Overcoming resistance to pathogens of vulvovaginal candidiasis using modern methods

Khashukoeva A.Z., Burdenko M.V., Markova E.A., Dmitrashko T.E.

1) Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia; 2) Russian Clinical and Research Center of Gerontology, Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia
Background: The therapy of vulvovaginal candidiasis (VVC) still remains an unsolved issue. The development of the pharmaceutical industry and clinical studies conducted with the use of various antimycotic drugs have not provided the clear answers to the questions about the treatment of VVC. Research work in this sphere is relevant. Among other antimycotic drugs in the pharmacological market, sertaconazole appears to be promising. It has high efficiency and safety indicators which are confirmed by a number of studies; the data of the studies are presented in the article. Sertaconazole is a drug that has a triple effect on fungal pathogens: fungicidal and fungistatic action, as well as inhibition of dimorphic transformation (it blocks the transition of the fungus from a non-pathogenic to a pathogenic one which significantly increases the inter-relapse interval of VVC.
Results: The therapeutic efficacy of sertaconazole was evaluated in 25 patients with chronic recurrent VVC. In all cases, the diagnosis of VVC was confirmed by clinical and laboratory methods, C. albicans was mainly identified in women. The patients received Zalain at a dose of 300 mg once in the form of a vaginal suppository. No patients reported side effects after taking the drug. A day after the introduction of the suppository, 13 patients noted a significant improvement in their condition due to a decrease in itching and burning and 12 patients noted the complete disappearance of symptoms of the disease. A week after the treatment, all patients’ symptoms of VVC were relieved; the results of the repeated cultural studies confirmed it.
Conclusion: The treatment of VVC with a drug containing sertaconazole determines a successful outcome in the fight against the disease. It is important to use an integrated approach in its treatment and include adjuvant therapy which significantly accelerates recovery. Such therapy can also be used for the prevention aimed at reducing the likelihood of recurrent VVC and/or concomitant diseases of the genital tract.


vulvovaginal candidiasis
recurrent vulvovaginal candidiasis
resistance to antifungal drugs
Zalagel Intim
Zalain suppository
Zalain cream


