Recurrent Vulvo-Vaginal Candidiasis: Diagnostic and Management Challenges in a Developing Country Context

Vulvovaginal candidiasis (VVC) is a frequent and common distressing disease affecting women of all ages and across social strata globally. It is the second most common cause of vaginal infections after bacterial vaginosis (BV) [1]. Estimates indicate that 70%–75% of women of childbearing age worldwide experience at least one episode during their lifetime, and 5%–10% of women with a primary episode of VVC experience frustrating recurrent infections (RVVC) [2], defined as at least three-four specific episodes within one year [3,4]. VVC is rare before puberty, its incidence increasing dramatically in the second decade of life, coinciding with the onset of sexual activity [5]. About 54.7% of women will experience one episode by age 25 [5]. It is classified as “uncomplicated and complicated”, which is now internationally accepted [7,8]. It is also classified as sporadic (acute) and recurrent based on the frequency of the infectious episodes [3]. RVVC is part of the complicated vulvo-vaginal candidiasis (Table 1).