American Board of Internal Medicine (ABIM) Certification Practice Exam

What approach should be used to prevent recurrent vulvovaginal candidiasis defined as four or more episodes in one year?

1. One-time antifungal treatment

2. Extended-course antifungal agent

3. Probiotics

4. Antihistamines

The correct answer is: Extended-course antifungal agent

To effectively prevent recurrent vulvovaginal candidiasis, particularly when defined as four or more episodes within a year, an extended-course antifungal therapy is recommended. This approach acknowledges the need for a more sustained intervention beyond a single dose or short-term treatment. Recurrent infections often indicate that the underlying factors contributing to the proliferation of Candida are not being adequately addressed by one-time treatments alone. The extended-course antifungal regimen works by providing a prolonged antifungal effect, which can help to eradicate the fungal load more effectively and reduce the risk of future episodes. Other approaches, such as one-time antifungal treatments, may provide temporary relief but do not address the frequency and chronic nature of recurrent infections. Although probiotics and antihistamines may have their roles in managing symptoms or supporting overall vaginal health, they do not directly target the underlying fungal overgrowth that leads to candidiasis. Therefore, an extended-course antifungal agent is the most suitable option for preventing further episodes.