Vulvovaginal Candidosis (Excluding Mucocutaneous Candidosis): Guideline of the German (DGGG), Austrian (OEGGG) and Swiss (SGGG) Society of Gynecology and Obstetrics (S2k-Level, AWMF Registry Number 015/072, September 2020)

Alex Farr; Isaak Effendy; Brigitte Frey Tirri; Herbert Hof; Peter Mayser; Ljubomir Petricevic; Markus Ruhnke; Martin Schaller; Axel P. A. Schäfer; Birgit Willinger; Werner Mendling

doi:10.1055/a-1345-8793

Geburtshilfe und Frauenheilkunde, Table of Contents

Geburtshilfe Frauenheilkd 2021; 81(04): 398-421
DOI: 10.1055/a-1345-8793

GebFra Science

Guideline/Leitlinie

Vulvovaginalkandidose (ausgenommen mukokutane Kandidose): Leitlinie der DGGG, OEGGG und SGGG (S2k-Level, AWMF-Registernummer 015/072, September 2020)

Article in several languages: English | deutsch

Alex Farr

¹Universitätsklinik für Frauenheilkunde, Medizinische Universität Wien, Wien, Austria

,

Isaak Effendy

²Hautklinik, Klinikum der Stadt Bielefeld, Bielefeld, Germany

,

Brigitte Frey Tirri

³Frauenklinik, Kantonsspital Baselland, Liestal, Switzerland

,

Herbert Hof

⁴MVZ Labor Limbach und Kollegen, Heidelberg, Germany

,

Peter Mayser

⁵Facharzt für Haut- und Geschlechtskrankheiten, Biebertal, Germany

,

Ljubomir Petricevic

¹Universitätsklinik für Frauenheilkunde, Medizinische Universität Wien, Wien, Austria

,

Markus Ruhnke

⁶Klinik für Hämatologie, Onkologie und Palliativmedizin, Helios Klinikum Aue, Aue, Germany

,

Martin Schaller

⁷Hautklinik, Zentrum für Dermato-Onkologie, Universität Tübingen, Tübingen, Germany

,

Axel P. A. Schäfer

⁸Facharzt für Frauenheilkunde und Geburtshilfe, Berlin, Germany

,

Birgit Willinger

⁹Abteilung für Klinische Mikrobiologie, Medizinische Universität Wien, Wien, Austria

,

Werner Mendling

¹⁰Deutsches Zentrum für Infektionen in Gynäkologie und Geburtshilfe, Wuppertal, Germany

› Author Affiliations

Abstract

Zusammenfassung

Ziel Das Ziel dieser offiziellen Leitlinie, die von der DGGG, OEGGG und SGGG unter Beteiligung der DMykG, DDG und AGII publiziert und koordiniert wurde, ist es, durch die Evaluation der relevanten Literatur einen konsensbasierten Überblick über die Diagnostik und das Management der Vulvovaginalkandidose zu geben.

Methoden Diese S2k-Leitlinie wurde durch einen strukturierten Konsens von repräsentativen Mitgliedern verschiedener Professionen im Auftrag der Leitlinienkommission der genannten Gesellschaften entwickelt.

Empfehlungen Diese Leitlinie gibt Empfehlungen zu Diagnostik, Management, Beratung, Prophylaxe und Screening der Vulvovaginalkandidose.

