Grzybica pochwy – Rokowania, prognozy i postęp choroby

Grzybica pochwy
Rokowania, prognozy i postęp choroby

Grzybica pochwy zazwyczaj dobrze reaguje na leczenie przeciwgrzybicze, zarówno miejscowe, jak i doustne, z całkowitym ustąpieniem objawów. Nawracająca grzybica pochwy (RVVC), definiowana jako ≥4 epizody infekcji drożdżakowej w ciągu roku, dotyczy około 5% kobiet i wymaga długotrwałej terapii. Nawrót obserwuje się u 14-28% zdrowych kobiet, a u 55% pacjentek po terapii podtrzymującej flukonazolem (150 mg raz w tygodniu przez 6 miesięcy) dochodzi do ponownego wystąpienia infekcji. Czynniki predysponujące obejmują przetrwałe szczepy Candida, reinfekcję endogenną, predyspozycje genetyczne, stosowanie antybiotyków, aktywność seksualną oraz choroby współistniejące, takie jak cukrzyca czy immunosupresja (np. HIV). Diagnostyka powinna obejmować badania mikologiczne potwierdzające obecność patogenu przy każdym nawrocie.

Prognoza grzybicy pochwy (Yeast infection (vaginal) – Prognosis)

Nawracająca grzybica pochwy
Przyczyny nawrotów
Czynniki wyzwalające nawroty
Strategia leczenia nawrotów
Skuteczność leczenia nawrotów
Leczenie infekcji wywołanych przez gatunki non-albicans
Wnioski prognostyczne
Kolejne rozdziały

Prognoza grzybicy pochwy (Yeast infection (vaginal) – Prognosis)

Większość przypadków grzybicy pochwy reaguje dobrze na odpowiednie leczenie, a objawy całkowicie ustępują po zastosowaniu właściwej terapii przeciwgrzybiczej. ¹ Leki przeciwgrzybicze (zarówno miejscowe jak i doustne) wykazują wysoką skuteczność w eliminacji infekcji. ² Jednakże pomimo odpowiedniego leczenia, w pewnym odsetku przypadków obserwuje się nawroty choroby.

Nawracająca grzybica pochwy

Nawrotowość grzybicy pochwy jest stosunkowo częstym zjawiskiem i szacuje się, że występuje u około 14% do 28% zdrowych kobiet. ³ Nawracająca grzybica pochwy (RVVC – Recurrent Vulvovaginal Candidiasis) definiowana jest jako cztery lub więcej epizodów objawowej infekcji drożdżakowej w ciągu jednego roku. ⁴ Około 5% kobiet rozwija nawracającą grzybicę pochwy i może wymagać przedłużonej terapii przeciwgrzybiczej. ⁵

Przyczyny nawrotów

Najczęstsze przyczyny nawrotów grzybicy pochwy obejmują:

Przetrwałe organizmy drożdżakowe w pochwie – najczęściej nawroty wynikają z utrzymywania się tych samych szczepów Candida ⁶
Endogenna reinfekcja identycznym szczepem Candida ⁷
Rzadziej – infekcja nowym szczepem Candida ⁸
Predyspozycje genetyczne – uważa się, że najczęstszą przyczyną jest genetyczna predyspozycja błony śluzowej pochwy do Candida albicans, w wyniku której nawet niewielka ilość drożdżaków wywołuje znaczącą reakcję zapalną ⁹

Czynniki wyzwalające nawroty

Do czynników mogących wywołać nawrót grzybicy pochwy należą:

Stosowanie antybiotyków ¹⁰
Aktywność seksualna ¹¹
Czynniki dietetyczne ¹²
Choroby współistniejące – obecność cukrzycy lub osłabionego układu odpornościowego (np. w zakażeniu HIV) może przyczynić się do nawrotów infekcji bezpośrednio po leczeniu lub braku odpowiedzi na standardowe leczenie ¹³

Strategia leczenia nawrotów

W przypadku nawracającej grzybicy pochwy zalecana jest dwuetapowa strategia leczenia:

Terapia indukcyjna (wysokie dawki przez krótki czas) – optymalna terapia rozpoczyna się od trzech dawek flukonazolu 150 mg podawanych co 72 godziny ¹⁴
Terapia podtrzymująca (niskie dawki przez długi czas) – po fazie indukcyjnej stosuje się flukonazol w dawce 150 mg raz w tygodniu przez sześć miesięcy ¹⁵

Po zastosowaniu takiego schematu leczenia, wiele pacjentek doświadcza długotrwałej remisji. Jednak u około 55% kobiet obserwuje się ponowne wystąpienie infekcji. ¹⁶ Ważne jest, aby każdy nawrót był potwierdzony badaniem mikologicznym (sama obecność objawów nie jest wystarczająca do rozpoznania). ¹⁷

Skuteczność leczenia nawrotów

Skuteczność długoterminowej terapii podtrzymującej w przypadku nawracającej grzybicy pochwy jest ograniczona:

Terapia jest skuteczna w osiąganiu ujemnych wyników posiewów, ale zapobiega nawrotom tylko tak długo, jak jest kontynuowana ¹⁸
U około 50% kobiet z nawracającą grzybicą pochwy nie udaje się osiągnąć trwałego wyleczenia ¹⁹

Leczenie infekcji wywołanych przez gatunki non-albicans

Miejscowe imidazole i doustny flukonazol wykazują mniejszą skuteczność u pacjentek z infekcjami wywołanymi przez gatunki Candida inne niż C. albicans. ²⁰ W takich przypadkach:

Wskazane jest wykonanie posiewu w kierunku grzybów u pacjentek z utrzymującymi się objawami po standardowym leczeniu niepowikłanej grzybicy pochwy ²¹
Kwas borowy (600 mg dopochwowo przez co najmniej 14 dni) jest często skuteczny w przypadku infekcji wywołanych przez C. glabrata i inne nietypowe gatunki ²²
Uwaga: Kwas borowy może być śmiertelny w przypadku spożycia doustnego, dlatego pacjentki muszą być dokładnie poinformowane o sposobie jego stosowania ²³

Wnioski prognostyczne

Podsumowując, rokowanie w grzybicy pochwy jest zazwyczaj dobre, a większość przypadków reaguje na standardowe leczenie przeciwgrzybicze. Jednak nawracająca grzybica pochwy stanowi wyzwanie terapeutyczne i wymaga długotrwałego leczenia. Identyfikacja czynników ryzyka nawrotów oraz odpowiednie dostosowanie schematu leczenia (szczególnie w przypadku infekcji wywołanych przez gatunki non-albicans) są kluczowe dla długoterminowego powodzenia terapii. ²⁴²⁵²⁶

Kolejne rozdziały

Zapraszamy do dalszego czytania naszego leksykonu.

Wybierz kolejny rozdział z menu poniżej, aby otworzyć nową podstronę kompedium wiedzy i uzyskać szczegółowe informację o leku, substancji lub chorobie.

