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Evidence summaries

Treatment for Recurrent Vulvovaginal Candidiasis

Oral or topical antifungals may be effective for symptomatic clinical recurrences compared with placebo or no treatment in women with recurrent vulvovaginal candidiasis. Level of evidence: "D"

The certainty of the evidence is downgraded by study quality (high or unclear risk of allocation concealment, blinding, and selective reporting in most trials).

Summary

A Cochrane review [Abstract] 1 included 23 studies with a total of 2212 subjects. Included studies were small (<100 participants). Six studies compared antifungal treatment with placebo (n=607); 4 studies compared oral versus topical antifungals (n=543); 2 studies compared different dosing regimens for antifungals (n=100); 3 studies compared complementary medicine with antifungals (n=354). Compared with placebo or no treatment, oral and topical drug treatments (eg. azoles and nystatin) showed a reduction in clinical recurrence at 6 months (RR 0.36, 95% CI 0.21 to 0.63; number needed to treat (NNTB) 2; 6 trials, n=607; I² = 82%; low-certainty evidence) and 12 months (RR 0.80, 95% CI 0.72 to 0.89; NNTB=6; 6 trials, n=585; I² = 21%; low-certainty evidence). There were no clear difference between different treatment options (oral vs topical treatment, different doses, or duration). Adverse events were scarce across both treatment and control groups.

Clinical comments

Note

Date of latest search: 2022-02-22

References

  • Cooke G, Watson C, Deckx L et al. Treatment for recurrent vulvovaginal candidiasis (thrush). Cochrane Database Syst Rev 2022;(1):CD009151. [PubMed]

Primary/Secondary Keywords