Schlüsselwörter

Candida albicans - Leitlinie - Pruritus - vulvovaginale Kandidose

Full Text

References

References/Literatur
1 Odds FC, Arai T, Disalvo AF. et al. Nomenclature of fungal diseases: a report and recommendations from a Sub-Committee of the International Society for Human and Animal Mycology (ISHAM). J Med Vet Mycol 1992; 30: 1-10
2 Loeffler W. Terminology of human mycoses. Nomenclature of mycotic diseases of man. List of accepted German terms translated, arranged and published, together with comments, for the International Society for Human and Animal Mycology (ISHAM). Mykosen 1983; 26: 346-384
3 Mendling W. Vaginose, Vaginitis, Zervizitis und Salpingitis. 2. Aufl.. Berlin, Heidelberg: Springer Verlag; 2006
4 Sobel JD. Vulvovaginal candidosis. Lancet 2007; 369: 1961-1971
5 Romeo O, Criseo G. Candida africana and its closest relatives. Mycoses 2011; 54: 475-486
6 Sharma C, Muralidhar S, Xu J. et al. Multilocus sequence typing of Candida africana from patients with vulvovaginal candidiasis in New Delhi, India. Mycoses 2014; 57: 544-552
7 Mendling W, Krauss C, Fladung B. A clinical multicenter study comparing efficacy and tolerability of topical combination therapy with clotrimazole (Canesten, two formats) with oral single dose fluconazole (Diflucan) in vulvovaginal mycoses. Mycoses 2004; 47: 136-142
8 Mendling W, Niemann D, Tintelnot K. Die vaginale Kolonisation durch Candidaarten unter besonderer Berücksichtigung von Candida dubliniensis. Geburtshilfe Frauenheilkd 2007; 67: 1132-1137
9 Hettiarachchi N, Ashbee HR, Wilson JD. Prevalence and management of non-albicans vaginal candidiasis. Sex Transm Infect 2010; 86: 99-100
10 Vermitsky JP, Self MJ, Chadwick SG. et al. Survey of vaginal-flora Candida species isolates from women of different age groups by use of species-specific PCR detection. J Clin Microbiol 2008; 46: 1501-1503
11 Goswami R, Dadhwal V, Tejaswi S. et al. Species-specific prevalence of vaginal candidiasis among patients with diabetes mellitus and its relation to their glycaemic status. J Infect 2000; 41: 162-166
12 Goswami D, Goswami R, Banerjee U. et al. Pattern of Candida species isolated from patients with diabetes mellitus and vulvovaginal candidiasis and their response to single dose oral fluconazole therapy. J Infect 2006; 52: 111-117
13 de Leon EM, Jacober SJ, Sobel JD. et al. Prevalence and risk factors for vaginal Candida colonization in women with type 1 and type 2 diabetes. BMC Infect Dis 2002; 2: 1
14 Corsello S, Spinillo A, Osnengo G. et al. An epidemiological survey of vulvovaginal candidiasis in Italy. Eur J Obstet Gynecol Reprod Biol 2003; 110: 66-72
15 Paultisch A, Weger W, Ginter-Hanselmayer G. et al. A 5-year (2000–2004) epidemiological survey of Candida and non-Candida yeast sepcies causing vulvovaginal candidiasis in Graz. Austria Mycoses 2006; 49: 471-475
16 Odds F. Candida and Candidosis. 2nd ed.. ed. London: Bailliere Tindall (WB Saunders); 1988
17 Spinillo A, Capuzzo E, Egbe TO. et al. Torulopsis glabrata Vaginitis. Obstet Gynecol 1995; 85: 993-998
18 Nyirjesy P, Alexander AB, Weitz MV. Vaginal Candida parapsilsosis: Pathogen or bystander?. Infect Dis Obstet Gynecol 2005; 13: 37-41
19 Singh S, Sobel JD, Bhargava P. et al. Vaginitis due to candida krusei: Epidemiology, Clinical aspects, and therapy. Clin Infect Dis 2002; 35: 1066-1070
