[{"data":1,"prerenderedAt":195},["ShallowReactive",2],{"content-route-/en/research/rvvc-recurrence-mechanisms-review-2025":3},{"state":4,"owner":4,"route":5,"locale":6,"template":7,"content":21,"projection":177,"alternates":186},"target","/en/research/rvvc-recurrence-mechanisms-review-2025","en-US",{"kind":8,"family":8,"sectionKeys":9},"research-summary",[10,11,12,13,14,15,16,17,18,19,20],"bottom-line","why-source-matters","study-population","tested","results","applicability","limitations","contribution","practical-change","funding-conflicts","source",{"kind":8,"title":22,"description":23,"firstPublished":24,"evidenceAsOf":24,"lastUpdated":24,"changeNote":25,"research":26,"relations":69,"body":73},"Recurrent vaginal yeast infection: possible mechanisms","A systematic review of 12 studies describes possible mechanisms behind recurrent vaginal yeast infection, without validating individual recurrence prediction.","2026-10-08","Initial publication of a contextual systematic-review summary; no clinical claim, evidence level, safety status, or practical action changed.",{"sourceId":27,"studyType":28,"population":29,"sampleScale":30,"contribution":31,"contributionRationale":32,"relatedEvidenceMap":33,"funding":34,"conflicts":35,"paperDate":36,"results":37,"applicability":44,"limitations":52,"practicalChange":68},"lobo-rvvc-recurrence-mechanisms-2025","PRISMA 2020 systematic review of observational mechanism studies; no meta-analysis","Women in studies of primary or idiopathic recurrent vulvovaginal candidiasis (RVVC), defined as at least three episodes in 12 months and compared with non-recurrent VVC and/or healthy controls. Studies excluded diabetes, HIV or iatrogenic immunosuppression, other causes of vaginitis, and clinical-only diagnoses.","12 studies (2 prospective cohorts, 2 cross-sectional studies, and 8 case-control studies); 2,277 women across study samples (843 with RVVC, 206 with VVC, and 1,228 healthy controls). One Colombian cohort of 40 women with RVVC appeared in two studies, so the total does not represent 2,277 independent people.","contextual","The review organizes observational findings on pathogen persistence, pathogen characteristics, host immune measures, and genetic associations. It performed no meta-analysis and provides no validated individual predictor or maintenance-treatment result; heterogeneous and sometimes conflicting mechanistic findings add context without changing clinical claims or practical guidance.","/en/research/evidence/recurrent-vaginal-yeast-symptoms","This research was funded by RISE-Health@RISE, Faculty of Medicine, University of Porto.","The authors declared no conflicts of interest.","2025-05-05",[38,39,40,41,42,43],"The search found 1,010 records: 533 duplicates were removed, 416 title-and-abstract records were excluded, and 61 full texts were assessed. Forty-nine full texts were excluded and 12 studies were included.","The 12 studies included 2,277 women across their samples: 843 with RVVC, 206 with VVC, and 1,228 healthy controls. A Colombian cohort of 40 women with RVVC was represented in two studies, so the total includes overlap.","In one Chinese prospective cohort, the same pathogen was reported in 26 of 44 women with RVVC at relapse (59.1%); 18 of 44 (40.9%) were reported as reinfections. This is one small cohort, not an individual prognosis or a general recurrence probability.","One study reported Candida albicans in 90% of RVVC strains and 96.1% of VVC strains; non-albicans proportions were 10% and 3.9%, respectively, with no statistically significant difference. Two studies found no significantly higher antifungal resistance in RVVC; one reported greater germ-tube and biofilm formation in RVVC isolates.","Immune findings varied by assay and study. Serum MBL was reported as lower in one study, not significantly different in one, and higher in one (0.330 versus 0.253 ng/mL). Small case-control studies reported genetic associations involving MBL2, IL-12, NLRP3, and TLR2; other tested variants, including Dectin-1 in one study, showed no association.","Reviewers rated 10 of 12 studies fair and 2 good. Treatment efficacy, treatment safety, and adverse outcomes were not review outcomes.",{"appliesTo":45,"doesNotApplyTo":48},[46,47],"Mechanism hypotheses reported in studies of women with primary or idiopathic RVVC, as defined by the review.","Understanding why recurrence mechanisms remain uncertain across