*1,2Okeke, P. C. U., 1,2Nwafia, I. N., and 1,2Emeribe, S. C.
¹Department of Medical Microbiology, University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu, Nigeria.
²Department of Medical Microbiology, College of Medicine, Faculty of Basic Clinical Sciences, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria.
*Correspondence to: princess.okeke@unn.edu.ng; Tel: +2348037117982; ORCID: https://orcid.org/0009–0004–2522–2416
Abstract:
Vulvovaginal candidiasis (VVC) is among the most common mucosal fungal infections affecting women, with recurrent disease (RVVC) affecting an estimated 138 million women annually. Despite its frequency, major gaps remain in diagnosis, treatment and prevention. This scoping review identifies critical gaps across the VVC disease pathway and proposes a precision framework to transform management from episodic treatment toward prediction, targeted therapy and durable recurrence prevention. A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and African Journals Online using keywords related to VVC, antifungal resistance, microbiome, and treatment. Studies published between 1990 and 2026 addressing epidemiological, microbiological, immunological, diagnostic, therapeutic or translational aspects of VVC were included. Data were synthesized thematically. Major gaps identified include: the true burden of microbiologically confirmed symptomatic disease remains uncertain; symptoms are nonspecific while Candida colonization may occur without disease, creating a fundamental diagnostic problem; the biological mechanisms determining why some women remain asymptomatically colonized whereas others develop symptomatic or recurrent disease are incompletely understood; the vaginal microbiome and mycobiome are emerging as important determinants of disease phenotype, but most studies remain crosssectional; Candida biofilms, strain-level variation and host inflammatory responses may contribute to persistence and recurrence, but their clinical significance requires better longitudinal investigation; and newer agents such as oteseconazole and ibrexafungerp have expanded therapeutic options, yet questions remain concerning comparative effectiveness, resistance, cost, access and long-term ecological effects. A precision framework integrating clinical phenotype, Candida biology, host susceptibility, microbial ecology and treatment history could transform VVC management. Priority areas include standardized disease definitions, longitudinal host–microbe studies, species- and strain-level characterization, antifungal susceptibility surveillance, microbiome and mycobiome research, patientcentred outcomes, and implementation studies in underrepresented populations.
Keywords: Recurrent vulvovaginal candidiasis, vaginal microbiome, mycobiome, antifungal resistance, precision medicine, antifungal stewardship
Download this Article in PDF format below