Dr Tania Day

Navigating complicated candidiasis

Vulvovaginal candidiasis (VVC) affects over half of women during their lifetime. There are two categorization systems for VVC: uncomplicated versus complicated and acute versus recurrent. Most uncomplicated or acute cases occur in postpubertal premenopausal girls and women as sporadic vaginitis due to Candida albicans. Complicated VVC includes recurrent, chronic, or severe cases, presence of non-albicans species, and/or disease occurring in people with diabetes, immunosuppression, or pregnancy. These classification systems fail to distinguish the two distinct clinical categories of genital candidiasis: estrogen-dependent VVC and estrogen-independent cutaneous candidiasis. These entities are characterized by different pathogenesis, patient demographics, predisposing conditions, symptoms, signs, investigations, differential diagnosis, treatment, and ancillary measures. The current international and national guidelines on VVC are inadequate in their description of the clinical presentation, role and limitations of culture, biopsy findings, and management of cutaneous candidiasis. Progress toward improved patient outcomes will require the interdisciplinary collaboration of researchers and guideline authors to separate these two entities, unify terminology for each, explore the roles of medications and comorbid dermatoses, detail pragmatic and accessible diagnostic processes, define treatment goals, and discuss the long-term management strategies pertinent to each condition.

(From Day T, Sobel J. Genital cutaneous candidiasis versus chronic recurrent vulvovaginal candidiasis: distinct diseases, different populations. Clinical Microbiology reviews 2025;38(2):e002025.