Treating recurrent vulvovaginal candidiasis with long-term antifungals can help avoid repeated treatment failures, a leading dermatologist says.
Dermatologist Associate Professor Gayle Fischer, from the University of Sydney, says maintenance therapy with prophylactic fluconazole is underused in chronic vulvovaginal candidiasis and should be seen in the same light as antiviral prophylaxis for preventing genital herpes.
“There is absolutely no difference here for people with chronic thrush. You have to draw the analogy and understand that this is a different situation to women who get the occasional thrush,” she said.
Professor Fischer was responding to an Australian-led review of international guidelines for recurrent vulvovaginal candidiasis, which found that most recommend six months of treatment with weekly fluconazole.
The 43% efficacy rate after stopping antifungals should not be viewed as treatment failure but as a need for maintenance therapy, Professor Fischer told Australian Doctor. She said long-term oral antifungal therapy may need to be continued until affected women reached menopause.
“People accept that it’s fine for someone with HIV or some immunodeficiency to take fluconazole prophylactically but not in these [women].”
The Australian review, co-authored by Professor Danielle Mazza from Monash University, said longer courses of oral antifungals may have better cure rates, but this was not yet supported by large-scale trials.
Australian and New Zealand Journal of Obstetrics and Gynaecology 2017; online.