20 Mendling W. Vaginose, Vaginitis, Zervizitis und Salpingitis. 2. Aufl.. Heidelberg: Springer; 2006
21 Sobel JD, Vazquez J, Lynch M. et al. Vaginitis due to Saccharomyces cerevisiae: epidemiology, clinical aspects, and therapy. Clin Infect Dis 1993; 16: 93-99
22 Fidel PL. Immunity in vaginal candidiasis. Curr Opin Infect Dis 2005; 18: 107-111
23 Yano J, Peters BM, Noverr MC. et al. Novel Mechanism behind the Immunopathogenesis of Vulvovaginal Candidiasis: “Neutrophil Anergy”. Infect Immun 2018; 86: e00684-17
24 Farrell SM, Hawkins DF, Ryder TA. Scanning electron microscope study of Candida albicans invasion of cultured human cervical epithelial cells. Sabouraudia 1983; 21: 251-254
25 Trumbore DJ, Sobel JD. Recurrent vulvovaginal candidiasis: vaginal epithelial cell susceptibility to Candida albicans adherence. Obstet Gynecol 1986; 67: 810-812
26 Sobel JD, Myers PG, Kaye D. et al. Adherence of Candida albicans to human vaginal and buccal epithelial cells. J Infect Dis 1981; 143: 76-82
27 De Bernardis F, Agatensi L, Ross IK. et al. Evidence for a role for secreted aspartate proteinase of Candida albicans in vulvovaginal candidiasis. J Infect Dis 1990; 161: 1276-1283
28 Naglik J, Albrecht A, Bader O. et al. Candida albicans proteinases and host/pathogen interactions. Cell Microbiol 2004; 6: 915-926
29 Ruchel R, Tegeler R, Trost M. A comparison of secretory proteinases from different strains of Candida albicans. Sabouraudia 1982; 20: 233-244
30 Ghannoum MA. Potential role of phospholipases in virulence and fungal pathogenesis. Clin Microbiol Rev 2000; 13: 122-143
31 Cassone A, De Bernardis F, Mondello F. et al. Evidence for a correlation between proteinase secretion and vulvovaginal candidosis. J Infect Dis 1987; 156: 777-783
32 Meinhof W. [Hydrochloric acid tolerance of Candida albicans]. Mykosen 1974; 17: 339-347
33 Lattif AA, Prasad R, Banerjee U. et al. The glyoxylate cycle enzyme activities in the pathogenic isolates of Candida albicans obtained from HIV/AIDS, diabetic and burn patients. Mycoses 2006; 49: 85-90
34 Cunha C, Carvalho A, Esposito A. et al. DAMP signaling in fungal infections and diseases. Front Immunol 2012; 3: 286
35 Zhao X, Malloy PJ, Ardies CM. et al. Oestrogen-binding protein in Candida albicans: antibody development and cellular localization by electron immunocytochemistry. Microbiology 1995; 141 (Pt 10): 2685-2692
36 Dennerstein G, Ellis DH. Oestrogen, glcogen and vaginal candidiasis. Obstet Gynecol 2001; 41: 326
37 Weissenbacher T, Witkin SS, Ledger WJ. et al. Relationship between clinical diagnosis of recurrent vulvovaginal candidiasis and detection of Candida species by culture and polymerase chain reaction. Arch Gynecol Obstet 2009; 279: 125-129
38 Beigi RH, Meyn LA, Moore DM. et al. Vaginal yeast colonization in nonpregnant women: a longitudinal study. Obstet Gynecol 2004; 104: 926-930
39 Mendling W, Gutschmidt J, Gantenberg R. Vergleich der Stammspezifität von Hefepilzen verschiedener Lokalisation bei Frauen mit Vaginalcandidosen. Mycoses 1998; 41: 23-25
40 Ruhnke M, Grosch-Worner I, Lischewski A. et al. Genotypic relatedness of yeast isolates from women infected with human immunodeficiency virus and their children. Mycoses 1999; 42: 385-394
41 Bohannon NJ. Treatment of vulvovaginal candidiasis in patients with diabetes. Diabetes Care 1998; 21: 451-456
