Oral Itraconazole Combined with Local Isoconazole in the Treatment Chronic Candida Vulvovaginitis

Background: Chronic vulvovaginal candidiasis is a major problem and common with poor quality of life from itching and discharge and it is difficult to treat because fungi are slow growers.Methods: Two hundred cases recruited from JAM clinic in Benha city, Egypt divided into two groups to study combination of oral itraconazole and local isoconazole in comparison with the use of local isoconazole only in chronic monilial vulvovaginitis and main outcome was relief of symptoms and signs with absent laboratory evidence of monilial infection by culture. Group one included 100 cases treated with combined oral itraconazole with three alternate days dose of local isoconazole (gynotrazonagen) and group two (local isoconazole only) included 100 cases treated with local isoconazole ovules on alternate days for 3 doses and week period.Results: Regarding the cure rate there were 90 clinically cured rate in the combined group compared to 70 in the local treatment group with p value of 0.0004 which was a very high statistically significant difference. Clinical cure included alleviation of the symptoms of discharge dysuria dyspareunia burning itching with also by clinical examination cure and disappearance of redness erythema edema fissures with absent pseudomycelia by microscopic examination. Usually, a symptom score of less than 2 is a positive one. Regarding the laboratory cure which means absent or negative candida culture on Sabaraud agar medium there were a laboratory cure rate of 84 out of 100 in the combined treatment group compared to 65 out of 100 in the local treatment group with p value of 0.002 and a high statistically significant difference.Conclusions: Oral itraconazole combined with local isoconazole is highly effective in treating chronic monilial vulvovaginitis.