  1. Хашукоева А.З., Сафонина М.С., Андреасян Г.О., Мясоутова А.И., Оверко А.В. Терапевтические подходы в лечении вульвовагинального кандидоза. Медицинский совет. 2020; 13: 138-46. [Khashukoeva A.Z., Afonina M.S., Andreasyan G.O., Myasoutova A.I., Overko A.V. Therapeutic approaches in the treatment of vulvovaginal candidiasis. Medical Council. 2020; 13: 138-46. (in Russian)]. https://dx.doi.org/10.21518/2079-701X-2020-13-138-146.
  2. Rathod S.D., Buffler P.A. Highly-cited estimates of the cumulative incidence and recurrence of vulvovaginal candidiasis are inadequately documented. BMC Women's Health. 2014; 14(1): 43. https://dx.doi.org/10.1186/1472-6874-14-43.
  3. Sobel J.D. Recurrent vulvovaginal candidiasis. Am. J. Obstet. Gynecol. 2016; 214(1): 15-21. https://dx.doi.org/10.1016/j.ajog.2015.06.067.
  4. Байрамова Г.Р., Баранов И.И., Припутневич Т.В., Чернова В.Ф. Вульвовагинальный кандидоз: клинические и терапевтические аспекты в практике акушера-гинеколога. Акушерство и гинекология: новости, мнения, обучение. 2017; 4: 63-9. [Bayramova G.R., Baranov I.I., Priputnevich T.V., Chernova V.F. Combined methods of bacterial vaginosis treatment in adolescents. Obstetrics and Gynecology: News, Opinions, Training. 2017; 4: 63-9. (in Russian)].
  5. Abbasi Nejat Z., Farahyar S., Falahati M., Ashrafi Khozani M., Hosseini A.F., Faiazy A. et al. Molecular identification and antifungal susceptibility pattern of non-albicans Candida species isolated from vulvovaginal candidiasis. Iran. Biomed. J. 2017; 22(1): 33-41. https://dx.doi.org/10.22034/ibj.22.1.33.
  6. Sobel J.D., Akins R.A. The role of PCR in the diagnosis of Candida vulvovaginitisea new gold standard? Curr. Infect. Dis. Rep. 2015; 17(6): 488. https://dx.doi.org/10.1007/s11908-015- 0488-3.
  7. Mendling W., Brasch J., Cornely O.A., Effendy I., Friese K., Ginter-Hanselmayer G. et al. Guideline: vulvovaginal candidosis (AWMF 015/072), S2k (excluding chronic mucocutaneous candidosis). Mycoses. 2015; 58(Suppl. 1): 1-15. https://dx.doi.org/10.1111/ myc.12292.
  8. Fukazawa E.I., Witkin S.S., Robial R., Vinagre J.G., Baracat E.C., Linhares I.M. Influence of recurrent vulvovaginal candidiasis on quality of life issues. Arch. Gynecol. Obstet. 2019; 300(3): 647-50. https://dx.doi.org/10.1007/s00404- 019-05228-3.
  9. Эфендиева З.Н. Сертаконазол в терапии вульвовагинального кандидоза. Медицинский совет. 2019; 13: 94-8. [Efendieva Z.N. Sertaconazole in the treatment of vulvovaginal candidiasis. Medical Council. 2019; 13: 94-8. (in Russian)]. https://dx.doi.org/10.21518/2079-701X-2019-13-94-98.
  10. Goncеalves B., Ferreira C., Alves C.T., Henriques M., Azeredo J., Silva S. Vulvovaginal candidiasis: Epidemiology, microbiology and risk factors. Crit. Rev. Microbiol. 2016; 42(6): 905-27. https://dx.doi.org/10.3109/1040841X.2015.1091805.
  11. Погосян Ш.М., Межевитинова Е.А., Донников А.Е., Муравьева В.В., Абакарова П.Р., Хлебкова Ю.С. Роль генотипических особенностей в развитии рецидивирующего вульвовагинального кандидоза и тактика терапии. Медицинский cовет. 2017; 13: 172-9. [Pogosyan S.M., Mezhevitinova E.A., Donnikov A.E., Muravyeva V.V., Abakarova P.R., Khlopkova Y.S. The role of genotypic features in the development of recurrent vulvovaginal candidiasis and therapy tactics. Medical Council. 2017; 13: 172-9. (in Russian)]. https://dx.doi.org/10.21518/2079-701X-2017-13-172-179.
  12. Rosentul D.C., Delsing C.E., Jaeger M., Plantinga T.S., Oosting M., Costantini I. et al. Gene polymorphisms in pattern recognition receptors and susceptibility to idiopathic recurrent vulvovaginal candidiasis. Front. Microbiol. 2014; 5: 483. https://dx.doi.org/10.3389/fmicb.2014.00483. eCollection 2014.
  13. Plantinga T.S., Johnson M.D., Scott W.K., van de Vosse E., Velez Edwards D.R. et al. Toll-like receptor 1 polymorphisms increase susceptibility to candidemia. J. Infect. Dis. 2012; 205(6): 934-43. https://dx.doi.org/10.1093/infdis/jir867.
  14. Ouederni M., Sanal O., Ikinciogullari A., Tezcan I., Dogu F., Sologuren I. et al. Clinical features of candidiasis in patients with inherited interleukin 12 receptor ß1 deficiency. Clin. Infect. Dis. 2014; 58(2): 204-13. https://dx.doi.org/10.1093/cid/cit722.
  15. Куликов И.А. Перспективное лечение бесконечно повторяющегося вульвовагинального кандидоза. Медицинский совет. 2020; 13:157-65. [Kulikov I.A. Advanced therapy for eternal vulvovaginal candidiasis recurrences. Medical Council. 2020; 13: 157-65. (in Russian)]. https://dx.doi.org/10.21518/2079-701X-2020-13-157-165.
  16. Левчук И.П., Соков С.Л., Курочка А.В., Назаров А.П. Поражения кожи при болезнях внутренних органов: иллюстрированное руководство для врачей. 2-е изд. М.: ГЭОТАР-Медиа; 2020. 352с. [Levchuk I.P., Sokov S.L., Kurochka A.V., Nazarov A.P. Skin lesions in diseases of internal organs: an illustrated guide for doctors. 2nd ed., Moscow: GEOTAR-Media; 2020. 352 p. (in Russian)]. Available at: https://www.rosmedlib.ru/book/ISBN9785970453797.html