42 Yano J, Sobel JD, Nyirjesy P. et al. Current patient perspectives of vulvovaginal candidiasis: incidence, symptoms, management and post-treatment outcomes. BMC Womens Health 2019; 19: 48
43 Donders GGG, Bellen G, Ruban K. et al. Short- and long-term influence of the levonorgestrel-releasing intrauterine system (Mirena(R)) on vaginal microbiota and Candida. J Med Microbiol 2018; 67: 308-313
44 Denning DW, Kneale M, Sobel JD. et al. Global burden of recurrent vulvovaginal candidiasis: a systematic review. Lancet Infect Dis 2018; 18: e339-e347
45 Unnikrishnan AG, Kalra S, Purandare V. et al. Genital infections with sodium glucose cotransporter-2 inhibitors: Occurrence and management in patients with type 2 diabetes mellitus. Indian J Endocrinol Metab 2018; 22: 837-842
46 Nyirjesy P, Sobel JD, Fung A. et al. Genital mycotic infections with canagliflozin, a sodium glucose co-transporter 2 inhibitor, in patients with type 2 diabetes mellitus: a pooled analysis of clinical studies. Curr Med Res Opin 2014; 30: 1109-1119
47 Willems HME, Ahmed SS, Liu J. et al. Vulvovaginal Candidiasis: A Current Understanding and Burning Questions. J Fungi (Basel) 2020; 6: 27
48 Eckert LO, Hawes SE, Stevens CE. et al. Vulvovaginal Candidiasis: clinical manifestations, risk factors, management algorithm. Obstet Gynecol 1998; 92: 757-765
49 Pirotta MV, Gunn JM, Chondros P. “Not thrush again!” Womenʼs experience of post-antibiotic vulvovaginits. Med J Aust 2003; 179: 43-46
50 Pirotta MV, Garland SM. Genital Candida species detected in samples from women in Melbourne, Australia, before and after treatment with antibiotics. J Clin Microbiol 2006; 44: 3213-3217
51 Xu J, Schwartz K, Bartoces M. et al. Effect of antibiotics on vulvovaginal candidiasis: a MetroNet study. J Am Board Fam Med 2008; 21: 261-268
52 Shukla A, Sobel JD. Vulvovaginitis Caused by Candida Species Following Antibiotic Exposure. Curr Infect Dis Rep 2019; 21: 44
53 Auger P, Joly J. Microbial flora associated with Candida albicans vulvovaginitis. Obstet Gynecol 1980; 55: 397-401
54 Aagaard K, Riehle K, Ma J. et al. A metagenomic approach to characterization of the vaginal microbiome signature in pregnancy. PLoS One 2012; 7: e36466
55 Hummelen R, Macklaim JM, Bisanz JE. et al. Vaginal microbiome and epithelial gene array in post-menopausal women with moderate to severe dryness. PLoS One 2011; 6: e26602
56 De Seta F, Parazzini F, De Leo R. et al. Lactobacillus plantarum P17630 for preventing Candida vaginitis recurrence: a retrospective comparative study. Eur J Obstet Gynecol Reprod Biol 2014; 182: 136-139
57 Mailander-Sanchez D, Wagener J, Schaller M. Potential role of probiotic bacteria in the treatment and prevention of localised candidosis. Mycoses 2012; 55: 17-26
58 Martinez RC, Seney SL, Summers KL. et al. Effect of Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 on the ability of Candida albicans to infect cells and induce inflammation. Microbiol Immunol 2009; 53: 487-495
59 Pendharkar S, Brandsborg E, Hammarstrom L. et al. Vaginal colonisation by probiotic lactobacilli and clinical outcome in women conventionally treated for bacterial vaginosis and yeast infection. BMC Infect Dis 2015; 15: 255
60 Ismail AM, Abbas AM, Shams AH. et al. The effect of use of vaginal Lactobacillus rhamnosus for prevention of recurrence of vulvovaginal candidiasis: a randomized controlled trial. Thai J Obstet Gynaecol 2017; 25: 62-68
