Clotrimazole for Vulvovaginal Candidosis: More Than 45 Years of Clinical Experience

Vulvovaginal candidosis is a common disease, and various treatment strategies have emerged over the last few decades. Clotrimazole belongs to the drugs of choice for the treatment of vulvovaginal candidosis. Although available for almost 50 years, systematic reviews on the usefulness of topical clotrimazole across disease severity and populations affected are scarce. Thus, we conducted a systematic literature search in the PubMed and Embase databases to summarize the effectiveness and safety of topical clotrimazole in the treatment of uncomplicated (acute) and complicated vulvovaginal candidosis. In total, 37 randomized controlled studies in women suffering from vaginal yeast infections qualified for inclusion in our review. In women with uncomplicated vulvovaginal candidosis, single intravaginal doses of clotrimazole 500 mg vaginal tablets provided high cure rates and were as effective as oral azoles. A single dose of clotrimazole 500 mg was equipotent to multiple doses of lower dose strengths. Prolonged treatment regimens proved to be effective in severe and recurrent cases as well as in symptomatic pregnant women. It is therefore expected that in the general population, clotrimazole will continue to be widely used in the field of vaginal health in the upcoming years; more so as clotrimazole resistance in vaginal candidosis is rare.

Preconceptional screening of sexually transmitted infections/diseases

Hungarian Preconceptional Care includes the preconceptional screening of sexually transmitted infections/disorders (STD) and vaginal candidosis of potential mothers and pyospermia of potential fathers. The aim of this study was to evaluate the effect of this screening and treatment for the rate of preterm births. Clinical and subclinical vaginal candidiasis (asymptomatic candida colonisation), combination of STD and vaginal candidiasis, STD without vaginal candidiasis, finally women without STD and vaginal candidiasis as references were evaluated in 4,672 pregnant women. The association of STD in pregnant women with higher risk of preterm birth was confirmed. However, an association was also found between clinically diagnosed vaginal candidiasis, asymptomatic candida colonisation, and a higher risk for preterm births. This risk was reduced with clotrimazole treatment. However, pregnant women without recognized STD and/or vaginal candidiasis had a higher risk for preterm birth than pregnant women with STD or vaginal candidiasis after appropriate treatment. Thus the conclusion of the study is that the preconceptional screening of STD and vaginal candidiasis followed by appropriate treatment is important to prevent a certain part of preterm birth but it is necessary to improve the efficacy of the previously used methods for this screening.

Treatment of vaginal infections: effectiveness of the association of metronidazole and clotrimazole

The normal vagina of women of reproductive age is colonised by lactobacilli that produce lactic acid, hydrogen peroxide and bacteriocins; these substances contribute to lowering the vaginal pH. A low vaginal pH creates an environment hostile to the growth of other microrganisms. When the number of lactobacilli is decreased, the resulting increase in the pH may favour vaginal infections. The three most common vaginal infections are bacterial vaginosis, trichomoniasis, and vaginal candidosis. There are multiple clinical and laboratory tests for diagnosing vaginal infections; the most commonly used methods for diagnosing bacterial vaginosis are the Amsel’s criteria and the Nugent’s Gram stain scale. Infections caused by Candida and Trichomonas vaginalis can be diagnosed by microscopic examination of vaginal secretions. Clotrimazole and metronidazole, especially when administered topically, are highly effective in treating vaginal infections.