Vulvovaginal candidiasis refers to a disorder characterized by signs and symptoms of vulvovaginal inflammation in the presence of Candida species. It is the second most common cause of vaginitis symptoms (after bacterial vaginosis) and accounts for approximately one-third of vaginitis cases . In contrast to oropharyngeal candidiasis, it is generally not considered an opportunistic infection, and, unlike trichomonas vaginitis, it is not considered a sexually transmitted disease (STD).
Candida species can be identified in the lower genital tract in 10 to 20 percent of healthy women in the reproductive age group, 6 to 7 percent of menopausal women, and 3 to 6 percent of prepubertal girls [2,3]. However, identification of vulvovaginal Candida is not necessarily indicative of candidal disease, as the diagnosis of vulvovaginitis requires the presence of vulvovaginal inflammation.
The prevalence of vulvovaginal candidiasis is difficult to determine because the clinical diagnosis is often based on symptoms and not confirmed by microscopic examination or culture (as many as one-half of clinically diagnosed women may have another condition ). In addition, the widespread use of over-the-counter antimycotic drugs makes epidemiologic studies difficult to perform and culture without clinical correlation is likely to overestimate the prevalence of disease.
In surveys, the prevalence of vulvovaginal candidiasis is highest among women in their reproductive years: 55 percent of female university students report having had at least one healthcare provider-diagnosed episode by age 25 years, 29 to 49 percent of premenopausal women report having had at least one lifetime episode, and 9 percent of women report having had four or more infections in a 12-month period (ie, recurrent vulvovaginal candidiasis [RVVC]) [5,6]. In women with an initial infection, the probability of RVVC was 10 percent by age 25 years, and 25 percent by age 50 years .
The prevalence increases with age up to menopause and is higher in African-American women than in other ethnic groups. The disorder is uncommon in postmenopausal women, unless they are taking estrogen therapy. It is also uncommon in prepubertal girls, in whom it is frequently overdiagnosed.