61 Santos CMA, Pires MCV, Leao TL. et al. Selection of Lactobacillus strains as potential probiotics for vaginitis treatment. Microbiology 2016; 162: 1195-1207
62 Dennerstein GJ, Ellis DH. Oestrogen, glycogen and vaginal candidiasis. Aust N Z J Obstet Gynaecol 2001; 41: 326-328
63 Naglik JR, Gaffen SL, Hube B. Candidalysin: discovery and function in Candida albicans infections. Curr Opin Microbiol 2019; 52: 100-109
64 Fischer G, Bradford J. Vulvovaginal candidiasis in postmenopausal women: the role of hormone replacement therapy. J Low Genit Tract Dis 2011; 15: 263-267
65 van de Wijgert JHHM, Verwijs MC, Turner AN. et al. Hormonal contraception decreases bacterial vaginosis but oral contraception may increase candidiasis: implications for HIV transmission. AIDS 2013; 27: 2141-2153
66 Spacek J, Kestranek J, Jilek P. et al. Comparison of two long-term gestagen regimens in the management of recurrent vulvovaginal candidiasis: A pilot study. Mycoses 2017; 60: 260-265
67 Babula O, Lazdāne G, Kroica J. et al. Frequency of interleukin-4 (IL-4) − 589 gene polymorphism and vaginal concentrations of IL-4, nitric oxide, and mannose-binding lectin in women with recurrent vulvovaginal candidiasis. Clin Infect Dis 2005; 40: 1258-1262
68 Donders GG, Babula O, Bellen G. et al. Mannose-binding lectin gene polymorphism and resistance to therapy in women with recurrent vulvovaginal candidiasis. BJOG 2008; 115: 1225-1231
69 Chaim W, Foxman B, Sobel JD. Association of recurrent vaginal candidiasis and secretory ABO and Lewis phenotype. J Infect Dis 1997; 176: 828-830
70 Nyman GSA, Tang M, Inerot A. et al. Contact allergy to beeswax and propolis among patients with cheilitis or facial dermatitis. Contact Dermatitis 2019; 81: 110-116
71 Cassone A, Casadevall A. Recent progress in vaccines against fungal diseases. Curr Opin Microbiol 2012; 15: 427-433
72 Holland SM, Vinh DC. Yeast infections – Human genetics on the rise. N Engl J Med 2009; 361: 1798-1801
73 de Jong MA, Vriend LE, Theelen B. et al. C-type lectin Langerin is a beta-glucan receptor on human Langerhans cells that recognizes opportunistic and pathogenic fungi. Mol Immunol 2010; 47: 1216-1225
74 Romani L. Immunity to fungal infections. Nat Rev Immunol 2004; 4: 1-23
75 Vecchiarelli A, Pericolini E, Gabrielli E. et al. New approaches in the development of a vaccine for mucosal candidiasis: progress and challenges. Front Microbiol 2012; 3: 294
76 Neves NA, Carvalho LP, De Oliveira MA. et al. Association between atopy and recurrent vaginal candidiasis. Clin Exp Immunol 2005; 142: 167-171
77 Reed BD, Zazove P, Pierson CL. et al. Candida transmission and sexual behaviors as risks for a repeat episode of Candida vulvovaginits. J Womens Health (Larchmt) 2003; 12: 979-989
78 Rylander E, Berglund AL, Krassny C. et al. Vulvovaginal candida in a young sexually active population: prevalence and association with oro-genital sex and frequent pain at intercourse. Sex Transm Infect 2004; 80: 54-57
79 Ehrstrom SM, Kornfeld D, Thuresson J. et al. Signs of chronic stress in women with recurrent candida vulvovaginitis. Am J Obstet Gynecol 2005; 193: 1376-1381
80 Meyer H, Goettlicher S, Mendling W. Stress as a cause of chronic recurrent vulvovaginal candidosis and the effectiveness of the conventional antimycotic therapy. Mycoses 2006; 49: 202-209
81 Cruickshank R. Acquired Immunity: Bacterial Infections. Mod Trends Immunol 1963; 1: 107-129
