Classification System Aids Vaginitis Treatment. (Vulvovaginal Candidiasis).

DURBAN, SOUTH AFRICA - Treatment of candidal vaginitis has been made much easier by introduction of the Infectious Diseases Society of America disease classification system, Dr. Jack D. Sobel said.

The IDSA classification system, of which Dr. Sobel was a coauthor (Clin. Infect. Dis. 30[4]:662-78, 2000), divides patients into those having uncomplicated or complicated disease. (See chart.)

At least 90% of women with vulvovaginal candidiasis fall into the "uncomplicated" category. The important implication of assigning a woman to this category is that she has a greater than 90% likelihood of responding to a very brief course of azole therapy he said at an industry-sponsored symposium held in conjunction with WONCA 2001, the conference of the World Organization of Family Doctors.

"In fact, the placebo response of uncomplicated candidal vaginitis is 60%," according to Dr. Sobel, professor of medicine at Wayne State University, Detroit.

Uncomplicated candidal vaginitis responds to any of numerous intravaginal preparations of clotrimazole, miconazole, tioconazole, and butaconazole available over the counter. Regimens of 1,3,7, and 14 days all work very well.

Alternatively, oral therapy is both highly effective and convenient. Regimens include a single 150-mg dose of fluconazole or, off label, 200 mg of itraconazole b.i.d. for 1 day. Resolution of signs and symptoms occurs in 48-72 hours, with mycologic cure seen in 4-7 days.

Recurrent or otherwise complicated candidal vaginitis is another matter entirely. The therapeutic strategy here is to employ maintenance therapy to prevent recolonization, thereby preventing clinical relapse. Start with 10-14 days of intensive induction therapy with any topical or oral azole, then follow with 6 months of maintenance therapy.