Vaginal candidiasis
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Epidemiology and Prevalence of Vaginal Candidiasis
Vaginal candidiasis, also known as vulvovaginal candidiasis (VVC), is a widespread infection affecting millions of women globally, with over 70% experiencing at least one episode in their lifetime and 5–10% developing recurrent infections (RVVC) Gonçalves2016MacAlpine2024Liu2025. The most common causative agent is Candida albicans, but non-albicans species like Candida glabrata are increasingly recognized, especially in recurrent cases Gonçalves2016Ardizzoni2021Fernandes2022+1 MORE.
Risk Factors and Predisposing Conditions
Several host-related and behavioral factors increase the risk of developing VVC. Key host-related risk factors include pregnancy, hormone replacement therapy, uncontrolled diabetes, immunosuppression, antibiotic and glucocorticoid use, and genetic predispositions Gonçalves2016Faustino2025Johal2016. Behavioral factors such as the use of oral contraceptives, intrauterine devices, spermicides, condoms, and certain hygiene, clothing, and sexual practices also contribute to susceptibility Gonçalves2016Fernandes2022Johal2016. Notably, women with a history of recurrent vaginal infections, those using over-the-counter antifungals, oral contraceptives, and non-cotton underwear are at higher risk .
Pathogenesis: Candida Virulence and Host Response
Candida albicans can exist harmlessly in the vaginal environment but becomes pathogenic when the balance with the host and microbiota is disturbed Valentine2025Ardizzoni2021Czechowicz2022. The transition from yeast to hyphal form, biofilm formation, adherence, and phenotypic switching are critical virulence factors that enable tissue invasion and infection Ardizzoni2021Faustino2025Czechowicz2022. The host’s immune response, particularly the innate immune system, plays a dual role: while it aims to control the infection, excessive or dysregulated inflammation—often involving neutrophils—can worsen symptoms without effectively clearing the fungus MacAlpine2024Ardizzoni2021Czechowicz2022.
Role of the Vaginal Microbiome
A healthy vaginal microbiome, dominated by Lactobacillus species, helps suppress Candida overgrowth. Disruption of this balance (dysbiosis) can facilitate Candida pathogenicity and trigger symptomatic infection Valentine2025Ardizzoni2021Liu2025. Microbiota alterations are especially relevant in recurrent cases, where non-albicans species and antifungal resistance are more common .
Diagnosis and Antifungal Resistance
Diagnosis of VVC is complicated by the limitations of traditional microbiological techniques, which may not distinguish between harmless colonization and active infection. Molecular assays offer improved detection but lack clear thresholds for clinical relevance . Increasing resistance to azole antifungals, particularly among non-albicans species, poses a significant challenge, highlighting the need for species identification and susceptibility testing to guide treatment Fernandes2022Liu2025.
Treatment Strategies and Emerging Therapies
Conventional treatments include topical and oral antifungal agents, but their effectiveness is limited by short residence time in the vaginal environment and rising resistance Faustino2025Johal2016. Mucoadhesive polymers and novel drug delivery systems, such as liposomes and nanoparticles, are being developed to enhance drug retention and efficacy Faustino2025Johal2016. Probiotics aimed at restoring Lactobacillus dominance and vaccines targeting Candida virulence factors (e.g., Sap2) are promising new approaches, especially for recurrent cases Faustino2025De Bernardis2018Liu2025.
Conclusion
Vaginal candidiasis is a common and often recurrent infection driven by a complex interplay of fungal virulence, host immune response, and microbiome balance. Risk factors are both physiological and behavioral, and rising antifungal resistance complicates management. Advances in diagnostics, drug delivery, microbiota modulation, and vaccine development offer hope for more effective and personalized prevention and treatment strategies in the future Gonçalves2016Valentine2025MacAlpine2024+7 MORE.
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