82 Donders GG, Prenen H, Verbeke G. et al. Impaired tolerance for glucose in women with recurrent vaginal candidiasis. Am J Obstet Gynecol 2002; 187: 989-993
83 Eckert LO, Hawes SE, Stevens CE. et al. Vulvovaginal candidiasis: clinical manifestations, risk factors, management algorithm. Obstet Gynecol 1998; 92: 757-765
84 Anderson MR, Klink K, Cohrssen A. Evaluation of vaginal complaints. JAMA 2004; 291: 1368-1379
85 Spacek J, Jilek P, Buchta V. The serum levels of calcium, magnesium, iron and zinc in patients with recurrent vulvovaginal candidosis during attack, remission and in healthy controls. Mycoses 2005; 48: 391-395
86 Fidel jr. PL, Vazquez JA, Sobel JD. Candida glabrata: Review of epidemiology, pathogenesis, and clincal disease with comparison to C. albicans. Clin Microbiol Rev 1999; 12: 80-96
87 Sobel JD. Vulvovaginitis due to Candida glabrata. An emerging problem. Mycoses 1998; 41: 18-22
88 Mendling W. [Torulopsis in gynecology]. Geburtshilfe Frauenheilkd 1984; 44: 583-586
89 Savini V, Catavitello C, Manna A. et al. Two cases of vaginitis caused by itraconazole-resistant Saccharomyces cerevisiae and a review of recently published studies. Mycopathologia 2008; 166: 47-50
90 Aballéa S, Guelfucci F, Wagner J. et al. Subjective health status and health-related qualitiy of life among women with Recurrent Vulvovaginal Candidosis (RVVC) in Europe and the USA. Health Qual Life Outcomes 2013; 11: 169
91 Mylonas I, Bergauer F. Diagnosis of vaginal discharge by wet mount microscopy: a simple and underrated method. Obstet Gynecol Surv 2011; 66: 359-368
92 Müller J, Nold B, Kubitza D. et al. Quantitative Untersuchungen über die Döderlein-Flora gesunder sowie mykosekranker Probandinnen unter lokaler Isoconazol-Nitrat-Therapie. In: Seeliger HPR. Hrsg. Gyno – Travogen, Monographie Excerpta Medica. Amsterdam: Oxford Princeton; 1981: 81-93
93 Nyirjesy P, Seeney SM, Grody MH. et al. Chronic fungal vaginitis: the value of cultures. Am J Obstet Gynecol 1995; 173 (3 Pt 1): 820-823
94 Hoffstetter SE, Barr S, LeFevre C. et al. Self-reported yeast symptoms compared with clinical wet mount analysis and vaginal yeast culture in a specialty clinic setting. J Reprod Med 2008; 53: 402-406
95 Mulhem E, Boyanton BL, Robinson-Dunn B. et al. Performance of the Affirm VP-III using residual vaginal discharge collected from the speculum to characterize vaginitis in symptomatic women. J Low Genit Tract Dis 2014; 18: 344-346
96 Bradford LL, Chibucos MC, Ma B. et al. Vaginal Candida spp. genomes from women with vulvovaginal candidiasis. Pathog Dis 2017; 75: ftx061
97 Wilson C. Recurrent vulvovaginitis candidiasis; an overview of traditional and alternative therapies. Adv Nurse Pract 2005; 13: 24-29 quiz 30
98 Plempel M. [Pharmacokinetics of imidazole-antimycotics]. Mykosen 1980; 23: 16-27
99 Scheklakow ND, Delektorski WW, Golodova OA. [Ultrastructural changes in Candida albicans caused by polyene antibiotics (authorʼs transl)]. Mykosen 1981; 24: 140-152
100 Niewerth M, Kunze D, Seibold M. et al. Ciclopirox olamine treatment affects the expression pattern of Candida albicans genes encoding virulence factors, iron metabolism proteins, and drug resistance factors. Antimicrob Agents Chemother 2003; 47: 1805-1817
101 Ritter W. Pharmacokinetics of Azole Compounds. In: Berg D, Plempel M. eds. Sterol Biosynthesis Inhibitors. Chichester: Ellis Horwood; 1988: 397-429
