Is non-response to fluconazole maintenance therapy for recurrent Candida vaginitis related to sensitization to atopic reactions?

PROBLEM: Is sensitization to atopic reaction related to treatment response of recurrent Candida vulvovaginal (RVVC)?

METHOD OF THE STUDY: Analysis of ReCiDiF trial data of optimal (OR) and non-responders (NR) to fluconazole maintenance treatment, to explore medical history, physical status, family history, and vaginal immune response for potential sensitization to atopic reaction.

RESULTS: Sociodemographic characteristics of 33 NR women were not different from 38 OR. NR had received higher number of different treatments (mean difference 1.6 different treatments (95% CI: 0.20-2.97), P = .03) and had more episodes of disease (P < .05). Multivariate regression analysis showed that family history of atopy (OR: 4.9, CI 95%: 1.1-22.2), duration of symptoms (OR: 1.2, CI 95%: 1.02-1.5), and vulvar excoriation (OR: 3.6, CI 95%: 1.4-9.3) were related to non-response. Vulvar excoriation at entry was the only statistically significant predictive factor for non-response in multivariate analysis with specificity 77.8% and sensitivity 51.6%.

CONCLUSION: Women with RVVC with vulvar excoriation, longer duration of disease, and family history of atopic disease are at increased risk not to respond to maintenance fluconazole treatment.