accurate diagnosis. They will prescribe the right treatment for the condition. […] Treatment of the infection depends on whether it is complicated or uncomplicated. A complicated yeast infection may involve more symptoms or they may be more severe. For example, a person may experience vaginal or labial swelling. […] There are two ways to treat an uncomplicated yeast infection: vaginal therapy or oral treatment. […] When treating an uncomplicated yeast infection, a short course of vaginal therapy is usually sufficient. […] One option is a one-time treatment of a prescription or an over-the-counter (OTC) medication, such as: butoconazole (Gynazole-1), clotrimazole (Gyne-Lotrimin), miconazole (Monistat 3), terconazole (Terazol 3).

• #16 Treatment of Vulvovaginal Candidiasis—An Overview of Guidelines and the Latest Treatment Methods

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10455317/

  Despite the effectiveness of the treatment of uncomplicated VVC with azoles, due to the potential systemic adverse effects associated with the use of oral drugs, it seems important to strive for the implementation of new methods of treatment for vaginal fungal infections. On the one hand, the studies we described showed that probiotics, TOL-463, and chlorhexidine were associated with significant effectiveness or a small number of side effects. On the other hand, the guidelines of the Centers for Disease Control and Prevention do not recommend the use of these drugs in the treatment of VVC. Therefore, it is necessary to conduct further studies, which may result in the approval of these drugs for use. […] Treatment of non-albicans species VVC is challenging because they are very often resistant to azoles and nearly 50% of affected women might present minimal or no symptoms. Currently, in the case of the C. glabrata infection, according to German guidelines from 2021, the local administration of nystatin or ciclopiroxolamine may be considered. In the event of recurrence, according to the guidelines of the American Centers for Disease Control and Prevention, it is worth considering the use of therapy including 600 mg of boric acid in a gelatin capsule administered vaginally once daily for 2 weeks. Nevertheless, it should be taken into account that the application of boric acid can impair fertility and might be embryotoxic; therefore, it is not recommended for women of reproductive age. What is more, in the study conducted by Philipps between 1995 and 2004, 10 patients identified with non-albicans (9 with C. glabrata and 1 with C. tropicalis) infection were treated with 50 mg amphotericin B vaginal suppositories for 14 days, and after that, 8 of them showed no further infection (2 who failed were infected with C. glabrata).

• #17 Treatment of Vulvovaginal Candidiasis—An Overview of Guidelines and the Latest Treatment Methods

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10455317/

  With regard to other species of Candida, C. dubliniensis is sensitive to imidazoles. As for C. tropicalis and C. guilliermondii, they can be successfully treated as C. albicans infections, and C. kefyr is unlikely to cause vaginitis. […] Along with research on the new possibilities of treating VVC appeared new hopes for reducing the treatment time for complicated episodes, thereby decreasing the risk of Candida strains developing resistance to the drugs. Oral ibrexafungerp exhibits in vitro activity against a broad range of Candida species, including echinocandin- and azole-resistant isolates. However, it was reported that the drug has lower potency against C. krusei than against other species. […] Another example of complicated VVC is associated with diabetes mellitus. Both patients struggling with the disease and those with an increased risk of developing it are in the group at higher risk of VVC. Possible reasons are connected with hyperglycemia in vaginal cells. It is associated with increased fungal adhesion and binding and also reduces the ability of neutrophils to perform effective phagocytosis of these cells. What is more, these patients are more likely to have non-albicans Candida species infections, particularly those caused by C. glabrata and characterized by a less effective response to antimycotic therapy. This may be due to the fact that some diabetic patients are treated with SGLT2 inhibitors (e.g., dapagliflozin and canagliflozin), which are supposed to increase the number of VVC episodes. This is probably related to the mechanism of action of these drugs, which is based on lowering blood glucose levels by decreasing the renal threshold for glucose and increasing its excretion in the urine, which may predispose to more frequent infections.

• #18 Treatment of Vulvovaginal Candidiasis—An Overview of Guidelines and the Latest Treatment Methods

