Vulvovaginal candidiasis (VVC) is an infectious disease of the lower genitals caused by yeast-like fungi of the genus Candida. VVC occurs in women. Every third woman suffers one episode of VVC during her life, and two of them go into relapse. The etiological agents of vulvovaginal candidiasis are most often the yeast-like fungi Candida albicans, but it is possible to isolate other types of fungi of the genus Candida (C. glabrata, C. tropicalis, C. krusei and others), which are collectively called Candida non-albicans. Among the listed yeast-like fungi, C. albicans is the most pathogenic. The following successive stages are distinguished in the course of VVC development:

1) Adhesion of Candida to the mucosal surface;

2) Colonization, invasion into the epithelium, overcoming the epithelial barrier of the mucous membrane, entering the lamina propria connective tissue, overcoming tissue and cellular defense mechanisms;

3) Penetration into blood vessels and hematogenous dissemination with damage to various organs and systems.

The causative agents of VVC are sexually transmitted, while the physiological states of the body, endocrinological diseases, the presence of neoplasms, infectious diseases, exhaustion, taking medications, and surgical interventions are of certain importance.

VVC is usually divided into uncomplicated VVC (caused by Candida albicans), which is characterized by a mild or moderate course, associated with  normal immunity, occurs sporadically in an individual patient (up to 4 cases per year) and responds well to treatment with conventional regimens of antifungal (antimycotic) drugs, and complicated VVC (can be caused by Candida non-albicans), which is characterized by a severe course with frequent relapses - more than 4 episodes per year, associated with concomitant pathology (immunosuppressive conditions and endocrinopathies), during pregnancy, and resistant to antimycotic therapy.

A feature of VVC is the frequent recurrence of the process, spread to other organs and systems with the generalization of the process and development of resistance to antimycotic therapy. Pregnant women with VVC can be a source of both intrauterine infection of the fetus and postnatal infection of newborns. Most often, patients come to doctors with complaints about redness (erythema), edema, itching, burning and discomfort in the external genital area, accompanied by pathological discharge of a white or yellowish curdled consistency. Also, these women may be concerned about pain and dysuria. VVC is an inflammatory process that affects the external female genital organs and/or the vagina. Absence of pain receptors in the walls of the vagina allows the inflammatory process to proceed without specific clinical manifestations, and when the process is localized on the vulva, rich in pain receptors, the disease proceeds with vivid clinical signs due to the introduction of yeast-like fungi of the genus Candida into the surface layer of epithelial cells and irritation of these receptors.

Uncontrolled independent use of drugs results in the emergence of erased or atypical forms of this condition, development of resistance to the ongoing antimycotic therapy or recurrence of the disease. When diagnosing VVC, microscopy, cultural diagnostics, serological (immunological) and molecular genetic methods are used. Modern VVC therapy includes the use of local antimycotics and antiseptics, as well as systemic antifungal agents. The choice of a specific drug depends on the patient's condition and on whether she has contraindications to the use of certain drugs. To reduce the risk of recurrent VVC, an antifungal drug must be prescribed correctly from the outset. When analyzing recommendations for the treatment of VVC, attention is drawn to the possibility of widespread use of local antifungal drugs in an ointment pharmaceutical form as a first-line therapy. This is due to the fact that it is this form that allows creating a high concentration of the active substance on the affected tissues and ensuring rapid relief of clinical symptoms.

Source: Kulikov I.A., Ovsyannikova T.V. Current views on vulvovaginal candidiasis. Obstetrics and gynecology. 2018; 10: 123-8. https://dx.doi.org/10/18565/aig.2018.10.123-128