Future Directions in Recurrent Vulvovaginal Candidiasis Care


Michael L. Krychman, MD, and Jack D. Sobel, MD, discuss the importance of awareness and education about RVVC, particularly given the impact of symptoms on patients’ psychosocial and sexual behavior.

Jack D. Sobel, MD: I don’t believe that the companies are going to take on fluconazole. It’s easy when somebody doesn’t tolerate, when someone has adverse effects, when someone’s allergic, when someone’s failing fluconazole and you understand the mechanism of the failure, when someone’s got resistance, when you’ve got a yeast that is broader that you can’t clear with fluconazole; that’s easier. You look at the 2 new drugs and both companies are coming up with novelty ideas of how to allow the patient to afford these drugs. They’re coming up with coupon systems and they’re being very creative in coming up with methods to afford these 2 drugs. That’s easy. So, I’ve told you all the easy reasons for turning to these 2 drugs. But in the patients who have none of the above, but a sensitive organism in there, and they’ve got no allergies and no adverse effects in the same drug; should I now use it? It’s going to be an economic factor more than anything else.

Michael L. Krychman, MD: Jack, I’m wondering if you have any last minute clinical pearls, takeaways for our listeners today?

Jack D. Sobel, MD: The only other thing I think that I’m very impressed about in my practice is that if you look at any standard text and textbook that deals with recurrent candida, and they go through triggers and underlying mechanisms, the one thing that is consistently absent is the role of bacterial vaginosis. Bacterial vaginosis is the most common trigger for yeast infections that I see in my clinical practice. You can’t control yeast, recurrent yeast, until you control the bacterial infections. We can spend hours and we don’t have time now, but we can spend hours talking about what the link is. But I would tell you that the commonest cause of recurrent candida vaginitis in my city where I live in Detroit, forget about the genetic factors because you can’t control them, is bacterial vaginosis.

Michael L. Krychman, MD: I think your point is well taken. Don’t think that BVC and RVBC exist in a vacuum and understand that it’s a complex interaction. I think for me, an important take-home message is, and I always say this, it’s not just a yeast infection. It’s not just another yeast infection and signs symptoms are very impactful not only on medical economics, but on a woman’s psychosocial, sexual behavior. There are certainly shortcomings in existing treatments, and I think we need to follow the data, follow the science, understand a little bit more about half lives and drug exposures and drug-drug interactions. I’m very excited about innovation. I’m very excited about ibrexafungerp and oteseconazole. I think more weapons in our war chest to help women who are suffering in silence and recurrently suffering in silence could very well change the landscape. I’m really excited that there’s new life into an existing condition that we didn’t really focus that much on as ob-gyns and women health care professionals. Dr Sobel, I want to thank you today; it’s been a really insightful, enjoyable discussion. Thank you to our audience for watching this presentation. We do hope that you found this Peers and Perspectives discussion useful, informative, and we want to thank you. Stay tuned for more emerging data and more science.

Transcript Edited for Clarity

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