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10455317/

  As for HIV infection, there is no evidence that HIV-positive women respond worse to therapies used in HIV-negative patients, and there is no proof that VVC predisposes to HIV infection. It is known that cases of VVC are less frequent than oropharyngeal candidiasis; however, if they occur in women with advanced immunosuppression, VVC episodes may be more severe and recur more often. In most cases, VVC in these patients is uncomplicated and should be treated according to general guidelines as uncomplicated VVC. In the available literature, there are also no data indicating that there would be a need to delay treatment with antiretroviral therapy (ART) until the treatment for candidiasis is completed. […] Long-term use of oral fluconazole and/or topical clotrimazole may increase the likelihood of the emergence of azole-resistant Candida species. The incidence of VVC caused by treatment-resistant species such as C. tropicalis, C. glabrata, C. krusei, C. parapsilosis, C. kefyr, and C. lusitaniae is estimated at 25-45%. The type of resistance and virulence of Candida in response to conventional VVC treatment is mainly dependent on the formation of the fungal biofilm. A biofilm is a group of microorganisms attached to a surface and surrounded by an extracellular matrix, which reduces the susceptibility of pathogens to antimicrobial agents. Therefore, due to differences in their pathogenicity and profiles of resistance to current antifungal drugs, studies describing new therapeutic strategies for azole-resistant Candida can be observed in recent times.

• #19 Treatment of Vulvovaginal Candidiasis—An Overview of Guidelines and the Latest Treatment Methods

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10455317/

  The increase in resistance of many Candida species to current antifungal drugs and the use of unproven VVC treatment methods by patients are important reasons and premises for further studies on the effectiveness of oteseconazole, ibrexafungerp, and voriconazole, as well as other new therapeutic strategies. This is important not only because of the high incidence of VVC in women, but also to improve patient comfort. […] RVVC is a chronic, difficult-to-treat, devastating infection affecting women worldwide. In the United States, RVVC is defined as three or more episodes of symptomatic VVC in less than one year. On the other hand, European guidelines and guidelines from the Infectious Diseases Society of America define RVVC as four or more symptomatic episodes of VVC during a one-year period. Current treatment protocols confirm that at least three symptomatic episodes of VVC are considered sufficient for the diagnosis of RVVC. The global prevalence of the disease is 38-71 per 100,000 women, and 372 million women are affected for their entire lifetime. Less common species such as C. glabrata, C. dubliniensis, C. lusitaniae, C. tropicalis, C. krusei, C. kefyr, and C. parapsilosis may be involved in the etiology of RVVC. Vaginitis caused by strains other than C. albicans is more resistant to treatment.

• #20 Treatment of Vulvovaginal Candidiasis—An Overview of Guidelines and the Latest Treatment Methods

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10455317/

  The most common treatment schedule for RVVC is induction therapy with a topical antifungal drug or oral fluconazole at a dose of 150 mg for 10-14 days, and then oral fluconazole is given at a dose of 150 mg for 6 months. Resistance to fluconazole is observed in women with RVVC, but improper use of the drug must be excluded before resistance can be diagnosed. Long-term treatment with fluconazole is associated with high costs and side effects, while about 50% of women experience a recurrence of symptoms a few months after the end of treatment. Therapeutic approaches also suggested include changing the method of contraception from hormonal to mechanical ones, treating the sexual partner, and using topical gentian violet. Topical treatment of RVVC may include clotrimazole, miconazole, terconazole, and vaginal boric acid, as well as nystatin. However, the literature suggests that azoles are more effective than nystatin. The limited efficacy of treatment with these methods indicates the importance of implementing new, more effective therapies for RVVC that can be used in the long term without significant side effects.

• #21 Vulvovaginal Candidiasis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/candidiasis.htm

  No substantial evidence exists to support using probiotics or homeopathic medications for treating VVC. […] Most episodes of recurrent VVC caused by C. albicans respond well to short-duration oral or topical azole therapy. […] To maintain clinical and mycologic control, a longer duration of initial therapy (e.g., 714 days of topical therapy or a 100-mg, 150-mg, or 200-mg oral dose of fluconazole every third day for a total of 3 doses [days 1, 4, and 7]) is recommended, to attempt mycologic remission, before initiating a maintenance antifungal regimen. […] Oral fluconazole (i.e., a 100-mg, 150-mg, or 200-mg dose) weekly for 6 months is the indicated maintenance regimen. […] If this regimen is not feasible, topical treatments used intermittently can also be considered. […] Suppressive maintenance therapies are effective at controlling recurrent VVC but are rarely curative long-term.

• #22 Treatment of Vulvovaginal Candidiasis—An Overview of Guidelines and the Latest Treatment Methods

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10455317/

  Oteseconazole (VT-1161) was approved in April 2022 by the US Food and Drug Administration (FDA) for the treatment of RVVC in women without reproductive potential. For women with RVVC, oteseconazole may probably be a first-line drug due to its prevention of vaginal recolonization for a longer period of time than current treatment options, especially in women infected with C. glabrata, as well as those with badly controlled diabetes mellitus in whom there is an impaired response to fluconazole. […] In June 2021, ibrexafungerp, a new oral glucan synthase inhibitor, was approved by the FDA for the treatment of RVVC in women after menopause. It is active against multiple strains of Candida that are resistant to azoles and echinocandins. The recommended dose for oral administration is 300 mg (150 mg twice a day). It shows fungicidal activity in a concentration-dependent manner against Candida spp., and the in vitro activity does not change with azole resistance. Phase III clinical trials have shown that ibrexafungerp is effective in inducing a complete clinical response with sustained resolution of symptoms compared to placebo in patients with acute VVC.