pathogen, immune, and genetic findings.",[49,50,51],"Estimating an individual's chance of recurrence, diagnosing the cause of symptoms, or choosing a treatment.","People with diabetes, HIV or iatrogenic immunosuppression, other causes of vaginitis, or clinical-only diagnoses; these groups or diagnoses were excluded.","Maintenance-treatment effectiveness, route comparisons, treatment safety, or adverse-event risk.",[53,56,59,62,65],{"finding":54,"limitation":55},"The review included 12 observational studies and reported no meta-analysis or pooled effect estimates.","Samples were small and heterogeneous; recruitment was non-random in some studies, no sample-size justification was reported, and population, control, and antifungal-exposure definitions varied.",{"finding":57,"limitation":58},"Immune and genetic findings included associations across different assays and comparators.","Immune results conflicted, including serum MBL findings; these associations do not establish cause or a validated clinical test or prediction score.",{"finding":60,"limitation":61},"The included study samples totalled 2,277 women.","One Colombian cohort of 40 women with RVVC was represented in two studies, so the count includes overlap and is not a count of independent people.",{"finding":63,"limitation":64},"Three articles were inaccessible in Chinese, and three studies did not clearly specify the microbiologic diagnostic method.","Incomplete access and inconsistent diagnostic-method reporting limit assessment of the review's underlying studies.",{"finding":66,"limitation":67},"One small prospective cohort reported same-pathogen relapse and reinfection.","Its 44 participants do not establish general recurrence probabilities or individual prognosis.","No practical change. The review adds mechanism context but does not establish a validated recurrence predictor, maintenance-treatment result, treatment choice, or safety action.",[70],{"group":71,"route":33,"label":72},"evidence","Recurrent vaginal yeast symptoms evidence map",{"type":74,"value":75,"toc":173},"minimark",[76,84,90,96,107,130,136,142,148,154,160],[77,78,80],"content-section",{"section-key":10,"title":79},"Bottom line",[81,82,83],"p",{},"This systematic review brings together 12 studies on possible mechanisms behind recurrent vulvovaginal candidiasis. The findings vary, and the review does not identify a validated way to predict recurrence for one person or assess maintenance treatment. It adds context but does not change practical guidance.",[77,85,87],{"section-key":11,"title":86},"Why this source matters",[81,88,89],{},"The review brings pathogen, immune, and genetic hypotheses together and reports how many studies and participants contributed. It also shows why these findings remain difficult to use in individual care: the studies were small and varied, immune results conflicted, and no meta-analysis was performed.",[77,91,93],{"section-key":12,"title":92},"Study type and population",[81,94,95],{},"This PRISMA 2020 systematic review searched PubMed, Scopus, and Web of Science on October 21, 2024, for studies published from 2014 through 2024. It included 12 studies: two prospective cohorts, two cross-sectional studies, and eight case-control studies. Across study samples, 2,277 women were reported: 843 with recurrent vulvovaginal candidiasis (RVVC), 206 with non-recurrent vulvovaginal candidiasis (VVC), and 1,228 healthy controls. One Colombian cohort of 40 women with RVVC appeared in two studies, so the total includes overlap.",[77,97,99],{"section-key":13,"title":98},"What was examined",[81,100,101,102,106],{},"The review examined observational studies of pathogen persistence or reinfection, ",[103,104,105],"em",{},"Candida"," characteristics such as virulence and antifungal resistance, host immune measures, and genetic associations. It did not evaluate treatment effectiveness or safety, compare maintenance-treatment routes, or test a recurrence-prediction model.",[77,108,110,113,116,127],{"section-key":14,"title":109},"Results",[81,111,112],{},"Of 1,010 records found, 533 duplicates were removed; 416 title-and-abstract records were excluded; and 61 full texts were assessed. The review excluded 49 full texts and included 12 studies.",[81,114,115],{},"One Chinese prospective cohort followed 44 women with RVVC. At relapse, the same pathogen was reported in 26 of 44 (59.1%), while 18 of 44 (40.9%) were reported