  17. Прилепская В.Н., Абакарова П.Р., Байрамова Г.Р., Бурменская О.В., Довлетханова Э.Р., Донников А.Е., Здоровенко Т.Б., Коган Е.А., Козаченко А.В., Короткова Н.А., Костава М.Н., Ледина А.В., Межевитинова Е.А., Мгерян А.Н., Мзарелуа Г.М., Назаренко Е.Г., Назарова Н.М., Погосян П.М., Сычева Е.Г., Трофимов Д.Ю., Хлебкова Ю.С., Фофанова И.Ю., Чернова В.Ф., Шиляев А.Ю. Заболевания шейки матки и генитальные инфекции. М.: ГЭОТАР-Медиа; 2016. 384с. [Prilepskaya V.N., Abakarova P.R., Bayramova G.R., Burmenskaya O.V., Dovletkhanova E.R., Donnikov A.E. et al. Diseases of the cervix and genital infections. Moscow: GEOTAR-Media; 2016. 384 p. (in Russian)]. Available at: https://www.rosmedlib.ru/book/ISBN9785970434062.html
  18. Любасовская Л.А., Муравьева В.В., Шабанова Н.Е., Припутневич Т.В. Этиотропное лечение рецидивирующего вагинального кандидоза: выбор терапии - системная или местная. Медицинский cовет. 2020; 13: 124-9. [Lyubasovskaya L.A., Muravyeva V.V., Shabanova N.E., Priputnevich T.V. Etiotropic treatment of recurrent vaginal candidiasis: the choice of therapy - systemic or local. Medical Council. 2020; 13: 124-9. (in Russian)]. https://dx.doi.org/10.21518/2079-701X-2020-13-124-129.
  19. Szweda P., Gucwa K., Romanowska E., Dzierz Anowska-Fangrat K., Naumiuk L., Brillowska-Da A. et al. Mechanisms of azole resistance among clinical isolates of Candida glabrata in Poland. J. Med. Microbiol. 2015; 64(6): 610-9. https://dx.doi.org/10.1099/jmm.0.000062.
  20. Гаспарян С.А., Хажбиев А.А., Рыжков В.В. Опыт применения сертаконазола у беременных с вульвовагинальным кандидозом. Медицинский cовет. 2019; 13: 160-5. [Gasparyan S.A., Habiev A.A., Ryzhkov V.V. Experience with the use of Itraconazole in pregnant women with vulvovaginal candidiasis. Medical Council. 2019; 13: 160-5. (in Russian)]. https://dx.doi.org/10.21518/2079-701X-2019-13-160-165.
  21. Rotem R., Fishman B., Daniel S., Koren G., Lunenfeld E., Levy A. Risk of major congenital malformations following first-trimester exposure to vaginal azoles used for treating vulvovaginal candidiasis: a population-based retrospective cohort study. BJOG. 2018; 125(12): 15501556. https://dx.doi.org/10.1111/1471-0528.15293.
  22. Selvan Т., Girisha G., Vijaybhaskar, Suthakaran R. Comparative evaluation of newer topical antifungal agents in the treatment of superficial fungal infections (tinea or dermatophytic). Int. Res. J. Pharmy. 2013; 4(6): 224-8. https://dx.doi.org/10.7897/2230-8407.04651.
  23. https://medvestnik.ru/content/medarticles/Mestnaya-etiotropnaya-terapiya-gribkovyh-porajenii-koji-i-slizistyh.html
  24. Кокоева Д.Н., Меджидова М.К., Домова Н.А., Кан Н.Е., Тютюнник В.Л. Профилактика преждевременных родов у беременных с вагинальным кандидозом. Медицинский совет. 2019; 7: 52-6. [Kokoeva D.N., Medzhidova M.K., Domova N.A., Kan N.E., Tyutyunnik V.L. Prevention of preterm birth in pregnant women with vaginal candidiasis. Medical Council. 2019; 7: 52-6. (in Russian)]. https://dx.doi.org/10.21518/2079701X-2019-7-52-56.
  25. Кашеваров Д.Ф., Воронцова И.В. Местная терапия вульвовагинального кандидоза. РМЖ. Мать и дитя. 2014; 19: 1394. [Kashevarov D.F., Vorontsova I.V. Local treatment of vulvovaginal candidiasis. Breast cancer. Mother and Child. 2014; 19: 1394. (in Russian)].
  26. Ипатова М.В., Маланова Т.Б. Медицинская реабилитация в гинекологии. В кн.: Савельева Г.М., Сухих Г.Т., Серов В.Н., Радзинский В.Е., Манухин И.Б., ред. Гинекология. Национальное руководство. 2-е изд. М.: ГЭОТАР-Медиа; 2017: 785-97. [Ipatova M.V., Malanova T.B. Medical rehabilitation in gynecology. In: Savelyeva G.M., Sukhikh G.T., Serov V.N., Radzinsky V.E., Manukhin I.B., ed. Gynecology: National guide. 2nd ed., reprint. Moscow: GEOTAR-Media; 2017: 785-97. (in Russian)].
  27. Доброхотова Ю.Э., Боровкова Е.И., Бондаренко К.Р. Кандидозный вульвовагинит: состояние изученности проблемы. Российский вестник акушера-гинеколога. 2017; 17(3): 108-11. [Dobrokhotova Y.E. et al. Candidiasis vulvovaginitis: the state of the problem's study. Russian bulletin of the obstetrician-gynecologist. 2017; 3: 108. (in Russian)].
  28. Фадеев И.Е., Полетова Т.Н., Масс Е.Е. Местный противогрибковый препарат сертаконазол: антимикотик резерва или средство первой линии эмпирической терапии вульвовагинитов? Consilium medicum. 2019; 21(6): 73-6. [Fadeev I.E., Politova T.N., Mass E.E. Local antifungal drug ketoconazole: reserve antimycotic or first-line empirical therapy for vulvovaginitis? Consilium Medicum. 2019; 21(6): 73-6. (in Russian)]. https://dx.doi.org/10/26442/20751753. 2019. 6. 190558.
  29. Хашукоева А.З., Агаева З.А., Агаева М.И. Тактика снижения частоты рецидивов вагинального кандидоза у женщин со сниженным иммунитетом. Акушерство и гинекология. 2018; 12: 88-92. [Khashukoeva A.Z., Agaeva Z.A., Agaeva M.I. Tactics of reducing the frequency of recurrent vaginal candidiasis in women with reduced immunity. Obstetrics and Gynecology. 2018; 12: 88-92. (in Russian)]. https://dx.doi.org/10.18565/aig.2018(12):88-92.
  30. Aluyor E.O., Oboh I.O. Preservatives: traditional preservatives - vegetable oils. In: Encyclopedia of food microbiology. 2nd ed. Academic Press; 2014: 137-40. https://dx.doi.org/10.1016/B978-0-12-384730-0.00263-9.
  31. https://medvestnik.ru/content/medarticles/Vulvovaginalnyi-kandidoz-mnogo-voprosov-i-odin-otvet.html
  32. https://medvestnik.ru/content/medarticles/Algoritm-vedeniya-ginekologicheskoi-bolnoi-s-vulvovaginalnym-kandidozom.html

