SpringerLink
Log in

Vaginal Yeast Infection

  • Inflammatory/Infectious Bladder Disorders (MS Mourad, Section Editor)
  • Published:
Current Bladder Dysfunction Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This review includes a detailed overview of the vaginal yeast infection based on current literature available, addressing etiology, epidemiology, risk factors, and pathophysiology, as well as clinical presentation, burden, diagnostic, and treatment strategies.

Recent Findings

There are multiple meta-analyses, systematic reviews, randomized control trials, and critical reviews recently published that have advanced the understanding of pathophysiology and answered questions regarding global burden, prevention, and treatment in a systematic way.

Summary

In the recent years, important work has been made to better understand the pathophysiology and global burden behind the vaginal yeast infection. Diagnostic criteria were proposed for chronic vulvovaginal candidiasis. While fluconazole resistance has been making maintenance suppressive therapy of recurrent vulvovaginal candidiasis difficult and probiotics do not seem to be very effective, significant improvements and advances in the area of antifungal therapeutic innovation research have been made and further results of vaccine trials are pending. There is a need for well-designed RCTs in evidence-based treatment development and research.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Spain)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Sobel JD. Recurrent vulvovaginal candidiasis. Am J Obstet Gynecol. 2016;214(1):15–21. https://doi.org/10.1016/j.ajog.2015.06.067.

    Article  PubMed  Google Scholar 

  2. Reichman O, Margesson LJ, Rasmussen CA, Lev-Sagie A, Sobel JD. Algorithms for managing vulvovaginal symptoms-a practical primer. Curr Infect Dis Rep. 2019;21(10):40. https://doi.org/10.1007/s11908-019-0693-6.

    Article  PubMed  Google Scholar 

  3. Sobel JD. Vulvovaginal candidosis. Lancet. 2007;369(9577):1961–71. https://doi.org/10.1016/S0140-6736(07)60917-9.

    Article  PubMed  Google Scholar 

  4. Gonçalves B, Ferreira C, Alves CT, Henriques M, Azeredo J, Silva S. Vulvovaginal candidiasis: epidemiology, microbiology and risk factors. Crit Rev Microbiol. 2016;42(6):905–27. https://doi.org/10.3109/1040841X.2015.1091805.

    Article  CAS  PubMed  Google Scholar 

  5. Petrova MI, Lievens E, Malik S, Imholz N, Lebeer S. Lactobacillus species as biomarkers and agents that can promote various aspects of vaginal health. Front Physiol. 2015;6:81. https://doi.org/10.3389/fphys.2015.00081.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Kalia N, Singh J, Kaur M. Microbiota in vaginal health and pathogenesis of recurrent vulvovaginal infections: a critical review. Ann Clin Microbiol Antimicrob. 2020;19(1):5. https://doi.org/10.1186/s12941-020-0347-4.

    Article  PubMed  PubMed Central  Google Scholar 

  7. • Bradford LL, Ravel J. The vaginal mycobiome: a contemporary perspective on fungi in women’s health and diseases. Virulence. 2017;8(3):342–51. https://doi.org/10.1080/21505594.2016.1237332Enlightens vaginal mycobiome and mechanisms of commensalism and disease.

    Article  PubMed  Google Scholar 

  8. Landers DV, Wiesenfeld HC, Heine RP, Krohn MA, Hillier SL. Predictive value of the clinical diagnosis of lower genital tract infection in women. Am J Obstet Gynecol. 2004;190:1004–10.

    Article  Google Scholar 

  9. Drell T, Lillsaar T, Tummeleht L, Simm J, Aaspõllu A, Väin E, et al. Characterization of the vaginal micro-and mycobiome in asymptomatic reproductive-age estonian women. PLoS One. 2013;8(1):e54379. https://doi.org/10.1371/journal.pone.0054379.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Ene IV, Cheng SC, Netea MG, Brown AJP. Growth of Candida albicans cells on the physiologically relevant carbon source lactate affects their recognition and phagocytosis by immune cells. Infect Immun. 2012;81:238–48. https://doi.org/10.1128/IAI.01092-12.

    Article  CAS  PubMed  Google Scholar 

  11. Niu XX, Li T, Zhang X, Wang SX, Liu ZH. Lactobacillus crispatus modulates vaginal epithelial cell innate response to Candida albicans. Chin Med J. 2017;130(3):273. https://doi.org/10.4103/0366-6999.198927.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Amjadi F, Salehi E, Mehdizadeh M, Aflatoonian R. Role of the innate immunity in female reproductive tract. Adv Biomed Res. 2014;3:1. https://doi.org/10.4103/2277-9175.124626.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Pear GT, French AL, Gilbert D, Zariffard MR, Mirmonsef P, Sullivan TH, et al. Human α-amylase present in lower-genital-tract mucosal fluid processes glycogen to support vaginal colonization by Lactobacillus. J Infect Dis. 2014;210(7):1019–28. https://doi.org/10.1093/infdis/jiu231.

