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REVIEW article

Front. Microbiol.

Sec. Infectious Agents and Disease

Volume 16 - 2025 | doi: 10.3389/fmicb.2025.1625952

This article is part of the Research TopicWomen in Infectious Agents and Disease: 2025View all articles

New Insights towards Personalized Therapies for Vulvovaginal Candidiasis and Vaginal Co-infections

Provisionally accepted
  • 1MRC Centre for Medical Mycology, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
  • 2Department of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Milan, Italy

The final, formatted version of the article will be published soon.

Lower genital tract infections, particularly vulvovaginal candidiasis (VVC) and bacterial vaginosis (BV), are among the most prevalent infections in women worldwide, especially those of reproductive age. These conditions not only cause significant clinical symptoms but also severely impact women's quality of life and mental health. Despite extensive research on the pathogens involved, substantial gaps remain in understanding the vaginal immune response and the complexity of the vaginal ecosystem, which is largely shaped by a Lactobacillusdominated microbiota and the high concentration of lactic acid, contributing to the vagina's unique acidic pH. This review explores the underlying pathophysiology of VVC, BV, and fungal-bacteria co-infections, as well as conventional and emerging treatments, including zinc, Lactobacillus spp., and lactic acid. The challenges of antifungal drug resistance are also discussed, in parallel with immune cell dysfunction and its potential link to the vaginal microbiota and ecosystem. Personalized treatments and approaches tailored to the individual vaginal environment are essential for maintaining eubiosis and preventing recurrent infections.Future research should prioritize modulating host and environmental factors rather than 2 targeting pathogens alone, to develop targeted therapies that prevent reinfection, minimize side effects, reduce development of drug-resistance, and ultimately improve women's health outcomes.

Keywords: vulvovaginal candidiasis, vaginal co-infections, microbiota, Lactic Acid, Immune cell dysfunction

Received: 09 May 2025; Accepted: 30 Jul 2025.

Copyright: © 2025 Roselletti, Warris and De Seta. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Elena Roselletti, MRC Centre for Medical Mycology, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom

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