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By Suzanne I. Singh, PharmD
Vulvovaginal candidiasis (VVC) is a common condition, and an estimated 75% of all women will experience an infection with candida yeast during their lifetime. Ninety percent of these infections are caused by Candida albicans.(3) The availability of nonprescription products for treatment of VVC allows pharmacists to play a role in counselling patients about when and how to self-treat and when to see a physician for evaluation or follow-up. Pharmacists must have an understanding of VVC, particularly its treatment options, so that they can make evidence-based recommendations to both patients and physicians.
Symptoms can mask STD
An accurate diagnosis of VVC is essential to initiate appropriate treatment. A first episode with signs and symptoms suggestive of VVC should always be confirmed by a physician so that women are accurately diagnosed and, if needed, treated for a sexually transmitted disease such as herpes, human papilloma virus, gonorrhea, or chlamydia.
It may also be prudent to consider referral to a physician for women with recurrent infections. One study showed that only one third of women who self-diagnosed VVC actually met the diagnostic criteria for the condition, and that women with a previous diagnosis of VVC were no more accurate in diagnosing subsequent infections than women without a previous diagnosis.(6)
Although VVC is not a sexually transmitted disease, women may benefit from their physician's guidance if cross-transmission of C. albicans from the sexual partner is a possibility.
Goals of treatment
The treatment of VVC with medication is aimed at resolving symptoms, eradicating infection, and preventing complications and recurrence.
A variety of antifungal agents have been used (see Table 2). Imidazole antifungals include clotrimazole, miconazole, and tioconazole, and triazole antifungals including terconazole and fluconazole. Fluconazole is available orally, whereas the other azole antifungals are used intravaginally. Nystatin, a polyene antifungal agent, and boric acid have also been used intravaginally in the management of VVC.(7)(8)
The choice of antifungal for both uncomplicated and complicated forms of VVC should take into account the comparative efficacy, adverse effects, interactions, convenience, and cost of the available agents, as well as the woman's preference (so as to maximize adherence).
Uncomplicated VVC
Treatment with azoles results in relief of symptoms and negative results on culture in 80% to 90% of...