    Article  CAS  Google Scholar 

  14. Blostein F, Levin-Sparenberg E, Wagner J, Foxman B. Recurrent vulvovaginal candidiasis. Ann Epidemiol. 2017;27:575–582.e3.

    Article  Google Scholar 

  15. Hong E, Dixit S, Fidel PL, Bradford J, Fischer G. Vulvovaginal candidiasis as a chronic disease: diagnostic criteria and definition. J Low Genit Tract Dis. 2014;18(1):31–8. https://doi.org/10.1097/LGT.0b013e318287aced.

    Article  PubMed  Google Scholar 

  16. •• Denning DW, Kneale M, Sobel JD, Rautemaa-Richardson R. Global burden of recurrent vulvovaginal candidiasis: a systematic review. Lancet Infect Dis. 2018;18(11):e339–47. https://doi.org/10.1016/S1473-3099(18)30103-8Represents global burden of VYI in numbers.

    Article  PubMed  Google Scholar 

  17. Donders GGG, Ravel J, Vitali B, Netea MG, Salumets A, Unemo M. Role of molecular biology in diagnosis and characterization of vulvo-vaginitis in clinical practice. Gynecol Obstet Investig. 2017;82(6):607–16. https://doi.org/10.1159/000478982.

    Article  Google Scholar 

  18. van der Meijden WI, Boffa MJ, Ter Harmsel WA, et al. 2016 European guideline for the management of vulval conditions. J Eur Acad Dermatol Venereol. 2017;31(6):925–41. https://doi.org/10.1111/jdv.14096.

    Article  PubMed  Google Scholar 

  19. van Schalkwyk J, Yudin MH. Infectious Disease Committee. Vulvovaginitis: screening for and management of trichomoniasis, vulvovaginal candidiasis, and bacterial vaginosis. J Obstet Gynaecol Can. 2015;37(3):266–74. https://doi.org/10.1016/S1701-2163(15)30316-9.

    Article  PubMed  Google Scholar 

  20. Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the infectious diseases society of America. Clin Infect Dis. 2016;62:e1–e50. https://doi.org/10.1093/cid/civ933.

    Article  PubMed  Google Scholar 

  21. Owen MK, Clenney TL. Management of vaginitis. Am Fam Physician. 2004;70:2125–32.

    PubMed  Google Scholar 

  22. Houang ET, Chappatte O, Byrne D, Macrae PV, Thorpe JE. Fluconazole levels in plasma and vaginal secretions of patients after a 150-milligram single oral dose and rate of eradication of infection in vaginal candidiasis. Antimicrob Agents Chemother. 1990;34:909–10.

    Article  CAS  Google Scholar 

  23. Sobel JD, Vazquez JA. Symptomatic vulvovaginitis due to fluconazole-resistant Candida albicans in a female who was not infected with human immunodeficiency virus. Clin Infect Dis. 1996;22:726–7.

    Article  CAS  Google Scholar 

  24. Sobel JD, Kapernick PS, Zervos M, Reed BD, Hooton T, Soper D, et al. Treatment of complicated Candida vaginitis: comparison of single and sequential doses of fluconazole. Am J Obstet Gynecol. 2001;185:363–9.

    Article  CAS  Google Scholar 

  25. Sobel JD, Faro S, Force RW, Foxman B, Ledger WJ, Nyirjesy PR, et al. Vulvovaginal candidiasis: epidemiologic, diagnostic, and therapeutic considerations. Am J Obstet Gynecol. 1998;178:203–11.

    Article  CAS  Google Scholar 

  26. Willems HME, Ahmed SS, Liu J, Xu Z, Peters BM. Vulvovaginal candidiasis: a current understanding and burning questions. J. Fungi. 2020;6:27. https://doi.org/10.3390/jof6010027.

    Article  Google Scholar 

  27. Sobel JD, Kapernick PS, Zervos M, Reed BD, Hooton T, Soper D, et al. Treatment of complicated Candida vaginitis: comparison of single and sequential doses of fluconazole. Am J Obstet Gynecol. 2001;185:363–9.

    Article  CAS  Google Scholar 

  28. Collins LM, Moore R, Sobel JD. Prognosis and long-term outcome of women with idiopathic recurrent vulvovaginal candidiasis caused by Candida albicans. J Low Genit Tract Dis. 2020;24:48–52.

    Article  Google Scholar 

  29. Sobel JD. Candida vulvovaginitis: treatment – up to date. Wolters Kluwer. https://www.uptodate.com/contents/candida-vulvovaginitis-treatment?search=vulvovaginitois&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3 (Accessed in June 2020; last update, Jun 01, 2020).

  30. • Lírio J, Giraldo PC, Amaral RL, Sarmento ACA, APF C, Gonçalves AK. Antifungal (oral and vaginal) therapy for recurrent vulvovaginal candidiasis: a systematic review protocol. BMJ Open. 2019;9(5):e027489. https://doi.org/10.1136/bmjopen-2018-027489Pending to identify the most effective and safe oral and intravaginal antifungal agents.

