Fluconazole keeps recurrent candidiasis at Bay. (Maintenance Prophylaxis).

WASHINGTON -- New data from two studies suggest that there is hope for women with complicated vulvovaginal candidiasis, Dr. Jack D. Sobel said at an update on sexually transmitted diseases sponsored by OB.GYN. NEWS and Boston University.

Maintenance prophylaxis with fluconazole appears to benefit women who typically relapse following what appears to be successful azole therapy. And women whose symptoms are caused by the nonalbicans strain Candida glabrata will probably respond to vaginal boric acid and/or flucytosine, said Dr. Sobel, professor and chief of the division of infectious diseases at Wayne State University, Detroit.

In the United States, 90% of vulvovaginal candidiasis cases in premenopausal women are uncomplicated, defined as mild to moderate in severity, with pseudohyphae, and occur infrequently or sporadically in women with normal immune systems. Nearly all of these cases will respond to one dose of fluconazole or single-dose azole therapy, Dr. Sobel said.

Complicated disease, on the other hand, may be moderate to severe and recurrent (at least four episodes a year). It may involve only budding yeast or it may occur in women with adverse risk factors such as uncontrolled diabetes, immunosuppression, and possibly pregnancy. In these women, prolonged treatment-lasting 7-14 days--is often required.

In some women, however, symptoms will return as soon as 1 month after what appears to be a complete mycologic cure. One theory is that these women are colonized with unique "adaptive strains" of Candida. Although susceptible to fluconazole, these strains remain alive--and detectable by polymerase chain reaction--despite negative cultures. "They are not new infections," Dr. Sobel noted.

Now even these women can potentially be cured. In a randomized, double-blind, multicenter study, 284 women with ...