• #23 Treatment of Vulvovaginal Candidiasis—An Overview of Guidelines and the Latest Treatment Methods

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10455317/

  An immunotherapeutic vaccine (NDV-3A) containing a recombinant C. albicans adhesin/invasin protein was evaluated for the prevention of RVVC in an exploratory, phase 2, randomized, double-blind, placebo-controlled trial. The study was conducted on 188 women with RVVC aged 18-55 years, using an approved method of birth control, who presented a clinically diagnosed, active episode of VVC at the time of study eligibility. A single intramuscular dose of the vaccine was safe; it generated a rapid and robust immune response and reduced the incidence of symptomatic RVVC episodes for up to 12 months in 188 women with RVVC. Despite the promising results, the efficacy of the vaccine was evaluated only according to symptoms, and a prolonged efficacy evaluation was missing. The study also did not include an assessment of patients’ quality of life, so some potential clinical measures of efficacy were not obtained. Further studies are required to confirm the safety and efficacy of immunotherapeutic vaccines in RVVC.

• #24 Treatment of Vulvovaginal Candidiasis—An Overview of Guidelines and the Latest Treatment Methods

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10455317/

  Designed antimicrobial peptides (dAMPs) are artificially synthesized molecules modeled on naturally occurring antimicrobial peptides that have direct fungicidal activity. A 2019 study by Woodburn et al. evaluated the efficacy in vitro of four types of dAMPs (RP504, RP544, RP556, and RP557) derived from tachyplesin I for their potential use in the topical treatment of RVVC. These peptides showed broad-spectrum antifungal activity against 46 clinical isolates, including fluconazole-sensitive and -resistant strains of C. albicans, C. glabrata, C. tropicalis, and C. parapsilosis, as well as spontaneously resistant C. krusei. Showing fungicidal activity, in contrast to fluconazole’s fungistatic effect, and having a low predisposition to induce resistance among microorganisms, dAMPs may become potential therapeutic agents for the treatment of RVVC.

• #25 Treatment of Vulvovaginal Candidiasis—An Overview of Guidelines and the Latest Treatment Methods

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10455317/

  The occurrence of VVC is strongly dependent on the current hormonal state of the patients. All conditions related to elevated estrogen levels, such as pregnancy and the use of hormonal contraceptives or hormonal replacement therapy, are VVC risk factors. It is estimated that during pregnancy the incidence of VVC significantly increases in comparison to that in non-pregnant women; however, the exact statistics are missing. The treatment of VVC in pregnancy is quite problematic, as on the one hand, it is definitely needed to avoid complications arising from the infection, and on the other hand, therapy schemes must be appropriately modified to make treatment the safest. […] Currently available guidelines are largely consistent when it comes to the usage of azoles in the therapy of VVC in pregnant women. In general, the use of locally administered azoles is recommended. The guidelines developed by the Centers for Disease Control and Prevention included a limited statement recommending the use of topical azoles for 7 days, and no other detailed recommendations were established. Contrastingly, the British Association for Sexual Health and HIV listed several treatment schemes which can be applied, and the distinct management for acute and recurrent VVC among pregnant women was distinguished. In case of acute VVC, the authors recommend the use of 500 mg of clotrimazole in pessary daily for 7 days. Moreover, as an alternative, they indicate a 7-day therapy regimen with the use of clotrimazole at a reduced dose (200 mg) or 5 mg of 10% clotrimazole in cream. Additionally, other treatment options include the use of 150 mg of econazole in pessary, as well as miconazole in cream (5 g of 2% agent, daily for 7 days) or in capsules (1200 or 400 mg daily for 7 days). In turn, in the case of the presence of RVVC, the guidelines recommend only the following management: topical imidazole for 10-14 days and 500 mg clotrimazole in pessary once a week for maintenance.

