Treatment recommendations for recurrent vulvovaginal candidiasis across complementary and conventional disciplines: a national survey of Australian healthcare professionals.

INTRODUCTION: Management of recurrent vulvovaginal candidiasis remains challenging. It is treated by healthcare professionals across disciplines including general practice, pharmacy, and complementary medicine. Conventional antifungal regimens supported by formal treatment guidelines are the standard of care. No standardised guidance exists for complementary medicine, and the treatments used in contemporary practice remain largely undocumented.

AIM: To identify treatments recommended for recurrent vulvovaginal candidiasis across healthcare disciplines and the sources used to inform clinical decisions.

METHOD: A national cross-sectional, open, anonymous, self-administered online survey of Australian healthcare professionals from conventional and complementary medicine disciplines was conducted between November 2022 and September 2023 using a 19-item questionnaire. The questionnaire captured treatment recommendations for recurrent or persistent Candida-related vulvovaginal symptoms, including conventional and complementary medicines, over-the-counter products, and lifestyle strategies such as dietary and hygiene advice, and information sources used in diagnosis and management.

RESULTS: A total of 223 healthcare professionals from 13 disciplines met the inclusion criteria, comprising 68 conventional medicine and 155 complementary medicine practitioners. Overall, 122 different treatments were identified, including 69 distinct herbal medicines, reflecting substantial variation in clinical recommendations across disciplines. Conventional medicines were recommended by 43.9% of respondents, herbal medicines by 65.0%, and nutrient-based interventions by 86.1%. Oral fluconazole and intravaginal clotrimazole were the most frequently recommended conventional agents. Probiotics, administered either orally or intravaginally, were cited across professional groups. Frequently recommended herbal medicines included Allium sativum (garlic), Handroanthus impetiginosus (pau d'arco), and Pseudowintera colorata (horopito). Common lifestyle strategies included reducing dietary sugar, alcohol moderation, avoiding synthetic underwear, and modifying post-toileting hygiene practices. Information sources also differed by discipline, with conventional medicine practitioners more often consulting the Therapeutic Guidelines (eTG) and complementary medicine practitioners more commonly consulting peer-reviewed journal articles.

CONCLUSION: Practitioner-reported recurrent vulvovaginal candidiasis management included a broad range of treatment strategies across healthcare disciplines. The heterogeneity of recommendations, together with overlap across disciplines, supports further evaluation of selected treatments and evidence-informed cross-disciplinary guidance to support safer, more coordinated care.