PDF(Pubmed)
Abstract：
Recurrent vulvovaginal candidosis (RVVC) is a chronic, difficult to treat vaginal infection, caused by Candida species, which affects women of all ages and ethnic and social background. A long-term prophylactic maintenance regimen with antifungals is often necessary. In most clinical practice guidelines, oral fluconazole is recommended as the first-line treatment. Although clinical resistance to antifungal agents remains rare, overexposure to azoles may increase the development of fluconazole-resistant C. albicans strains. In addition, non-albicans Candida species are frequently dose-dependent susceptible or resistant to fluconazole and other azoles, and their prevalence is rising. Available therapeutic options to treat such fluconazole-resistant C. albicans and low susceptibility non-albicans strains are limited. Ten experts from different European countries discussed problematic issues of current RVVC diagnosis and treatment in two audiotaped online sessions and two electronic follow-up rounds. A total of 340 statements were transcribed, summarized, and compared with published evidence. The profile of patients with RVVC, their care pathways, current therapeutic needs, and potential value of novel drugs were addressed. Correct diagnosis, right treatment choice, and patient education to obtain adherence to therapy regimens are crucial for successful RVVC treatment. As therapeutic options are limited, innovative strategies are required. Well- tolerated and effective new drugs with an optimized mechanism of action are desirable and are discussed. Research into the impact of RVVC and treatments on health-related quality of life and sex life is also needed.
摘要：
复发性外阴阴道念珠菌病（RVVC）是一种慢性，很难治疗阴道感染，由念珠菌引起，影响所有年龄、种族和社会背景的妇女。通常需要使用抗真菌剂的长期预防性维持方案。在大多数临床实践指南中，推荐口服氟康唑作为一线治疗.尽管临床上对抗真菌药物的耐药性仍然很少，过度暴露于唑类可能会增加氟康唑耐药的白色念珠菌菌株的发展。此外,非白色念珠菌属物种通常剂量依赖性对氟康唑和其他唑类药物敏感或耐药，他们的患病率正在上升。治疗此类氟康唑抗性白色念珠菌和低敏感性非白色念珠菌菌株的可用治疗选择是有限的。来自不同欧洲国家的十位专家在两次录音在线会议和两次电子随访中讨论了当前RVVC诊断和治疗的问题。共抄录了340份陈述,总结,并与已发表的证据进行比较。RVVC患者的概况，他们的护理途径，目前的治疗需求，并探讨了新药的潜在价值。正确诊断,正确的治疗选择,和患者教育以获得对治疗方案的依从性对于成功的RVVC治疗至关重要。由于治疗选择有限，需要创新战略。具有优化作用机制的良好耐受性和有效的新药是理想的，并进行了讨论。还需要研究RVVC和治疗对健康相关生活质量和性生活的影响。
