Role of antifungal drug resistance in the pathogenesis of recurrent vulvovaginal candidiasis.

The aetiology of recurrent vulvovaginal candidiasis (RVVC) caused by Candida albicans remains unclear. To adequately address the role of antifungal resistance as a potential mechanism for RVVC, a longitudinal susceptibility analysis of 177 C. albicans isolates collected from 50 C. albicans RVVC patients over a period of 3 months to 7 years was performed. Antifungals tested included clotrimazole, ketoconazole, miconazole, itraconazole and fluconazole. Results showed that all vaginal isolates were uniformly susceptible to all drugs tested and that successive isolates from individual patients did not show increased resistance to any drug despite long-term exposure to azoles. These results suggest that episodes of RVVC caused by C. albicans are rarely of ever attributable to azole antifungal resistance.