Treatment of recurrent vulvovaginal candidiasis -systemic or topical therapy

Despite a certain breadth of expertise and simplicity in diagnosis of candidal vaginitis, current monitoring of the etiological disease structure and a variety of drugs for treatment, the problem of therapy for recurrent forms of this nosology is still unresolved.

Among the problematic non albicans (C. glabrata, C. kruzei) species, the strains mainly had a dose-dependent sensitivity to the main antimycotics (fluconazole, itraconazole, miconazole, ketoconazole,), i.e. their efficacy in vivo if taken at doses safe for humans is directly associated with the ability of the drug to accumulate in the mucous membrane, creating the necessary concentration for non albicans. In this regard, determining sensitivity of fungi in clinical practice is currently more justified for non albicans species. The studies of recent years arguing against assumptions concerning pathogenesis associated with the biofilm formation by fungi of the genus Candida on the surface of the vaginal mucosa may allow come closer to the pathogenetic substantiation of the use of local and systemic etiotropic therapy.

In this case, at least two factors should be taken into account: the yeast fungus may be resistant to the used antimycotic agent, which is characteristic mainly of non-albicans species, especially C. glabrata and C. krusei, and the invasion of the fungus pseudomycelium into the vaginal mucosa.

The article discusses the issues of etiotropic therapy for vulvo-vaginal candidiasis based on the current medical data. The authors provide recommendations for the use of systemic and local antimycotics and substantiated the expediency of their separate and combined use in certain clinical situations.

1. Ankirskaya A.S., Muravyeva V.V., Mironova T.G., Koroleva T. Ye., Lyubasov-skaya L.A., Karapetyan T.E., Bairamova G.R. Genital candidiasis in the pattern of opportunistic vaginal infections. The principles of laboratory diagnosis and the value of monitoring of fungal susceptibility to anti-mycotics. Akusherstvo i ginekologiya = Obstetrics and Gynecology. 2009;(5):31-37. (In Russ.) Available at: https://elibrary.ru/item.asp?id=13064215.

2. Blostein F., Levin-Sparenberg E., Wagner J., Foxman B. Recurrent vulvovaginal candidiasis. Ann Epidemiol. 2017;27(9):575-582.e3. doi: 10.1016/j.annepidem.2017.08.010.

3. Rodriguez-Cerdeira C., Gregorio M.C., Molares-Vila A., Lopez-Barcenas A., Fabbrocini G., Bardhi B., Sinani A. et al. Biofilms and vulvovaginal candidi-

4. Swidsinski A., Guschin A., Tang Q., Dorffel Y., Verstraelen H., Tertychnyy A. Vulvovaginal candidiasis: histologic lesions are primarily polymicrobial and invasive and do not contain biofilms. Am J Obstet Gynecol. 2019;220(1):91.e1-91.e8. doi: 10.1016/j.ajog.2018.10.023.

5. Polyak M.S. The basics of antibiotic therapy. St Petersburg: Anatolia; 2003. 56 p. (In Russ.)

6. Kozlov R.S., Sukhorukova M.V, Ehydelshteyn M.V., Ivanchik N.V, Skleenova E.Yu., Romanov A.V. et al. Determination of the sensitivity of microorganisms to antimicrobial drugs: clinical guidelines. Version-2018-03. Moscow; 2018. 206 p. (In Russ.) Available at: http://wwwantibiotic.nj/minzdrav/files/docs/clrec-dsma2018.pdf.

7. Garrigues M.L., Mallie M., Dupont B., Bastide J.M., Carls B., Dromer F. EvaLuation d'une galerie pour tester la sensibilite des levures aux anti-fongiques. Colloque de la Societe Frangaise de Mycologie Medicale, Institut Pasteur. 22-23 Novembre 1996.

8. Willinger B., Apfalter P., Hirschl A.M., Makristathis A., Rotter M., Seibold M. Susceptibility testing of Candida species: comparison of NCCLS microdilution method with Fungitest. Diagn Microbiol Infect Dis. 2000;38(1):11-15. doi: 10.1016/S0732-8893(00)00172-3.

9. Paulitsch A., Weger W., Ginter-Hanselmayer G., Marth E., Buzina W. A 5-year (2000-2004) epidemiological survey of Candida and non-Candida yeast species causing vulvovaginal candidiasis in Graz, Austria. Mycoses. 2006;49(6):471-475. doi: 10.1111/j.1439-0507.2006.01284.x.

10. Sadanov A.K., Berezin V.E., Trenozhnikova L.P. et al. (eds.). Human mycoses and antifungal drugs. Almaty; 2016. 315 p. (In Russ.) Available at: http://acagor.kz:8080/xmlui/handle/123456789/100.

11. Peyton L.R., Gallagher S., Hashemzadeh M. Triazole antifungals: a review. Drugs Today (Barc). 2015;51(12):705-718. doi: 10.1358/dot.2015.51.12.2421058.

12. Zonios D.I., Bennett J.E. Update on Azole Antifungals. Semin Respir Crit Care Med. 2008;29(2):198-210. doi: 10.1055/s-2008-1063858.

13. Kozlov S.N., Kozlov R.S. Modern antimicrobial chemotherapy. 3rd ed. Moscow: Medical Information Agency; 2017. 400 p. (In Russ.) Available at: https://elibrary.ru/item.asp?id=32785761.

14. Prilepskaya VN., Mirzabaeva A.K., Kira E.F., Gomberg M.A., Apolikhina I.A., Bayramova G.R. Diagnosis and treatment of diseases accompanied by pathological discharge from the genital tract of women: federal clinical guidelines. Moscow; 2013. 50 p. (In Russ.) Available at: http://docplayer.ru/26676497-Federalnye-klinicheskie-rekomendacii-diagnostika-i-lechenie-zabolevaniy-soprovozhdayushchihsya-patologicheskimi-vydeleniyami-iz-polovyh-putey-zhenshchin.html.