• #26 Treatment of Vulvovaginal Candidiasis—An Overview of Guidelines and the Latest Treatment Methods

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10455317/

  According to the latest guidelines prepared by the previously mentioned German research group, the most desirable treatment scheme is in line with the previously mentioned schemes and includes the use of clotrimazole locally. The authors especially highlight the reasonableness of such management in the first pregnancy trimester to avoid oral azole administration and the following potential fetal malformations. Although the results of meta-analysis regarding the occurrence of complications resulting from fluconazole therapy indicated that such a treatment regimen did not significantly increase the risk of various congenital malformations, they suggested the need for further investigation of a potential association between heart defects and fluconazole exposure. […] Several national and international guidelines recommend the application of boric acid as a substitute for azole-based therapy in non-pregnant women; however, in pregnant individuals, such a treatment regimen may be associated with an increased risk of various congenital malformations, and thus it seems that it should be avoided. Another treatment option that was discussed in terms of the treatment of pregnant women affected by VVC was the use of dequalinium chloride (DQC), known for its antimicrobial and antifungal properties. Mendling and colleagues have indicated this agent as an effective treatment option leading to the cure of VVC in pregnant patients; however, their conclusions were drawn based on the results of an unpublished drug utilization trial, as well as a study with a small sample size. That is why their findings cannot be considered as certainly relevant.

• #27 Treatment of Vulvovaginal Candidiasis—An Overview of Guidelines and the Latest Treatment Methods

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10455317/

  Apart from the evaluation of the role of conventional treatment methods for VVC, there are also studies concerning the usage of alternative ones based on substances of natural origin. Abdelmonem et al. decided to compare the efficacy of the vaginal-administered mixture consisting of bee honey and yogurt with vaginal-administered tioconazole at a dose of 100 mg in the treatment of VVC in 129 pregnant women. Interestingly, among the patients in the first group, the authors noticed a greater clinical improvement in terms of itching, discharge, and vulvovaginal redness. Additionally, the application of this natural mixture resulted in a significantly lower incidence of reported treatment-related symptoms in the form of local irritation. Thus, the results of this study indicate the possibility of the application of natural-derived substances locally in VVC treatment. Studies describing non-azole-based treatment methods in VVC affecting pregnant women are presented in Table 4. […] Thus, considering satisfactory effectiveness, as well as a minor risk of side effects of such natural-product-based therapies, further experiments should also focus on these kinds of agents.

• #28 11 Home Remedies for Vaginal Yeast Infection

  https://www.healthline.com/health/womens-health/yeast-infection-home-remedy

  Probiotics can be effective against Candida Albicans and yogurt can be considered a probiotic because it contains live bacteria, such as Lactobacillus acidophilus. These bacteria help promote a healthy environment in your vagina, and they can help address an overgrowth caused by an imbalance. […] Boric acid vaginal suppositories may be used in combination with medications to treat vaginal infections. […] A 2017 study suggests oregano essential oil may prove effective for altering the growth of Candida Albicans. […] Probiotics can help restore the bacteria-yeast balance throughout your body. […] Research suggests coconut oil is effective against C. Albicans, making this home remedy one of the few with supportive evidence behind it. […] In fact, research supports tea tree oils antifungal properties.

• #29 11 Home Remedies for Vaginal Yeast Infection

  https://www.healthline.com/health/womens-health/yeast-infection-home-remedy

  One popular yeast infection remedy is an apple cider vinegar bath. […] Evidence suggests garlic may also help kill Candida, though some strains may prove more effective than others. […] Hydrogen peroxide is an antiseptic that can kill bacteria and yeast. […] Vitamin C, also called ascorbic acid, has antimicrobial components, so some people add it to their diet to treat Candida overgrowth. […] Some doctors recommend vitamin E for certain types of vaginal inflammation. […] The fastest and most reliable way to get rid of a yeast infection is to visit a doctor if you suspect you have one. […] Most simple vaginal yeast infections improve with OTC vaginal creams or suppositories. You can find these products in 1-day, 3-day, and 7-day treatments.

• #30 Treatment of Vulvovaginal Candidiasis—An Overview of Guidelines and the Latest Treatment Methods

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10455317/

  Probiotics seem to be a controversial alternative to azoles. In vitro studies have shown that exogenous Lactobacilli inhibit the formation of C. albicans biofilm. In 2021, Stabile et al. conducted a study on 40 women divided into two groups. The first group consisted of patients treated with topical clotrimazole for 6 days, and the second group of patients was treated with oral clotrimazole which contained live strains of Saccharomyces cerevisiae, melatonin, and Lactobacillus idophilus GLA-14 (Unilen Microbio+). C. albicans infection was found in 85% of women, and C. glabrata was the cause in the remaining women. Treatment with Unilen Microbio+ has been shown to be more effective than topical treatment with clotrimazole alone (90% vs. 80%). No patient experienced side effects during treatment. Moreover, the frequency of relapses was twice as high in the group treated with clotrimazole alone than in the group treated with the preparation. However, the guidelines of the Centers for Disease Control and Prevention clearly indicate the lack of evidence for the use of probiotics in the treatment of VVC.

