Vaginal complaints are common. Vulvovaginitis, or inflammation of the vulva and vagina, is most often secondary to infectious agents in women of reproductive age. Candidal vulvovaginitis is responsible for about a third of cases. Candidal vulvovaginitis is caused by inflammatory changes in the vaginal and vulvar epithelium due to infection with Candida species, most commonly Candida albicans. Candida is part of the normal flora in many women and is often asymptomatic. Therefore, candidal vulvovaginitis requires both the presence of candida in the vagina/vulva and the symptoms of irritation, itching, dysuria, or inflammation. Candidal vulvovaginitis is common. It is responsible for one-third of all cases of vulvovaginitis in women of reproductive age, and 70% of women report having candidal vulvovaginitis at some point in their lives. About 8% of women suffer from recurrent candidal vulvovaginitis. The most common pathogen responsible is Candida albicans (in about 90% of cases), with most of the remaining cases being caused by Candida glabrata. Recognized risk factors for acute candidal vulvovaginitis include estrogen use, increased endogenous estrogens (from pregnancy or obesity), diabetes mellitus, immunosuppression (ie, patients undergoing chemotherapy or taking antimetabolic drugs, HIV infection, or transplant patients), and use of broad-spectrum antibiotics. Although candidal vulvovaginitis is more common in women who are sexually active, there is no evidence that candidal infection is sexually transmitted. Patients with recurrent candidal vulvovaginitis (defined as four or more episodes of culture-proven candidal vulvovaginitis) have predisposing genetic factors that make them susceptible to recurrent fungal infections. These factors may also predispose to candida hypersensitivity. Candida vulvovaginitis occurs when Candida species penetrate superficially through the vaginal mucosa and trigger an inflammatory response. The predominant inflammatory cells are usually polymorphonuclear cells and macrophages. Patients may have discharge that is usually thick, “external” dysuria, vaginal itching, vaginal burning, dyspareunia, or bloating. Female patients usually complain of irritation, itching and burning. Symptoms often appear just before the menstrual cycle. Most infections are secondary to Candida albicans, and the presence of yeast cells in the secretions of women of reproductive age with vulvovaginitis does not require confirmatory microbiological cultures for Candida. Because Candida species are part of the normal vaginal flora in many women, routine cultures in asymptomatic women are also not recommended. Women with recurrent episodes of candidal vulvovaginitis should be cultured to identify the species of fungus thatthat may be resistant to typical therapy, or to identify alternative causes of vaginitis. Acute candidal vulvovaginitis is treated with antifungal agents. Because most cases of candidal vulvovaginitis are secondary to C. albicans species, and because C. albicans does not have significant resistance to antifungal agents, these are the agents of first choice for this disease. Antifungals can be taken orally as a single dose or can be administered intravaginally in one-day or 3-day regimens that are available over the counter. In patients with uncomplicated disease (those without immunosuppression or pregnancy who do not have recurrent candidal vulvovaginitis), both therapies are equally effective. If patients do not respond to standard therapy, cultures may need to be screened for other Candida species, which are often resistant to first-line drugs. Patients with complicated candidal vulvovaginitis, for example immunosuppressed patients, require longer therapy. Typically, therapy includes intravaginal globules for at least 1 week or oral antifungal medication once every 3 days for three doses. Pregnant patients should not take oral antifungals. In these patients, a 7-day course of intravaginal therapy is appropriate References: 1. Buggio L, Somigliana E, Borghi A, Vercellini P. Probiotics and vaginal microecology: fact or fancy? BMC Women’s Health. 