Treatment of Vulvovaginal Can... Video Transcript

Participants

Ronald S. Gibbs MD, Paul Nyirjesy MD, Andrea Rapkin MD, Jack D. Sobel MD, David E. Soper MD, Sterling Williams MD

Summary

Appropriate treatment for vulvovaginal candidiasis depends on a variety of factors including severity of symptoms, species of yeast and patient factors. Treatments range from a short course of oral or topical therapy for uncomplicated cases to longer courses of therapy and boric acid suppositories for complicated cases.

Webcast Transcript

ANNOUNCER: Appropriate treatment for vulvovaginal candidiasis depends on a variety of factors. On the basis of symptomatology, frequency of attacks, host factors and etiology, vulvovaginal candidiasis cases can be classified as either uncomplicated or complicated.

PAUL NYIRJESY, MD: An uncomplicated case of candidiasis is a patient who is a normal, healthy host who has sporadic episodes, who has mild to moderate symptoms, and where you think that the infection is due to Candida albicans. A case of complicated candidiasis is somebody with severe symptomatology, recurrent episodes, an abnormal host or an infection due to a species other than Candida albicans.

JACK SOBEL, MD: Any one of these four criteria puts the patient in the category of complicated Candida vaginitis. These patients will not do well with short-course oral or topical therapy. So if you want to offer the patient more than a 50/50 chance of getting better, the patients need longer duration therapy to achieve relief of symptoms as well as to achieve a culture negative status.

ANNOUNCER: There are a variety of possible causes of recurrent yeast infections, but it's not always known why some women develop them and others don't.

STERLING WILLIAMS, MD: Recurrent Candida albicans infections are sort of an enigma for us because there is no one cause, so I like to look at it as associations. There are certain things that are frequently associated with recurrent yeast infections, such as history of diabetes mellitus, a history of intake of antibiotics and almost any antibiotic will do it. Those patients who are immunocompromised are frequently more prone to yeast infections. Patients who are taking steroids, be they birth control pills or estrogen replacement therapy, those patients who have coexisting other sexually transmissible diseases. However, you can take a group of patients with all the things I just named, and many of them will never have a yeast infection. So I can't call them etiologies. I call them associations.

ANDREA RAPKIN, MD: It's really not known why women get recurrent Candida albicans infections. There are various factors that play a role. There are probably host factors, and those factors have to do more with relapse of infection than with reinfection.

ANNOUNCER: Proper treatment may require a longer course of therapy.

PAUL NYIRJESY, MD: There have been a variety of methods which have been proposed to treat women with recurrent candidiasis. The most effective way seems to be to put patients on some type of long-term maintenance antifungal regimen, which will help to keep the patient comfortable and in many cases will break her out of her pattern of recurrence.

ANNOUNCER: Choice of therapy for vulvovaginal candidiasis also depends on the species of Candida. Treatment of non-albicans Candida infections can be quite different from therapy for Candida albicans infections.

PAUL NYIRJESY, MD: The other types of species that may cause yeast infections include organisms such as Candida glabrata, Candida parapsilosis, Candida tropicalis, and a variety of other organisms.

RONALD GIBBS, MD: For women who have non-albicans infection, therapy must be modified. That's why it's important on the culture to distinguish the patient who has albicans species from non-albicans species. For patients who have non-albicans species, Candida glabrata is one of the most common species, and the therapy of choice for Candida glabrata infection is vaginal boric acid suppositories. Alternatives would include flucytosine, and in an occasional patient, itraconazole.