Probiotics for vulvovaginal candidiasis in non-pregnant women

Probiotics media: significance, challenges, and future perspective - a mini review

The health benefits associated with probiotics have increased their application in pharmaceutical formulations and functional food development. High production of probiotic biomass requires a cost-effective production method and nutrient media optimization. The biomass production of probiotics can be enhanced by optimizing growth parameters such as substrate, pH, incubation time, etc. For economical industrial production of probiotic biomass, it is required to design a new medium with low cost. Wastes from the food industries are promising components for the development of the low-cost medium. Industrial wastes such as cheese whey and corn steep liquor are excellent examples of reliable sources of nitrogen for the biomass production of probiotic bacteria. The increased yield of biomass reduced the cost of production. This review focuses on the importance of probiotic media for biomass production and its challenges.

Graphical Abstract

Management of recurrent vulvovaginal candidosis: Narrative review of the literature and European expert panel opinion

Recurrent vulvovaginal candidosis (RVVC) is a chronic, difficult to treat vaginal infection, caused by Candida species, which affects women of all ages and ethnic and social background. A long-term prophylactic maintenance regimen with antifungals is often necessary. In most clinical practice guidelines, oral fluconazole is recommended as the first-line treatment. Although clinical resistance to antifungal agents remains rare, overexposure to azoles may increase the development of fluconazole-resistant C. albicans strains. In addition, non-albicans Candida species are frequently dose-dependent susceptible or resistant to fluconazole and other azoles, and their prevalence is rising. Available therapeutic options to treat such fluconazole-resistant C. albicans and low susceptibility non-albicans strains are limited. Ten experts from different European countries discussed problematic issues of current RVVC diagnosis and treatment in two audiotaped online sessions and two electronic follow-up rounds. A total of 340 statements were transcribed, summarized, and compared with published evidence. The profile of patients with RVVC, their care pathways, current therapeutic needs, and potential value of novel drugs were addressed. Correct diagnosis, right treatment choice, and patient education to obtain adherence to therapy regimens are crucial for successful RVVC treatment. As therapeutic options are limited, innovative strategies are required. Well- tolerated and effective new drugs with an optimized mechanism of action are desirable and are discussed. Research into the impact of RVVC and treatments on health-related quality of life and sex life is also needed.

Complementary Medicine and Self-Care Strategies in Women with (Recurrent) Urinary Tract and Vaginal Infections: A Cross-Sectional Study on Use and Perceived Effectiveness in The Netherlands

Due to the excessive use of antibiotic and antimycotic treatments, the risk of resistant microbes and fungi is rapidly emerging. Previous studies have demonstrated that many women with (recurrent) urinary tract infection (UTI) and/or vaginal infections (VIs) welcome alternative management approaches to reduce the use of antibiotics and antifungals and avoid short- and long-term adverse effects. This study aims to determine which complementary medicine (CM) and self-care strategies are being used by women suffering from (recurrent) UTI and VI in The Netherlands and how they perceive their effectiveness in order to define directions for future research on safety, cost-effectiveness, and implementation of best practices. A cross-sectional online survey was performed among women, ≥18 years old, with a history of UTIs; 162 respondents were included in the data analysis, with most participants aged between 50 and 64 years (36.4%). The women reported having consulted a CM practitioner for UTI-specific symptoms (23.5%) and VI-specific symptoms (13.6%). Consultations of homeopaths, acupuncturists, and herbal physicians are most often reported. Overall, 81.7% of the women suffering from UTI used complementary or self-care strategies besides regular treatment, and 68.7% reported using CM/self-care strategies to treat vaginal symptoms. UTI- related use of cranberries (51.9%), vitamin C (43.8%), and D-mannose (32.7%) were most reported. Perceived effectiveness was mostly reported for homeopathic remedies and D-mannose. The results showed a substantial burden of UTI and VI on daily and sexual activities. Besides the frequency of use, the indication of perceived effectiveness seems to be an important parameter for further and rigorously designed research to encourage nonantibiotic/antifungal treatment implementation into daily clinical practice.

Current concept of the diagnostics and treatment of vulvovaginal candidosis

In spite of high prevalence of vulvovaginal candidosis (VVC), its diagnostics and treatment pose a serious problem. Factors such as accessibility of antimycotic drugs, their uncontrolled application by patients and absence of any appropriate laboratory diagnostics result in the growth of the incidence rate, in particular, of recurrent forms related to a steady growth in the number of fungi of clinical importance as well as strains resistant to antifungal drugs. Discussion and conclusion. Today the problem of the need to develop VVC prevention drugs is increasingly urgent because reduced immunity results in relapses of the disease. Clinical trials of drugs for immune system correction are ongoing, and some of them have reached Phase 2. Based on the present-day research data, it is possible to conclude that the key standards for VVC diagnostics and treatment are as follows: mandatory diagnostics with the use of microbiological tests to determine the sensitivity to antifungal medicines, in particular, in case of recurrent VVC, and collection of detailed medical history data and physical examination to determine the form and severity of the disease (acute, recurrent, complicated or uncomplicated) and treatment duration: 1-7 days for acute uncomplicated forms and 7-14 days for recurrent complicated forms. The specific drug and route of administration are to be selected based on the physician’s preferences, patient’s convenience and cost of the drug provided the drug sensitivity is determined by laboratory tests. The administration of probiotics for VVC prevention and treatment is disputable today.