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The Recurrent Vulvovaginal Candidiasis: Proposal of a Personalized Therapeutic Protocol

DOI: 10.5402/2011/806065

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Background. Recurrent vulvovaginal candidiasis (RVC) is an increasing challenge in clinical practice. Objective. The purpose of this study was to reduce the episodes of RVC through the intake of fluconazole 200?mg/dose with a personalized regimen at growing administration intervals with a probiotic. Method. 55 patients received a 200?mg fluconazole as an induction dose for 3 alternate days. Symptoms resolution after 10–14 days made the patients eligible to continue with a maintenance therapy of fluconazole weekly for one month, followed by 200?mg after 10, 15, 20 and 30 days. Patients were allowed to move on to the next level of maintenance therapy only if they were symptom free. Patients were also given a probiotic with Beta Glucan and Echinacea Purpurea. Results. Among the 55 patients enrolled, four (7%) have withdrawn after the induction phase. 51 patients completed the whole therapeutic maintenance period, and eight (15,6%) experienced a recurrence before the end of the therapy. Five women (9,8%) relapsed (two after 2 months and three after 6 months). Conclusion. The positive results of our study prove the effectiveness of an individualized protocol for a rather short period, with a slowly decreasing administration of fluconazole + probiotic. 1. Introduction The mycotic vulvovaginitis is a common infection. It is estimated that about 75% of women will experience this infection at least once during their life time. In 15% of these cases the mycotic infection may evolve in a “cyclic recurrent type” (RVC) defined as four or more episodes of mycotic vulvovaginitis during one year [1, 2]. Over 85% of cases are caused by Candida Albicans, while Candida Tropicalis and Glabrata are more common in diabetic women. The VVC has a negative effect on women’s personal confidence and self-esteem [3]. It may cause or contribute to psycosexual problems, namely, introital dyspareunia, with progressive loss of genital arousal (pain is the strongest reflex inhibitor of vaginal congestion and lubrication), secondary loss of desire, and avoidance of sexual intimacy for fear of experiencing pain and recurrence of another Candida vulvovaginitis. It may as well cause discomfort, uneasiness, sense of shame, or unworthiness in informing both doctor and partner about the inconveniences of such a recurring infection. An antimycotic prophylaxis with fluconazole for long periods of time has proven to be effective for the prevention of mycotic recurrent episodes. The oral weekly administration of a single dose of 150?mg of fluconazole for a period of 6 months proved to be


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