Treatment of Vulvovaginal Candidiasis with Chronic Recurrent Episodes (More Than 4 per Year)
Clinical Scenario
This protocol applies to women with chronic recurrent vulvovaginal candidosis (RVVC) — defined as more than 4 episodes of vulvovaginal candidosis per year. This pattern of frequent recurrence calls for a targeted long-term management strategy beyond single-episode treatment.
Treatment Approach
Management involves oral antifungal maintenance (suppression) therapy following a structured, dose-reducing schedule. Multiple evidence-based regimen options are available. The full protocol details the complete sequence, options, and step criteria.
Treatment Goal
Absence of symptoms and negative Candida microscopy/culture after 14 days at each treatment step.
References
DOI: 10.1111/myc.13248
- Many of them have > 4 episodes per year, which is defined as recurrent VVC (RVVC).
- Women with chronic recurrent Candida albicans vulvovaginitis should undergo dose-reducing maintenance therapy with oral triazoles.
- In cases of chronic RVVC, dose-reducing suppression therapy with 200 mg oral fluconazole might be considered as follows: three times weekly for one week; followed by once weekly for two months; if symptom-or fungus-free, then twice monthly for four months; and finally once monthly for six months (Figure 1).
- Donders et al recommend an initial dose of 200 mg fluconazole for 3 days in the first week in cases with chronic RVVC, followed by a maintenance regimen once the patient is free of symptoms or fungi with 200 mg fluconazole once per month for a duration of one year (Figure 1).
- If 150 mg of fluconazole is administered weekly, the cumulative dose is 3,600 mg at 6 months and 7,200 mg per year, and treatment results are most likely comparable.
- Symptoms? Microscopy/culture negative after 14 days?