as reinfections. These results describe one small cohort; they are not a general recurrence probability or a prediction for an individual.",[81,117,118,119,122,123,126],{},"In one included study, ",[103,120,121],{},"Candida albicans"," made up 90% of RVVC strains and 96.1% of VVC strains. Non-",[103,124,125],{},"albicans"," strains made up 10% and 3.9%, respectively; the difference was not statistically significant. Two studies found no significantly higher antifungal resistance in RVVC, while one reported greater germ-tube and biofilm formation in RVVC isolates.",[81,128,129],{},"Immune results varied. Two studies reported lower Th1/Th17-related and higher Th2/Treg-related findings; another reported lower neutrophil fungicidal capacity and reduced stimulated immune-cell proliferation. Serum mannose-binding lectin (MBL) was reported as lower in one study, not significantly different in another, and higher in a third (0.330 versus 0.253 ng/mL). Small case-control studies reported genetic associations involving MBL2, IL-12, NLRP3, and TLR2, while other tested variants, including Dectin-1 in one study, showed no association. No pooled effect estimate was calculated.",[77,131,133],{"section-key":15,"title":132},"Applicability",[81,134,135],{},"These findings describe selected studies of primary or idiopathic RVVC, defined in the review as at least three episodes in 12 months. They do not establish what caused one person's symptoms or how likely that person is to have another episode. The review excluded diabetes, HIV or iatrogenic immunosuppression, other causes of vaginitis, and clinical-only diagnoses, so its findings do not directly cover those groups.",[77,137,139],{"section-key":16,"title":138},"Limitations",[81,140,141],{},"The included studies were small and differed in populations, controls, antifungal-exposure reporting, assays, and methods. The review reports that 10 of 12 studies were fair quality and 2 were good; it also identifies non-random recruitment, no sample-size justification, and limitations in blinding exposure assessment. Immune findings conflicted, and no meta-analysis or causal comparison was performed. Three articles were inaccessible in Chinese, and three studies did not clearly describe their microbiologic diagnostic method. One 40-person Colombian RVVC cohort appeared in two studies, so the combined count is not a count of independent participants. Treatment, treatment safety, and individual recurrence prediction were not assessed.",[77,143,145],{"section-key":17,"title":144},"Contribution to the evidence",[81,146,147],{},"Contextual contribution. The review organizes mechanistic hypotheses about recurrence but does not establish a causal mechanism, validated clinical test, individual prediction model, or treatment result. It does not change the broader evidence map's claims or practical actions.",[77,149,151],{"section-key":18,"title":150},"Practical change",[81,152,153],{},"No practical change. The review does not support a treatment choice, maintenance-treatment conclusion, safety action, or individual recurrence prediction. Current care decisions remain grounded in the linked evidence map and applicable clinical guidance.",[77,155,157],{"section-key":19,"title":156},"Funding and conflicts",[81,158,159],{},"The research was funded by RISE-Health@RISE, Faculty of Medicine, University of Porto. The authors declared no conflicts of interest.",[77,161,163],{"section-key":20,"title":162},"Source",[81,164,165,172],{},[166,167,171],"a",{"href":168,"rel":169},"https://pmc.ncbi.nlm.nih.gov/articles/PMC12112908/",[170],"nofollow","Read the original systematic review"," (published May 5, 2025).",{"title":174,"searchDepth":175,"depth":175,"links":176},"",2,[],{"sources":178,"claims":184,"safety":185},[179],{"sourceId":27,"title":180,"canonicalId":181,"canonicalUrl":168,"publisher":182,"sourceType":183,"publicationDate":36,"lastChecked":24},"Recurrent Vulvovaginal Candidosis and Its Underlying Mechanisms: A Systematic Review","PMID:40422691; DOI:10.3390/jof11050357","Journal of Fungi","systematic-review",[],[],[187,190,193],{"rel":188,"hreflang":6,"href":189},"alternate","https://candipedia.org/en/research/rvvc-recurrence-mechanisms-review-2025/",{"rel":188,"hreflang":191,"href":192},"pl-PL","https://candipedia.org/pl/research/mechanizmy-nawrotow-rvvc-przeglad-2025/",{"rel":188,"hreflang":194,"href":189},"x-default",1791487498305]