Materiały źródłowe

#1 Vaginal yeast infection Information | Mount Sinai – New York
https://www.mountsinai.org/health-library/diseases-conditions/vaginal-yeast-infection
Most of the time, symptoms go away completely with proper treatment. […] A woman may have diabetes or weak immune system (such as in HIV) if: The infection recurs right after treatment, The yeast infection does not respond well to treatment.
#2 Vaginal Yeast Infection – Harvard Health
https://www.health.harvard.edu/a_to_z/vaginal-yeast-infection-a-to-z
Medications cure most vaginal yeast infections. About 5% of women develop RVVC and may require further treatment with prolonged antifungal therapy.
#3 Vaginal Candidiasis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK459317/
Prognosis: Despite appropriate treatment, recurrence is relatively common and is estimated to range from 14% to 28% in otherwise healthy individuals. Most often, recurrent disease arises from persistent vaginal organisms or endogenous reinfection with an identical strain of Candida. Less commonly, the disease may result from a new strain of Candida. Recurrent disease may be triggered by antibiotic use, sexual activity, or dietary factors. Genetic susceptibility may also affect a person’s risk for recurrent disease. […] Topical imidazole and oral fluconazole are less likely to be effective in patients with non-albicans species of Candida. Therefore, fungal culture is indicated in patients with persistent symptoms after standard treatment for uncomplicated vulvovaginal candidiasis. Boric acid (600 mg vaginally for at least 14 days) is often effective against C glabrata and other atypical species. Note that boric acid can be fatal if orally ingested, so patients must be well-counseled on its use.
#4 All you need to know about recurrent yeast infection in females
https://stdcenterny.com/articles/female-recurrent-yeast-infection.html
Recurrent yeast infection is defined as four or more episodes of symptomatic yeast infection within one year. […] The most common cause is believed to be a genetic predisposition of the vaginal mucosa to Candida albicans, which results in a small amount of yeast causing a significant inflammatory reaction. […] If female has recurrent yeast infection, an initial induction therapy (a high dose for a short time) is followed by maintenance therapy (a low dose for a long time). […] Optimal therapy begins with three doses of fluconazole 150 mg tablets given 72 hours apart, followed by a fluconazole tablet weekly for six months. After this therapy, many people will go into a long remission, but 55% of females experience recurrence of yeast infection. Reoccurrences need to be confirmed with a culture test (the presence of symptoms is not sufficient). […] This therapy is effective at achieving a negative culture, but it is effective at preventing recurrent infection only as long as it is continued. In 50% of females with recurrent yeast infection, a cure is not achieved.
#5 Vaginal Yeast Infection – Harvard Health
https://www.health.harvard.edu/a_to_z/vaginal-yeast-infection-a-to-z
Medications cure most vaginal yeast infections. About 5% of women develop RVVC and may require further treatment with prolonged antifungal therapy.
#6 Vaginal Candidiasis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK459317/
Prognosis: Despite appropriate treatment, recurrence is relatively common and is estimated to range from 14% to 28% in otherwise healthy individuals. Most often, recurrent disease arises from persistent vaginal organisms or endogenous reinfection with an identical strain of Candida. Less commonly, the disease may result from a new strain of Candida. Recurrent disease may be triggered by antibiotic use, sexual activity, or dietary factors. Genetic susceptibility may also affect a person’s risk for recurrent disease. […] Topical imidazole and oral fluconazole are less likely to be effective in patients with non-albicans species of Candida. Therefore, fungal culture is indicated in patients with persistent symptoms after standard treatment for uncomplicated vulvovaginal candidiasis. Boric acid (600 mg vaginally for at least 14 days) is often effective against C glabrata and other atypical species. Note that boric acid can be fatal if orally ingested, so patients must be well-counseled on its use.
#7 Vaginal Candidiasis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK459317/
Prognosis: Despite appropriate treatment, recurrence is relatively common and is estimated to range from 14% to 28% in otherwise healthy individuals. Most often, recurrent disease arises from persistent vaginal organisms or endogenous reinfection with an identical strain of Candida. Less commonly, the disease may result from a new strain of Candida. Recurrent disease may be triggered by antibiotic use, sexual activity, or dietary factors. Genetic susceptibility may also affect a person’s risk for recurrent disease. […] Topical imidazole and oral fluconazole are less likely to be effective in patients with non-albicans species of Candida. Therefore, fungal culture is indicated in patients with persistent symptoms after standard treatment for uncomplicated vulvovaginal candidiasis. Boric acid (600 mg vaginally for at least 14 days) is often effective against C glabrata and other atypical species. Note that boric acid can be fatal if orally ingested, so patients must be well-counseled on its use.