2019 Jan 31;19(1):25. [PMC free article] [PubMed] 2. Aguirre-Qui?onero A, Castillo-Sedano IS, Calvo-Muro F, Canut-Blasco A. Accuracy of the BD MAX� vaginal panel in the diagnosis of infectious vaginitis. Eur J Clin Microbiol Infect Dis. 2019 May;38(5):877-882. [PubMed] 3. Ahangari F, Farshbaf-Khalili A, Javadzadeh Y, Adibpour M, Sadeghzadeh Oskouei B. Comparing the effectiveness of Salvia officinalis, clotrimazole and their combination on vulvovaginal candidiasis: A randomized, controlled clinical trial. J Obstet Gynecol Res. 2019 Apr;45(4):897-907. [PubMed] 4. Swidsinski A, Guschin A, Tang Q, D?rffel Y, Verstraelen H, Tertychnyy A, Khayrullina G, Luo X, Sobel JD, Jiang X. Vulvovaginal candidiasis: histologic lesions are primarily polymicrobial and invasive and do not contain biofilms . Am J Obstet Gynecol. 2019 JanIf patients do not respond to standard therapy, cultures may need to be screened for other Candida species, which are often resistant to first-line drugs. Patients with complicated candidal vulvovaginitis, for example immunosuppressed patients, require longer therapy. Typically, therapy includes intravaginal globules for at least 1 week or oral antifungal medication once every 3 days for three doses. Pregnant patients should not take oral antifungals. In these patients, a 7-day course of intravaginal therapy is appropriate References: 1. Buggio L, Somigliana E, Borghi A, Vercellini P. Probiotics and vaginal microecology: fact or fancy? BMC Women’s Health. 2019 Jan 31;19(1):25. [PMC free article] [PubMed] 2. Aguirre-Qui?onero A, Castillo-Sedano IS, Calvo-Muro F, Canut-Blasco A. Accuracy of the BD MAX� vaginal panel in the diagnosis of infectious vaginitis. Eur J Clin Microbiol Infect Dis. 2019 May;38(5):877-882. [PubMed] 3. Ahangari F, Farshbaf-Khalili A, Javadzadeh Y, Adibpour M, Sadeghzadeh Oskouei B. Comparing the effectiveness of Salvia officinalis, clotrimazole and their combination on vulvovaginal candidiasis: A randomized, controlled clinical trial. J Obstet Gynecol Res. 2019 Apr;45(4):897-907. [PubMed] 4. Swidsinski A, Guschin A, Tang Q, D?rffel Y, Verstraelen H, Tertychnyy A, Khayrullina G, Luo X, Sobel JD, Jiang X. Vulvovaginal candidiasis: histologic lesions are primarily polymicrobial and invasive and do not contain biofilms . Am J Obstet Gynecol. 2019 JanIf patients do not respond to standard therapy, cultures may need to be screened for other Candida species, which are often resistant to first-line drugs. Patients with complicated candidal vulvovaginitis, for example immunosuppressed patients, require longer therapy. Typically, therapy includes intravaginal globules for at least 1 week or oral antifungal medication once every 3 days for three doses. Pregnant patients should not take oral antifungals. In these patients, a 7-day course of intravaginal therapy is appropriate References: 1. Buggio L, Somigliana E, Borghi A, Vercellini P. Probiotics and vaginal microecology: fact or fancy? BMC Women’s Health. 2019 Jan 31;19(1):25. [PMC free article] [PubMed] 2. Aguirre-Qui?onero A, Castillo-Sedano IS, Calvo-Muro F, Canut-Blasco A. Accuracy of the BD MAX� vaginal panel in the diagnosis of infectious vaginitis. Eur J Clin Microbiol Infect Dis. 2019 May;38(5):877-882. [PubMed] 3. Ahangari F, Farshbaf-Khalili A, Javadzadeh Y, Adibpour M, Sadeghzadeh Oskouei B. Comparing the effectiveness of Salvia officinalis, clotrimazole and their combination on vulvovaginal candidiasis: A randomized, controlled clinical trial. J Obstet Gynecol Res. 2019 Apr;45(4):897-907. [PubMed] 4. Swidsinski A, Guschin A, Tang Q, D?rffel Y, Verstraelen H, Tertychnyy A, Khayrullina G, Luo X, Sobel JD, Jiang X. Vulvovaginal candidiasis: histologic lesions are primarily polymicrobial and invasive and do not contain biofilms . Am J Obstet Gynecol. 2019 Janhistologic lesions are primarily polymicrobial and invasive and do not contain biofilms. Am J Obstet Gynecol. 2019 Janhistologic lesions are primarily polymicrobial and invasive and do not contain biofilms. Am J Obstet Gynecol. 2019 Jan