Reply to Dr. Reichman's comments on "Vulvovaginal candidiasis as a chronic disease: diagnostic criteria and definition"

Chronic vulvovaginal candidiasis in patients using a levonorgestrel-containing intrauterine device

Chronic vulvovaginal candidiasis is usually responsive to therapy with oral antifungals. We present a case series of 13 patients with this condition who were also using a levonorgestrel intrauterine system (LNG-IUS). All cases responded to ongoing oral fluconazole therapy while the LNG-IUS was in situ. The LNG-IUS was removed in six patients and of these, two experienced clinical improvement with lower fluconazole dosage requirements and three experienced complete resolution of symptoms. One remains on fluconazole 100 mg daily.