#8 Vaginal Candidiasis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK459317/
Prognosis: Despite appropriate treatment, recurrence is relatively common and is estimated to range from 14% to 28% in otherwise healthy individuals. Most often, recurrent disease arises from persistent vaginal organisms or endogenous reinfection with an identical strain of Candida. Less commonly, the disease may result from a new strain of Candida. Recurrent disease may be triggered by antibiotic use, sexual activity, or dietary factors. Genetic susceptibility may also affect a person’s risk for recurrent disease. […] Topical imidazole and oral fluconazole are less likely to be effective in patients with non-albicans species of Candida. Therefore, fungal culture is indicated in patients with persistent symptoms after standard treatment for uncomplicated vulvovaginal candidiasis. Boric acid (600 mg vaginally for at least 14 days) is often effective against C glabrata and other atypical species. Note that boric acid can be fatal if orally ingested, so patients must be well-counseled on its use.
#9 All you need to know about recurrent yeast infection in females
https://stdcenterny.com/articles/female-recurrent-yeast-infection.html
Recurrent yeast infection is defined as four or more episodes of symptomatic yeast infection within one year. […] The most common cause is believed to be a genetic predisposition of the vaginal mucosa to Candida albicans, which results in a small amount of yeast causing a significant inflammatory reaction. […] If female has recurrent yeast infection, an initial induction therapy (a high dose for a short time) is followed by maintenance therapy (a low dose for a long time). […] Optimal therapy begins with three doses of fluconazole 150 mg tablets given 72 hours apart, followed by a fluconazole tablet weekly for six months. After this therapy, many people will go into a long remission, but 55% of females experience recurrence of yeast infection. Reoccurrences need to be confirmed with a culture test (the presence of symptoms is not sufficient). […] This therapy is effective at achieving a negative culture, but it is effective at preventing recurrent infection only as long as it is continued. In 50% of females with recurrent yeast infection, a cure is not achieved.
#10 Vaginal Candidiasis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK459317/
Prognosis: Despite appropriate treatment, recurrence is relatively common and is estimated to range from 14% to 28% in otherwise healthy individuals. Most often, recurrent disease arises from persistent vaginal organisms or endogenous reinfection with an identical strain of Candida. Less commonly, the disease may result from a new strain of Candida. Recurrent disease may be triggered by antibiotic use, sexual activity, or dietary factors. Genetic susceptibility may also affect a person’s risk for recurrent disease. […] Topical imidazole and oral fluconazole are less likely to be effective in patients with non-albicans species of Candida. Therefore, fungal culture is indicated in patients with persistent symptoms after standard treatment for uncomplicated vulvovaginal candidiasis. Boric acid (600 mg vaginally for at least 14 days) is often effective against C glabrata and other atypical species. Note that boric acid can be fatal if orally ingested, so patients must be well-counseled on its use.
#11 Vaginal Candidiasis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK459317/
Prognosis: Despite appropriate treatment, recurrence is relatively common and is estimated to range from 14% to 28% in otherwise healthy individuals. Most often, recurrent disease arises from persistent vaginal organisms or endogenous reinfection with an identical strain of Candida. Less commonly, the disease may result from a new strain of Candida. Recurrent disease may be triggered by antibiotic use, sexual activity, or dietary factors. Genetic susceptibility may also affect a person’s risk for recurrent disease. […] Topical imidazole and oral fluconazole are less likely to be effective in patients with non-albicans species of Candida. Therefore, fungal culture is indicated in patients with persistent symptoms after standard treatment for uncomplicated vulvovaginal candidiasis. Boric acid (600 mg vaginally for at least 14 days) is often effective against C glabrata and other atypical species. Note that boric acid can be fatal if orally ingested, so patients must be well-counseled on its use.
#12 Vaginal Candidiasis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK459317/
