Management of recurrent vulvovaginal candidosis: Narrative review of the literature and European expert panel opinion.

Recurrent vulvovaginal candidosis (RVVC) is a chronic, difficult to treat vaginal infection, caused by Candida species, which affects women of all ages and ethnic and social background. A long-term prophylactic maintenance regimen with antifungals is often necessary. In most clinical practice guidelines, oral fluconazole is recommended as the first-line treatment. Although clinical resistance to antifungal agents remains rare, overexposure to azoles may increase the development of fluconazole-resistant C. albicans strains. In addition, non-albicans Candida species are frequently dose-dependent susceptible or resistant to fluconazole and other azoles, and their prevalence is rising. Available therapeutic options to treat such fluconazole-resistant C. albicans and low susceptibility non-albicans strains are limited. Ten experts from different European countries discussed problematic issues of current RVVC diagnosis and treatment in two audiotaped online sessions and two electronic follow-up rounds. A total of 340 statements were transcribed, summarized, and compared with published evidence. The profile of patients with RVVC, their care pathways, current therapeutic needs, and potential value of novel drugs were addressed. Correct diagnosis, right treatment choice, and patient education to obtain adherence to therapy regimens are crucial for successful RVVC treatment. As therapeutic options are limited, innovative strategies are required. Well- tolerated and effective new drugs with an optimized mechanism of action are desirable and are discussed. Research into the impact of RVVC and treatments on health-related quality of life and sex life is also needed.

Factors influencing women's preference to select a combined hormonal contraceptive method: a cross-sectional survey in Lithuania.

BACKGROUND AND OBJECTIVE: Effectiveness and side effects are the main concerns when selecting a contraceptive method. Therefore, the aim of this study was to identify the preference of a combined hormonal contraception method by Lithuanian women, the reasons for selecting one of them and rejecting other two methods, and the factors determining selection or rejection. MATERIAL AND METHODS: A cross-sectional multicenter survey was performed by the Lithuanian Society of Private Obstetricians and Gynecologists. A total of 4134 women, aged 18-49, who visited their physician due to initiation or reinitiation of hormonal contraception completed self-administered questionnaires identifying the reasons to select one method and reject the two remaining ones. Descriptive and inferential statistics methods were used for data analysis. RESULTS: The vaginal ring was the most accepted contraception method (55.4%), followed by the pill (35.6%). The skin patch was least preferable (9%). The vaginal ring and the skin patch were mainly selected for the frequency of use (72.9% and 51.2%, respectively), convenience (48.5% and 71%, respectively), and lower probability of noncompliance (48.7% and 63.5%, respectively). The main reason for selecting the pill was familiarity with the method (50.7%). The acceptance of vaginal ring increased with age and was higher among women with higher education. CONCLUSIONS: The most important factors when selecting a contraceptive method among the methods with equal effectiveness and similar safety profile were convenience, frequency of use, and lower probability of noncompliance. Age, education, and employment status were found to be other reasons associated with the choice of contraceptive method.