102 Fan S, Liu X, Liang Y. Miconazole nitrate vaginal suppository 1,200 mg versus oral fluconazole 150 mg in treating severe vulvovaginal candidiasis. Gynecol Obstet Invest 2015; 80: 113-118
103 Mendling W. Azoles in the Therapy of vaginal Candidosis. In: Berg D, Plempel M. eds. Sterol Biosynthesis Inhibitors. Chichester: Ellis Horwood; 1988: 480-506
104 Wajnberg M, Wajnberg A. [A comparative double blind trial with vaginal creams of cyclopyroxolamine and miconazole in vulvovaginal candidosis (authorʼs transl)]. Mykosen 1981; 24: 721-730
105 das Neves J, Pinto E, Teixeira B. et al. Local treatment of vulvovaginal candidosis: general and practical considerations. Drugs 2008; 68: 1787-1802
106 Moran GP, Sanglard D, Donnelly SM. et al. Identification and expression of multidrug transporters responsible for fluconazole resistance in Candida dubliniensis. Antimicrob Agents Chemother 1998; 42: 1819-1830
107 Sobel JD. Management of recurrent vulvovaginal candidiasis with intermittent ketokonazole prophylaxis. Obstet Gynecol 1985; 65: 435-440
108 Davidson F, Mould RF. Recurrent genital candidosis in women and the effect of intermittent prophylactic treatment. Br J Vener Dis 1978; 54: 176-183
109 Roth AC, Milsom I, Forssman L. et al. Intermittent prophylactic treatment of recurrent vaginal candidiasis by postmenstrual application of a 500 mg clotrimazole vaginal tablet. Genitourin Med 1990; 66: 357-360
110 Sobel JD, Wiesenfeld H, Martens M. Maintenance fluconazole therapy for recurrent vulvovaginal candidiasis. N Engl J Med 2004; 35: 875-883
111 Sobel JD. Recurrent vulvovaginal candidiasis. Am J Obstet Gynecol 2016; 214: 15-21
112 Donders G, Bellen G, Byttebier G. et al. Individualized decreasing-dose maintenance fluconazole regimen for recurrent vulvovaginal candidiasis (ReCiDiF trial). Am J Obstet Gynecol 2008; 199: 613.e1-613.e9
113 Donders GGG, Grinceviciene S, Bellen G. et al. Is non-response to fluconazole maintenance therapy for recurrent Candida vaginitis related to sensitization to atopic reactions?. Am J Reprod Immunol 2018; 79: e12811
114 Ho J, Wickramasinghe DN, Nikou S-A. et al. Candidalysin Is a Potent Trigger of Alarmin and Antimicrobial Peptide Release in Epithelial Cells. Cells 2020; 9: 699
115 Grinceviciene S, Ruban K, Bellen G. et al. Sexual behaviour and extra-genital colonisation in women treated for recurrent Candida vulvo-vaginitis. Mycoses 2018; 61: 857-860
116 Czeizel AE, Tóth M, Rockenbauer M. No teratogenic effect after clotrimazole therapy during pregnancy. Epidemiology 1999; 10: 437-440
117 Czeizel AE, Fladung B, Vargha P. Preterm birth reduction after clotrimazole treatment during pregnancy. Eur J Obstet Gynecol Reprod Biol 2004; 116: 157-163
118 Czeizel AE, Puhó EH, Kazy Z. The use of data set of the Hungarian case-control surveillance of congenital abnormalities for evaluation of birth outcomes beyond birth defects. Cent Eur J Public Health 2007; 15: 147-153
119 Hay P, Czeizel AE. Asymptomatic trichomonas and candida colonization and pregnancy outcome. Best Pract Res Clin Obstet Gynaecol 2007; 21: 403-409
120 Kiss H, Petricevic L, Husslein P. Prospective randomised controlled trial of an infection screening programme to reduce the rate of preterm delivery. BMJ 2004;
