Epidemiology and etiology

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VVC, also known as moniliasis, is a common form of vaginitis, accounting for 20% to 25% of vaginitis cases. Although VVC is uncommon prior to menarche, nearly 50% of women will experience one or more episodes by the age of 25 years.1 A survey of women in the United States found that 6.5% of women over the age of 18 years reported experiencing at least one episode of vaginitis during the previous 2 months.

According to the treatment guidelines of the Centers for Disease Control and Prevention (CDC),3 VVC

can be classified as uncomplicated or complicated. Uncomplicated infections are typically infrequent and cause mild to moderate symptoms. Complicated infections, including recurrent or severe infections, may be caused by azole-resistant fungal organisms. Immunocompromise, including immunosuppres-sion, uncontrolled diabetes, pregnancy, or debilitation, is a risk factor for developing recurrent infection. Recurrent VVC, defined as four or more infections per year, occurs in less than 5% of women.4 Recurrent infection is distinguishable from a persistent infection by the presence of a symptom-free interval between infections.

Q Candida albicans is the primary pathogen responsible for VVC, accounting for more than 90% of cases.5 A small percentage of cases are caused by nonalbicans species including C. glabrata, C. tropicalis, C. krusei, and C. parapsilosis. In patients with recurrent vaginitis, the causative Candida is twice as likely to be nonalbicans.6 The incidence of nonalbicans VVC is increasing, possibly due to overuse of nonprescription vaginal antifungal products, short-course antifungal treatments, and long-term suppressive therapy with antifungals.

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