Received 01.02.2021

Accepted 14.12.2021

About the Authors

Asiyat Z. Khashukoeva, Dr. Med. Sci., Professor of the Department of Obstetrics and Gynecology, Pirogov Russian National Research Medical University, Ministry of Health of the Russian Federation, +7(499)187-12-54, azk05@mail.ru, https://orcid.org/0000-0001-7591-6281, 129226, Russia, Moscow, 1st Leonova str., 16.
Marina V. Burdenko, PhD, Associate Professor, Department of Obstetrics and Gynecology, Deputy Dean of the Faculty of Additional Vocational Education, Pirogov Russian National Research Medical University, Ministry of Health of the Russian Federation, +7(499)166-97-41, +7(926)280-63-67, bmv-0306@rambler.ru, https://orcid.org/0000-0002-0304-4901, 105187, Russia, Moscow, Fortunatovskaya str., 1.
Eleonora A. Markova, PhD, Assistant of the Department of Obstetrics and Gynecology, Pirogov Russian National Research Medical University, Ministry of Health of the Russian Federation, +7(499)166-97-41, +7(926)280-63-67, markova.eleonora@mail.ru, https://orcid.org/0000-0002-9491-9303, 105187, Russia, Moscow, Fortunatovskaya str., 1.
Tatyana Ye. Dmitrashko, obstetrician-gynaecologist, Russian Gerontological Research and Clinical Center, Pirogov Russian National Research Medical University, Ministry of Health of the Russian Federation, +7(499)187-12-54, lesnoy_elf@list.ru, https://orcid.org/0000-0002-0523-846X, 129226, Russia, Moscow, 1-st Leonova str., 16.

Authors’ contributions: Khashukoeva A.Z., Burdenko M.V. – developing the concept and design of the study;
Dmitrashko T.E. – collecting and processing the material; Dmitrashko T.E., Markova E.A. – statistical data processing; Khashukoeva A.Z., Markova E.A. – writing the text of the manuscript; Khashukoeva A.Z. – editing the text.
Conflicts of interest: The authors declare that they have no competing interests.
Funding: The study was performed without any financial support.
Patient Consent for Publication: All patients provided informed consent for the publication of their data.
For citation: Khashukoeva A.Z., Burdenko M.V., Markova E.A., Dmitrashko T.E. Overcoming resistance to pathogens of vulvovaginal candidiasis using modern methods.
Akusherstvo i Ginekologiya/ Obstetrics and Gynecology. 2022; 2: 102-108 (in Russian)

Similar Articles

By continuing to use our site, you consent to the processing of cookies that ensure the proper functioning of the site.