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Upon completion of the chapter, the reader will be able to:

  1. Explain the underlying pathophysiology of vulvovaginal candidiasis (VVC), oropharyngeal candidiasis (OPC), esophageal candidiasis, and fungal skin infections.

  2. Identify symptoms of VVC, OPC, esophageal candidiasis, and fungal skin infections.

  3. Identify the desired therapeutic outcomes and monitoring parameters for resolution and safety for patients with uncomplicated and complicated VVC, OPC, esophageal candidiasis, and fungal skin infections.

  4. Recommend appropriate lifestyle modifications and pharmacotherapy interventions for patients with VVC, OPC, esophageal candidiasis, and fungal skin infections.

  5. Recognize when long-term suppressive therapy is indicated for a patient with VVC.

  6. Identify when topical versus oral treatment is indicated for a patient with OPC, esophageal candidiasis, VVC, and fungal skin infections.

  7. Educate patients regarding their disease state, appropriate lifestyle modifications, and medication therapy required for effective treatment of VVC, OPC, esophageal candidiasis, and fungal skin infections.


Superficial fungal infections, also referred to as mycoses, are common and treatable conditions seen in everyday practice. Treatment largely focuses on the use of azole and allylamine antifungal agents, either topically or orally, depending on the site, severity, and immune status of the patient.


Vulvovaginal candidiasis (VVC), whether symptomatic or asymptomatic, refers to an infection in women whose vaginal cultures are positive for Candida species.


VVC, also known as moniliasis, is a common form of vaginitis, accounting for 20% to 25% of vaginitis cases. Although VVC is uncommon prior to menarche, an estimated 75% of women will have at least one occurrence of VVC.1

According to the treatment guidelines of the Centers for Disease Control and Prevention (CDC),1 VVC can be classified as uncomplicated or complicated. Uncomplicated infections occur sporadically, cause mild-to-moderate symptoms, and occur in nonimmunocompromised women. Uncomplicated infections, most often caused by Candida albicans, have no identifiable precipitating cause. Complicated infections, including recurrent, severe infections, and those in women with uncontrolled diabetes, debilitation, or immunosuppression, may be caused by nonalbicans or azole-resistant fungal organisms. Recurrent VVC, defined as four or more infections per year, occurs in less than 5% of women and is distinguishable from a persistent infection by the presence of a symptom-free interval between infections.1

C. albicans is the primary pathogen responsible for VVC, accounting for 66% of cases. Other nonalbicans implicated pathogens include Candida glabrata, Candida tropicalis, Candida krusei, and Candida parapsilosis.2


The normal vaginal environment protects women against vaginal infections. Under the influence of estrogen, vaginal epithelium cornifies to reduce the risk of infection. Vaginal discharge, composed of exfoliated cells, cervical mucus, and colonized bacteria, cleans the vagina. The normal pH of vaginal secretions, near 4.0, is toxic to many pathogens and is maintained by Lactobacillus acidophilus, diphtheroids, ...

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