• #31 Yeast infections: Causes, symptoms, and treatment

  https://www.medicalnewstoday.com/articles/151172

  Alternatively, a person can use an oral antifungal, such as fluconazole (Diflucan), in one single dose. […] In the case of a complicated yeast infection, treatment will include the use of long-course vaginal therapy or multidose oral formulations. […] Long-course vaginal therapy includes treatment with a vaginal cream, ointment, tablet, or suppository for approximately 714 days. […] If symptoms are severe, a doctor may prescribe a few days of topical steroids to help ease symptoms while the antifungal medication works. […] If maintenance medications are necessary, these begin after one of the above methods of treatment has finished. It may include weekly treatment with oral fluconazole for 6 months or weekly treatment with vaginal clotrimazole.

• #32 Treatment of Candidiasis | Candidiasis | CDC

  https://www.cdc.gov/candidiasis/treatment/index.html

  Candidiasis is treated with antifungal medication. […] Antifungal medications come in different forms: creams, oral gels, pills, or intravenous (IV). […] The type of antifungal, dose, and length of treatment depend on the type and severity of infection and the patient’s overall health. […] Take antifungal medications as instructed for as long as directed. […] Treatment is usually an antifungal cream applied inside the vagina or a single dose of fluconazole taken by mouth. […] If symptoms return, don’t improve, or get worse after starting treatment, healthcare providers may adjust the treatment by prescribing: More doses of fluconazole taken by mouth. […] Other medicines applied inside the vagina, such as boric acid, nystatin, or flucytosine.

• #33

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=uf7069

  With treatment, most yeast infections get better in a few days. […] Ask your doctor about over-the-counter (OTC) medicines for yeast infections. If you use an OTC treatment, read and follow all instructions on the label. […] If you are using a vaginal medicine, don’t have sex until you have finished your treatment. But if you do have sex, don’t depend on a latex condom or diaphragm for birth control. The oil in some vaginal medicines weakens latex. […] Call your doctor or nurse advice line now or seek immediate medical care if: You have new or increased pain in your vagina or pelvis. […] You are not getting better after 2 days. […] Your symptoms come back after you finish your medicines.

• #34 Vaginal Yeast Infection: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/5019-vaginal-yeast-infection

  Most yeast infections clear up with medication after a few days, but it may take a full week. […] No, a yeast infection cant go away on its own. Only a medication that destroys fungus (yeast) will treat a vaginal yeast infection. […] If you get more than four vaginal yeast infections per year, have a discussion with your healthcare provider. […] Your healthcare provider will use your test results to make sure you receive the right treatment. It can be important to treat the underlying cause while treating your yeast infection. […] Yeast infections are a very common fungal infection that most women will have in their lifetime. Its highly treatable with medication, some of which are available to purchase at your local drug store without a prescription.

• #35 Nonprescription Management of Vulvovaginal Candidiasis

  https://www.uspharmacist.com/article/nonprescription-management-of-vulvovaginal-candidiasis

  Patient counseling should include information on proper use, including instructions on cleaning the applicator if using reusable applicators. […] Some patients have turned to probiotics for preventing VVC. […] There are many OTC antifungal agents that can treat VVC. They generally differ in cost, formulation, and duration of treatment (1, 3, or 7 days), but are all equally effective. […] A sitz bath may be used to provide prompt relief. Daily consumption of yogurt with live cultures may help prevent VVC recurrences. […] It is vital to know that length of treatment does not always correspond with resolution of symptoms, particularly for shorter treatments; symptoms may take up to a week to resolve.

• #36 Vaginal yeast infections

  https://womenshealth.gov/a-z-topics/vaginal-yeast-infections

  Most women will get a vaginal yeast infection at some point in their life. […] Yeast infections are easy to treat, but it is important to see your doctor or nurse if you think you have an infection. […] Yeast infections are caused by overgrowth of the microscopic fungus Candida. […] Yeast infections are usually treated with antifungal medicine. […] You can then buy antifungal medicine for yeast infections at a store, without a prescription. Antifungal medicines come in the form of creams, tablets, ointments, or suppositories that you insert into your vagina. […] Your doctor or nurse can also give you a single dose of antifungal medicine taken by mouth, such as fluconazole (floo-CON-uh-zohl). […] If you get more than four vaginal yeast infections a year, or if your yeast infection doesn’t go away after using over-the-counter treatment, you may need to take regular doses of antifungal medicine for up to six months.

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