Prognosis: Despite appropriate treatment, recurrence is relatively common and is estimated to range from 14% to 28% in otherwise healthy individuals. Most often, recurrent disease arises from persistent vaginal organisms or endogenous reinfection with an identical strain of Candida. Less commonly, the disease may result from a new strain of Candida. Recurrent disease may be triggered by antibiotic use, sexual activity, or dietary factors. Genetic susceptibility may also affect a person’s risk for recurrent disease. […] Topical imidazole and oral fluconazole are less likely to be effective in patients with non-albicans species of Candida. Therefore, fungal culture is indicated in patients with persistent symptoms after standard treatment for uncomplicated vulvovaginal candidiasis. Boric acid (600 mg vaginally for at least 14 days) is often effective against C glabrata and other atypical species. Note that boric acid can be fatal if orally ingested, so patients must be well-counseled on its use.
#13 Vaginal yeast infection Information | Mount Sinai – New York
https://www.mountsinai.org/health-library/diseases-conditions/vaginal-yeast-infection
Most of the time, symptoms go away completely with proper treatment. […] A woman may have diabetes or weak immune system (such as in HIV) if: The infection recurs right after treatment, The yeast infection does not respond well to treatment.
#14 All you need to know about recurrent yeast infection in females
https://stdcenterny.com/articles/female-recurrent-yeast-infection.html
Recurrent yeast infection is defined as four or more episodes of symptomatic yeast infection within one year. […] The most common cause is believed to be a genetic predisposition of the vaginal mucosa to Candida albicans, which results in a small amount of yeast causing a significant inflammatory reaction. […] If female has recurrent yeast infection, an initial induction therapy (a high dose for a short time) is followed by maintenance therapy (a low dose for a long time). […] Optimal therapy begins with three doses of fluconazole 150 mg tablets given 72 hours apart, followed by a fluconazole tablet weekly for six months. After this therapy, many people will go into a long remission, but 55% of females experience recurrence of yeast infection. Reoccurrences need to be confirmed with a culture test (the presence of symptoms is not sufficient). […] This therapy is effective at achieving a negative culture, but it is effective at preventing recurrent infection only as long as it is continued. In 50% of females with recurrent yeast infection, a cure is not achieved.
#15 All you need to know about recurrent yeast infection in females
https://stdcenterny.com/articles/female-recurrent-yeast-infection.html
Recurrent yeast infection is defined as four or more episodes of symptomatic yeast infection within one year. […] The most common cause is believed to be a genetic predisposition of the vaginal mucosa to Candida albicans, which results in a small amount of yeast causing a significant inflammatory reaction. […] If female has recurrent yeast infection, an initial induction therapy (a high dose for a short time) is followed by maintenance therapy (a low dose for a long time). […] Optimal therapy begins with three doses of fluconazole 150 mg tablets given 72 hours apart, followed by a fluconazole tablet weekly for six months. After this therapy, many people will go into a long remission, but 55% of females experience recurrence of yeast infection. Reoccurrences need to be confirmed with a culture test (the presence of symptoms is not sufficient). […] This therapy is effective at achieving a negative culture, but it is effective at preventing recurrent infection only as long as it is continued. In 50% of females with recurrent yeast infection, a cure is not achieved.
#16 All you need to know about recurrent yeast infection in females
https://stdcenterny.com/articles/female-recurrent-yeast-infection.html
Recurrent yeast infection is defined as four or more episodes of symptomatic yeast infection within one year. […] The most common cause is believed to be a genetic predisposition of the vaginal mucosa to Candida albicans, which results in a small amount of yeast causing a significant inflammatory reaction. […] If female has recurrent yeast infection, an initial induction therapy (a high dose for a short time) is followed by maintenance therapy (a low dose for a long time). […] Optimal therapy begins with three doses of fluconazole 150 mg tablets given 72 hours apart, followed by a fluconazole tablet weekly for six months. After this therapy, many people will go into a long remission, but 55% of females experience recurrence of yeast infection. Reoccurrences need to be confirmed with a culture test (the presence of symptoms is not sufficient). […] This therapy is effective at achieving a negative culture, but it is effective at preventing recurrent infection only as long as it is continued. In 50% of females with recurrent yeast infection, a cure is not achieved.
#17 All you need to know about recurrent yeast infection in females
https://stdcenterny.com/articles/female-recurrent-yeast-infection.html
