Q&A: ‘Clear underestimation’ of need for vulvovaginal candidiasis recognition, treatment

Vulvovaginal candidiasis is a common infection that causes vaginal and vulvar irritation and itchiness, as well as discharge.

Most women will experience vulvovaginal candidiasis (VVC) during their life, and many will experience multiple episodes. Although it is not categorized as a sexually transmitted infection, it is more common once regular sexual activity is initiated, according to the Mayo Clinic.

Healio spoke with Nkechi Azie, MD, FIDSA, vice president of clinical development and medical sciences at Scynexis, to learn more about VVC.

Healio: What are yeast infections? Are there different types?

Azie: VVC, commonly known as a vaginal yeast infection, is the second most common vaginal infection affecting women of reproductive age in the United States. An estimated 75% of women worldwide will have at least one episode of VVC in their lifetime, and 40% to 50% of those will experience multiple episodes. Recurrent vulvovaginal candidiasis (RVVC) is defined as three or more episodes of VVC in the past 12 months and affects approximately 5% to 8% of women during their childbearing years.

Candida, a type of fungus, can cause yeast infections when the immune system is unable to keep it under control. Yeast infections can occur in different parts of the body. For example, there are vaginal yeast infections, thrush (occurring in the mouth, but it can spread to the esophagus) and skin yeast infections, as well as infections in the bloodstream, which can be fatal.

Although frequently caused by C. albicans, infections caused by fluconazole-resistant and non-albicans Candida strains, such as C. glabrata, have been reported to be on the rise. Approximately 18 million prescriptions are written annually in the United States to treat yeast infections. However, fungi are evolving organisms that have increasingly become resistant to treatment with agents in the azole drug class.

Healio: How do vaginal yeast infections affect the people who have them?

Azie: Though common, vaginal yeast infections are sometimes dismissed or ignored as not serious. The symptoms of VVC include vaginal itching or soreness, pain or discomfort when urinating, pain during sexual intercourse and abnormal vaginal discharge. VVC can be a debilitating condition associated with an estimated 1.4 million outpatient visits each year.

In addition, RVVC infection is an underappreciated and underreported women’s health condition. More than 130 million women worldwide experience RVVC annually, and approximately 650,000 women in the United States suffer from RVVC.

RVVC results in considerable suffering, costs and interference with sexual satisfaction. Health-related quality of life is negatively influenced by RVVC, according to an online survey conducted in 620 women experiencing RVVC in Europe and the United States.

Healio: What treatments are currently available? Are there any in the pipeline?

Azie: There are several over-the-counter and prescription “azole” treatments currently available. In addition, the product from Mycovia (oteseconazole, Vivjoa) approved by the FDA last year for reducing incidence of RVVC is an azole. In addition, ibrexafungerp tablets (Brexafemme, Scynexis) an oral, non-azole medication, is approved by the FDA for both the treatment of VVC and, as of December, the reduction in the incidence of RVVC.

Our treatment, ibrexafungerp tablets, is fungicidal, meaning it kills yeast. Azoles are fungistatic, which means they suppress the yeast that causes the infection. In patients with challenging infections, having a fungicidal alternative that kills the yeast could help address an unmet need in this patient population.

It’s important to note that ibrexafungerp is contraindicated in pregnancy because it may cause fetal harm based on findings from animal reproductive studies. Patients should verify they are not pregnant prior to initiating treatment, and they should use effective contraception during treatment. For RVVC treatment, reassessing pregnancy status prior to each dose is recommended because it is used monthly for 6 months for reduction in the incidence of RVVC.

The most common adverse reactions observed in clinical trials of VVC were diarrhea, nausea, abdominal pain, dizziness and vomiting. Most common adverse reactions observed in a clinical trial of RVVC were headache, abdominal pain, diarrhea, nausea, urinary tract infection and fatigue.

Healio: What gaps exist in the understanding of yeast infections?

Azie: Our work in women’s health is putting a spotlight on vaginal yeast infections, which the scientific research community has all but ignored.

When it comes to infectious diseases, the area of women’s health is very much underserved. There is a considerable misunderstanding or lack of awareness of how vaginal yeast infections can significantly affect women’s well-being, potentially resulting in fewer drug development companies focusing on this area.

Reference:

• Mayo Clinic. Yeast infection (vaginal). mayoclinic.org/diseases-conditions/yeast-infection/symptoms-causes/syc-20378999. Published March 17, 2021. Accessed Jan. 9, 2023.