[Pitfalls of the current laboratory diagnosis and treatment of vulvovaginal candidiasis]. / Úskalí soucasné laboratorní diagnostiky a terapie vulvovaginální kandidózy.

ABSTRACT

Vulvovaginal candidiasis remains one of the most frequently diagnosed inflammatory diseases of the vagina, which affects most sexually active women. In most patients, it is manifested as acute inflammation which is easy to diagnose and treat. However, in the susceptible population, it may be characterized by recurrent episodes, usually with an unknown cause or exacerbating moment. These facts complicate the diagnosis and therapy. This is highlighted by both non-specific symptoms shared with many other vaginal infections and paucity of reliable signs for diagnosis. Under these circumstances, it is difficult to associate vaginal complaints with yeasts and, vice versa, the presence of yeasts does not necessarily confirm fungal aetiology. Therefore, it is better to regard the condition as a syndrome and the chronic problems as vulvovaginal discomfort. It is a prerequisite for an unbiased diagnostic approach, increasing the probability of finding the real cause of the problem and the chances of treating or even curing the disease. The article is concerned with controversial and problematic aspects of diagnosis and treatment of vulvovaginal candidiasis with a focus on laboratory diagnosis, terminology, epidemiology and ecology of yeasts in relation to vaginal microbiota and, last but not least, on alternative therapeutic approaches.