Recurrent yeast infection is defined as four or more episodes of symptomatic yeast infection within one year. […] The most common cause is believed to be a genetic predisposition of the vaginal mucosa to Candida albicans, which results in a small amount of yeast causing a significant inflammatory reaction. […] If female has recurrent yeast infection, an initial induction therapy (a high dose for a short time) is followed by maintenance therapy (a low dose for a long time). […] Optimal therapy begins with three doses of fluconazole 150 mg tablets given 72 hours apart, followed by a fluconazole tablet weekly for six months. After this therapy, many people will go into a long remission, but 55% of females experience recurrence of yeast infection. Reoccurrences need to be confirmed with a culture test (the presence of symptoms is not sufficient). […] This therapy is effective at achieving a negative culture, but it is effective at preventing recurrent infection only as long as it is continued. In 50% of females with recurrent yeast infection, a cure is not achieved.
#18 All you need to know about recurrent yeast infection in females
https://stdcenterny.com/articles/female-recurrent-yeast-infection.html
Recurrent yeast infection is defined as four or more episodes of symptomatic yeast infection within one year. […] The most common cause is believed to be a genetic predisposition of the vaginal mucosa to Candida albicans, which results in a small amount of yeast causing a significant inflammatory reaction. […] If female has recurrent yeast infection, an initial induction therapy (a high dose for a short time) is followed by maintenance therapy (a low dose for a long time). […] Optimal therapy begins with three doses of fluconazole 150 mg tablets given 72 hours apart, followed by a fluconazole tablet weekly for six months. After this therapy, many people will go into a long remission, but 55% of females experience recurrence of yeast infection. Reoccurrences need to be confirmed with a culture test (the presence of symptoms is not sufficient). […] This therapy is effective at achieving a negative culture, but it is effective at preventing recurrent infection only as long as it is continued. In 50% of females with recurrent yeast infection, a cure is not achieved.
#19 All you need to know about recurrent yeast infection in females
https://stdcenterny.com/articles/female-recurrent-yeast-infection.html
Recurrent yeast infection is defined as four or more episodes of symptomatic yeast infection within one year. […] The most common cause is believed to be a genetic predisposition of the vaginal mucosa to Candida albicans, which results in a small amount of yeast causing a significant inflammatory reaction. […] If female has recurrent yeast infection, an initial induction therapy (a high dose for a short time) is followed by maintenance therapy (a low dose for a long time). […] Optimal therapy begins with three doses of fluconazole 150 mg tablets given 72 hours apart, followed by a fluconazole tablet weekly for six months. After this therapy, many people will go into a long remission, but 55% of females experience recurrence of yeast infection. Reoccurrences need to be confirmed with a culture test (the presence of symptoms is not sufficient). […] This therapy is effective at achieving a negative culture, but it is effective at preventing recurrent infection only as long as it is continued. In 50% of females with recurrent yeast infection, a cure is not achieved.
#20 Vaginal Candidiasis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK459317/
Prognosis: Despite appropriate treatment, recurrence is relatively common and is estimated to range from 14% to 28% in otherwise healthy individuals. Most often, recurrent disease arises from persistent vaginal organisms or endogenous reinfection with an identical strain of Candida. Less commonly, the disease may result from a new strain of Candida. Recurrent disease may be triggered by antibiotic use, sexual activity, or dietary factors. Genetic susceptibility may also affect a person’s risk for recurrent disease. […] Topical imidazole and oral fluconazole are less likely to be effective in patients with non-albicans species of Candida. Therefore, fungal culture is indicated in patients with persistent symptoms after standard treatment for uncomplicated vulvovaginal candidiasis. Boric acid (600 mg vaginally for at least 14 days) is often effective against C glabrata and other atypical species. Note that boric acid can be fatal if orally ingested, so patients must be well-counseled on its use.
#21 Vaginal Candidiasis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK459317/
Prognosis: Despite appropriate treatment, recurrence is relatively common and is estimated to range from 14% to 28% in otherwise healthy individuals. Most often, recurrent disease arises from persistent vaginal organisms or endogenous reinfection with an identical strain of Candida. Less commonly, the disease may result from a new strain of Candida. Recurrent disease may be triggered by antibiotic use, sexual activity, or dietary factors. Genetic susceptibility may also affect a person’s risk for recurrent disease. […] Topical imidazole and oral fluconazole are less likely to be effective in patients with non-albicans species of Candida. Therefore, fungal culture is indicated in patients with persistent symptoms after standard treatment for uncomplicated vulvovaginal candidiasis. Boric acid (600 mg vaginally for at least 14 days) is often effective against C glabrata and other atypical species. Note that boric acid can be fatal if orally ingested, so patients must be well-counseled on its use.
