Approach to recurrent vulvovaginalcandidiasis by restoring the vaginalmicrobiota

Abstract

Recurrent vulvovaginal candidiasis (RVVC) is a clinical challenge due to high recurrence and antifungal resistance. We report the case of a 29-year-old woman with over ten years of RVVC unresponsive to conventional antifungal regimens. Vaginal microbiome
analysis showed severe dysbiosis, with loss of Lactobacillus crispatus and jensenii, and overgrowth of Candida albicans and Prevotella spp. A sequential therapeutic approach was applied: vaginal acidification with boric and lactic acid, recolonization with oral and vaginal probiotics (L. crispatus, jensenii, gasseri), antifungal dietary intervention, and psychological support. Complete symptom resolution was achieved
within three months, with no subsequent recurrence. This case underscores the
potential role of vaginal microbiota restoration as a complementary therapeutic strategy in refractory RVVC.