![]() ![]() The costs given in Table 2 do not include the expenses associated with decreased work productivity, missed work days, toxicity monitoring or office visits. The expense of each regimen should be considered. Information from references 5 and 7 through 15. Mechanical irritation of vulvovaginal area 7 TABLE 1 Possible Risk Factors for Recurrent Vulvovaginal Candidiasis Candida species 16 If an infection recurs at least three months after the previous episode, it is more likely to be caused by a different C. Between 15 and 20 percent of women with negative cultures after treatment have positive cultures within three months. A recurrence may also represent an inadequately treated infection. For example, a patient may not complete the entire course of antifungal therapy, especially if an inconvenient topical treatment has been prescribed. 5, 7 – 15 Noncompliance with a treatment regimen may result in persistent infection that is mislabeled as a recurrence. Patients are more likely to comply when antifungal therapy is administered orally, but oral treatment carries a greater potential for systemic toxicity and drug interactions.Īlthough antifungal resistance can cause treatment failure, other factors may contribute to recurrent vulvovaginal candidiasis ( Table 1). Because many patients experience recurrences once prophylaxis is discontinued, long-term therapy may be warranted. ![]() After the acute episode has been treated, subsequent prophylaxis (maintenance therapy) is important. If microscopic examination of vaginal secretions in a potassium hydroxide preparation is negative but clinical suspicion is high, fungal cultures should be obtained. Known etiologies of recurrent vulvovaginal candidiasis include treatment-resistant Candida species other than Candida albicans, frequent antibiotic therapy, contraceptive use, compromise of the immune system, sexual activity and hyperglycemia. ![]() Patients who self-diagnose may miss other causes or concurrent infections. Clinical evaluation of recurrent episodes is essential. Although greater than 50 percent of women more than 25 years of age develop vulvovaginal candidiasis at some time, fewer than 5 percent of these women experience recurrences. Vulvovaginal candidiasis is considered recurrent when at least four specific episodes occur in one year or at least three episodes unrelated to antibiotic therapy occur within one year. ![]()
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