    Article  PubMed  PubMed Central  Google Scholar 

  31. •• Zhang Z, Zhang X, Zhou YY, Jiang CM, Jiang HY. The safety of oral fluconazole during the first trimester of pregnancy: a systematic review and meta-analysis. BJOG. 2019;126(13):1546–52. https://doi.org/10.1111/1471-0528.15913In pregnancy oral fluconazole during the first trimester may be associated with heart malformations and spontaneous abortion.

    Article  CAS  PubMed  Google Scholar 

  32. US Food and Drug Administration. Safety communication: Oral fluconazole in pregnancy. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm497656.htm?source=gov delivery&utm_medium=email&utm_source=govdelivery (Accessed in June 2020, released on April 26, 2016).

  33. Sobel JD, Chaim W. Treatment of Torulopsis glabrata vaginitis: retrospective review of boric acid therapy. Clin Infect Dis. 1997;24:649–52.

    Article  CAS  Google Scholar 

  34. Sobel JD, Chaim W, Nagappan V, Leaman D. Treatment of vaginitis caused by Candida glabrata: use of topical boric acid and flucytosine. Am J Obstet Gynecol. 2003;189:1297–300.

    Article  CAS  Google Scholar 

  35. •• Alves IA, Savi FM, de Vasconcelos C, Braz J, Quintans Junior LJ, Serafini MR. The patenting and technological trends in candidiasis treatment: a systematic review (2014–2018). Curr Top Med Chem. 2019;19(28):2629–39. https://doi.org/10.2174/1568026619666191030091211Identified significant improvements and advances in the area of antifungal therapeutic innovation research.

    Article  CAS  PubMed  Google Scholar 

  36. Cassone A. Vulvovaginal Candida albicans infections: pathogenesis, immunity and vaccine prospects. BJOG. 2015;122:785–94.

    Article  CAS  Google Scholar 

  37. •• Edwards JE Jr, Schwartz MM, Schmidt CS, et al. A fungal immunotherapeutic vaccine (NDV-3A) for treatment of recurrent vulvovaginal candidiasis-a phase 2 randomized, double-blind, placebo-controlled trial. Clin Infect Dis. 2018;66(12):1928–36. https://doi.org/10.1093/cid/ciy185Therapeutic vaccine could enhance or rectify tolerance/inflammation imbalance in the vagina.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. •• van de Wijgert J, Verwijs MC. Lactobacilli-containing vaginal probiotics to cure or prevent bacterial or fungal vaginal dysbiosis: a systematic review and recommendations for future trial designs. BJOG. 2020;127(2):287–99. https://doi.org/10.1111/1471-0528.15870Vaginal probiotics don’t seem to be very effective.

    Article  PubMed  Google Scholar 

  39. Hillier SL. The need for better evidence to support probiotics for vaginitis. BJOG. 2020;127(2):300. https://doi.org/10.1111/1471-0528.15910.

    Article  CAS  PubMed  Google Scholar 

  40. Ali S, Ashraf U, Shah F, Ali O, Hayes K, Oakeshott P. Re: lactobacilli-containing vaginal probiotics to cure or prevent bacterial or fungal vaginal dysbiosis: a systematic review and recommendations for future trial designs. BJOG. 2020;127(2):304–5. https://doi.org/10.1111/1471-0528.15961.

    Article  PubMed  Google Scholar 

  41. •• **e HY, Feng D, Wei DM, et al. Probiotics for vulvovaginal candidiasis in non-pregnant women. Cochrane Database Syst Rev. 2017;11(11):CD010496. Published 2017 Nov 23. https://doi.org/10.1002/14651858.CD010496.pub2Vaginal probiotics don’t bring a higher frequency of long-term clinical or mycological cure.

  42. Russo R, Superti F, Karadja E, De Seta F. Randomised clinical trial in women with recurrent Vulvovaginal candidiasis: efficacy of probiotics and lactoferrin as maintenance treatment. Mycoses. 2019;62(4):328–35. https://doi.org/10.1111/myc.12883.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gynecology and Obstetrics, Department of Gynecology, University Medical Centre Ljubljana, Šlajmerjeva 3, 1000, Ljubljana, Slovenia

    Mija Blaganje & Matija Barbič

  2. Medical faculty, University of Ljubljana, Ljubljana, Slovenia

    Mija Blaganje & Matija Barbič

Authors
  1. Mija Blaganje
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Matija Barbič
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mija Blaganje.

Ethics declarations

Conflict of Interest

Mija Blaganje and Matija Barbič declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Inflammatory/Infectious Bladder Disorders

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Blaganje, M., Barbič, M. Vaginal Yeast Infection. Curr Bladder Dysfunct Rep 15, 325–331 (2020). https://doi.org/10.1007/s11884-020-00606-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11884-020-00606-z

Keywords

Search

Navigation