ResearchResearch summary
Maintenance treatment for recurrent vulvovaginal candidiasis
A Cochrane review found fewer recurrences during maintenance treatment, with a smaller and uncertain benefit after treatment ended.
In this pathway
- Current topic
- Maintenance treatment for recurrent vulvovaginal candidiasisCurrent
Bottom line
Maintenance antifungal treatment reduced recurrence while treatment continued, but the smaller post-treatment benefit and low-certainty evidence do not support a cure promise.
Why this source matters
It separates recurrence during maintenance from recurrence after treatment stops and exposes uncertainty in harms and route comparisons.
Study and population
The review included 23 studies and 2,212 test-confirmed RVVC participants aged 17–67; six placebo or no-treatment comparisons informed the main six-month result.
What was tested
The review assessed oral and topical maintenance antifungals and other interventions against placebo, no treatment, or another active approach.
Results
At six months, 64 of 318 treated participants and 187 of 289 comparison participants had a recurrence. At 12 months, pooled risks were 625 versus 781 per 1,000.
Applicability
The main result concerns nonpregnant people with test-confirmed RVVC. It does not select one regimen or establish durable cure.
Limitations
Most trials were small; risks of bias, missing data, funding, heterogeneity, and inconsistent adverse-event reporting lowered confidence.
Contribution to the evidence
Supporting. The review directly supports recurrence control during maintenance and the weaker durability boundary after stopping.
Practical change
No practical change. Maintenance can control recurrence but should not be described as reliably curative.
Funding and conflicts
Nine studies reported industry funding, three independent funding, and the remainder did not report funding. The review found high or unclear bias across mostly small trials.
Source
Read the original publication (published 10 January 2022).
Study type, population, and sample scale
- Study type
- Cochrane systematic review of randomized and quasi-randomized treatment trials
- Population
- Nonpregnant participants aged 17 to 67 with RVVC confirmed by a positive test; included comparisons covered oral and topical antifungals and several non-drug interventions
- Sample scale
- 23 studies with 2,212 participants; six antifungal-versus-placebo or no-treatment studies included 607 participants at six months
Results
- At six months, clinical recurrence occurred in 64 of 318 participants receiving oral or topical antifungal maintenance and 187 of 289 receiving placebo or no maintenance (20 versus 65 per 100; six studies, 607 participants).
- At 12 months, after six months of treatment and six months of observation, the pooled estimate was 625 recurrences per 1,000 with treatment versus 781 per 1,000 with placebo or no treatment (six studies, 585 participants; low-certainty evidence).
- Adverse events could not be pooled because studies reported them differently.
Limitations
- Maintenance treatment was associated with fewer clinical recurrences at six months.
- Certainty was low because of bias, missing data, pharmaceutical funding, and substantial heterogeneity.
- A smaller benefit remained at 12 months after maintenance had stopped.
- Follow-up evidence was limited and does not support a permanent-eradication claim.
- The review included harms as an outcome.
- Inconsistent adverse-event reporting prevented a pooled estimate.
Applies to
- Group-level recurrence during and after studied maintenance regimens in nonpregnant people with test-confirmed RVVC
Does not apply to
- A reliable permanent cure, individualized drug selection, pregnancy, immunocompromise, or unconfirmed recurrent symptoms
Contribution to the current conclusion
Supporting
This broad randomized-evidence review directly traces reduced recurrence during maintenance, weaker durability after treatment, adverse-event reporting gaps, and important population exclusions.
Related evidence mapPractical change or no change
No practical change. The review supports maintenance as control during treatment, not a reliable long-term cure or an individualized regimen ranking.
Funding and conflicts
- Funding
- Nine included studies reported industry funding, three independent funding, and the remainder did not report funding.
- Conflicts
- The review reports high or unclear risk of bias, including poor blinding and reporting, across mostly small trials.
- Paper date
- 2022-01-10
Sources
View all 1 source
- Treatment for recurrent vulvovaginal candidiasis (thrush)
- Source type
- Systematic review
- Published
- 2022-01-10