121 Roberts CL, Rickard K, Kotsiou G. et al. Treatment of asymptomatic vaginal candidiasis in pregnancy to prevent preterm birth: an open-label pilot randomized controlled trial. BMC Pregnancy Childbirth 2011; 11: 18
122 Farr A, Kiss H, Holzer I. et al. Effect of asymptomatic vaginal colonization with Candida albicans on pregnancy outcome. Acta Obstet Gynecol Scand 2015; 94: 989-996
123 Blaschke-Hellmessen R. Subpartale Übertragung von Candida und ihre Konsequenzen. Mycoses 1998; 41: 31-36
124 Blaschke-Hellmessen R. [Epidemiological studies of the occurrence of yeasts in children and their mothers]. Mykosen 1968; 11: 611-616
125 Howley MM. Using meta-analyses to improve risk estimates of specific birth defects. BJOG 2019; 126: 1553
126 Molgaard-Nielsen D, Pasternak B, Hviid A. Use of oral fluconazole during pregnancy and the risk of birth defects. N Engl J Med 2013; 369: 830-839
127 Molgaard-Nielsen D, Svanstrom H, Melbye M. et al. Association Between Use of Oral Fluconazole During Pregnancy and Risk of Spontaneous Abortion and Stillbirth. JAMA 2016; 315: 58-67
128 Della Casa V, Noll H, Gonser S. et al. Antimicrobial activity of dequalinium chloride against leading germs of vaginal infections. Arzneimittel-Forschung 2002; 52: 699-705
129 Frey Tirri B. Antimicrobial topical agents used in the vagina. Curr Probl Dermatol 2011; 40: 36-47
130 Mendling W, Weissenbacher ER, Gerber S. et al. Use of locally delivered dequalinium chloride in the treatment of vaginal infections: a review. Arch Gynecol Obstet 2016; 293: 469-484
131 Walker PP, Reynolds MT, Ashbee HR. et al. Vaginal yeasts in the era of “over the counter” antifungals. Sex Transm Infect 2000; 76: 437-438
132 Ferris DG, Nyirjesy P, Sobel JD. et al. Over-the-counter antifungal drug misuse associated with patient-diagnosed vulvovaginal candidiasis. Obstet Gynecol 2002; 99: 419-425
133 Mardh PA, Novikova N, Stukalova E. Colonisation of extragenital sites by Candida in women with recurrent vulvovaginal candidosis. BJOG 2003; 110: 934-937
134 Felix TC, de Brito Röder DVD, Dos Santos Pedroso R. Alternative and complementary therapies for vulvovaginal candidiasis. Folia Microbiol (Praha) 2019; 64: 133-141
135 Russo R, Superti F, Karadja E. et al. Randomised clinical trial in women with Recurrent Vulvovaginal Candidiasis: Efficacy of probiotics and lactoferrin as maintenance treatment. Mycoses 2019; 62: 328-335
136 Chew SY, Cheah YK, Seow HF. et al. Probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 exhibit strong antifungal effects against vulvovaginal candidiasis-causing Candida glabrata isolates. J Appl Microbiol 2015; 118: 1180-1190
137 Kosgey JC, Jia L, Fang Y. et al. Probiotics as antifungal agents: Experimental confirmation and future prospects. J Microbiol Methods 2019; 162: 28-37
138 Capoci IR, Bonfim-Mendonça Pde S, Arita GS. et al. Propolis Is an Efficient Fungicide and Inhibitor of Biofilm Production by Vaginal Candida albicans. Evid Based Complement Alternat Med 2015; 2015: 287693
139 Ahangari F, Farshbaf-Khalili A, Javadzadeh Y. et al. Comparing the effectiveness of Salvia officinalis, clotrimazole and their combination on vulvovaginal candidiasis: A randomized, controlled clinical trial. J Obstet Gynaecol Res 2019; 45: 897-907
140 Huang Y, Merkatz RB, Hillier SL. et al. Effects of a One Year Reusable Contraceptive Vaginal Ring on Vaginal Microflora and the Risk of Vaginal Infection: An Open-Label Prospective Evaluation. PLoS One 2015; 10: e0134460