Can Saccharomyces cerevisiae be used as a therapeutic agent for vulvovaginal candidiasis?

INTRODUCTION: Vulvovaginal candidiasis (VVC) is a highly prevalent fungal vaginal infection with a substantial impact on women's quality of life. Increasing evidence indicates that VVC pathogenesis is driven not only by high fungal burden but also by dysregulated host-immune responses, highlighting the need for therapeutic strategies that extend beyond conventional antifungal treatment.

AREAS COVERED: In this review, recent advances elucidating the antifungal and immunomodulatory properties of Saccharomyces cerevisiae in the context of (recurrent) VVC are critically examined. Evidence from in vitro, ex vivo, in vivo, and clinical studies is integrated to assess S. cerevisiae-mediated attenuation of Candida virulence, modulation of host inflammatory responses, and interactions with the vaginal microbiota. In addition, translational challenges, safety considerations, regulatory constraints, and the therapeutic potential of yeast-based combination strategies are discussed.

EXPERT OPINION: S. cerevisiae treatment will play a role in both the prevention of recurrence/occurrence of Candida infections and the integration into combination regimens, where they can complement antifungal and host-directed therapies rather than function as standalone treatments. Future advances will depend on patient stratification, strain-specific optimization, and the integration of microbial therapies into combination treatment frameworks aimed at restoring and maintaining mucosal homeostasis.