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Managing recurrent candidal vulvovaginitis in primary care

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 Vulvovaginal candidiasis affects roughly one in 1 Vulvovaginal candidiasis affects roughly one in 15 women in the UK

Recurrent candidal vulvovaginitis (VVC) is a difficult to manage condition that affects 5-8% of women of reproductive age. It can be difficult to treat, relapse rates are high and this can adversely affect quality of life.1 This article aims to explain what candidal vulvovaginitis is, why it develops, how it is treated and how to address treatment failure and recurrence.

What is candidal vulvovaginitis?

Candidal vulvovaginitis is caused by infection with candida. Candida albicans causes 90% of candidal vulvovaginitis, followed by Candida glabrata.2 Candida is part of the normal vaginal flora in many women and does not usually cause infection.3

Why does it develop?

Normally candida is held in check by the balance of normal flora within the body and the acidity of vaginal secretions. Certain conditions and medications can affect this normal balance and allow infection to occur. Pregnancy, menopause and the use of hormonal contraceptives decrease the acidity of the vagina and this increases the risk of a candida infection.4 Corticosteroid use impairs the immune system and increases the risk of candida infections, similarly Candida glabrata may be more common in steroid users.5

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