Chronic Vulvovaginal Candidiasis: Impact on Quality of Life Data, Long Term Outcomes of Treatment with Oral Fluconazole and Risk Factors

Chronic vulvovaginal candidiasis (CVVC) is a recently defined sub-type of vulvovaginal candidiasis (VVC) that describes a chronic, unremitting, relapsing form of vulvovaginitis that differs from previously described types of VVC that are characterised by episodes of VVC that occur sporadically as in acute vulvovaginal candidiasis (AVVC), or are discretely episodic as in recurrent vulvovaginal candidiasis (RVVC). Being a recently defined entity, there is limited data available on CVVC. The incidence is unknown, risk factors have not been characterised, there is no standard diagnostic test or definitive treatment guideline, impact on quality of life is unknown and long-term outcomes of current treatment are not detailed in the literature. A before and after study was conducted to explore the impact of CVVC on quality of life using the validated Dermatology Life Quality Index (DLQI) questionnaire, and the subsequent impact of treatment on quality of life. DLQI scores and subjective symptoms were compared before and after a treatment regimen with low dose oral fluconazole. A statistically significant difference was found in both DLQI scores and subjective symptoms before and after treatment. A retrospective long-term outcomes study was performed to evaluate the long-term effects of an oral fluconazole treatment regimen on patients with CVVC. The majority of patients (99%) required long term oral antifungal therapy for symptom suppression with 95% of patients remaining on oral fluconazole for maintenance treatment with a mean duration of follow up of 26.2 months. Low dose oral fluconazole is a safe and effective treatment to control symptoms in CVVC and is needed long-term to maintain symptom remission. A retrospective case series was performed to identify the association between the levonorgestrel intra-uterine system (LNG-IUS) and CVVC as a risk factor in 13 patients. It was found that in 6 cases CVVC was precipitated by the LNG-IUS and in the other 7 cases symptoms were exacerbated by the LNG-IUS. These results suggest the LNG-IUS is associated with CVVC and patients should be given the option to remove the device to improve symptom control if this presents as a safe and clinically appropriate option