#22 Vaginal Candidiasis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK459317/
Prognosis: Despite appropriate treatment, recurrence is relatively common and is estimated to range from 14% to 28% in otherwise healthy individuals. Most often, recurrent disease arises from persistent vaginal organisms or endogenous reinfection with an identical strain of Candida. Less commonly, the disease may result from a new strain of Candida. Recurrent disease may be triggered by antibiotic use, sexual activity, or dietary factors. Genetic susceptibility may also affect a person’s risk for recurrent disease. […] Topical imidazole and oral fluconazole are less likely to be effective in patients with non-albicans species of Candida. Therefore, fungal culture is indicated in patients with persistent symptoms after standard treatment for uncomplicated vulvovaginal candidiasis. Boric acid (600 mg vaginally for at least 14 days) is often effective against C glabrata and other atypical species. Note that boric acid can be fatal if orally ingested, so patients must be well-counseled on its use.
#23 Vaginal Candidiasis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK459317/
Prognosis: Despite appropriate treatment, recurrence is relatively common and is estimated to range from 14% to 28% in otherwise healthy individuals. Most often, recurrent disease arises from persistent vaginal organisms or endogenous reinfection with an identical strain of Candida. Less commonly, the disease may result from a new strain of Candida. Recurrent disease may be triggered by antibiotic use, sexual activity, or dietary factors. Genetic susceptibility may also affect a person’s risk for recurrent disease. […] Topical imidazole and oral fluconazole are less likely to be effective in patients with non-albicans species of Candida. Therefore, fungal culture is indicated in patients with persistent symptoms after standard treatment for uncomplicated vulvovaginal candidiasis. Boric acid (600 mg vaginally for at least 14 days) is often effective against C glabrata and other atypical species. Note that boric acid can be fatal if orally ingested, so patients must be well-counseled on its use.
#24 Vaginal Candidiasis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK459317/
Prognosis: Despite appropriate treatment, recurrence is relatively common and is estimated to range from 14% to 28% in otherwise healthy individuals. Most often, recurrent disease arises from persistent vaginal organisms or endogenous reinfection with an identical strain of Candida. Less commonly, the disease may result from a new strain of Candida. Recurrent disease may be triggered by antibiotic use, sexual activity, or dietary factors. Genetic susceptibility may also affect a person’s risk for recurrent disease. […] Topical imidazole and oral fluconazole are less likely to be effective in patients with non-albicans species of Candida. Therefore, fungal culture is indicated in patients with persistent symptoms after standard treatment for uncomplicated vulvovaginal candidiasis. Boric acid (600 mg vaginally for at least 14 days) is often effective against C glabrata and other atypical species. Note that boric acid can be fatal if orally ingested, so patients must be well-counseled on its use.
#25 All you need to know about recurrent yeast infection in females
https://stdcenterny.com/articles/female-recurrent-yeast-infection.html
Recurrent yeast infection is defined as four or more episodes of symptomatic yeast infection within one year. […] The most common cause is believed to be a genetic predisposition of the vaginal mucosa to Candida albicans, which results in a small amount of yeast causing a significant inflammatory reaction. […] If female has recurrent yeast infection, an initial induction therapy (a high dose for a short time) is followed by maintenance therapy (a low dose for a long time). […] Optimal therapy begins with three doses of fluconazole 150 mg tablets given 72 hours apart, followed by a fluconazole tablet weekly for six months. After this therapy, many people will go into a long remission, but 55% of females experience recurrence of yeast infection. Reoccurrences need to be confirmed with a culture test (the presence of symptoms is not sufficient). […] This therapy is effective at achieving a negative culture, but it is effective at preventing recurrent infection only as long as it is continued. In 50% of females with recurrent yeast infection, a cure is not achieved.
#26 Vaginal yeast infection Information | Mount Sinai – New York
https://www.mountsinai.org/health-library/diseases-conditions/vaginal-yeast-infection
Most of the time, symptoms go away completely with proper treatment. […] A woman may have diabetes or weak immune system (such as in HIV) if: The infection recurs right after treatment, The yeast infection does not respond well to treatment.