The annual Fungal Diseases Awareness Week (18-22 September 2023) aims to highlight growing challenges, complexities, and the devastating impact of fungal diseases.

We are currently working on a clinical trial protocol for the topical treatment of thrush caused by Candida albicans.

• Candidal vaginitis is the most prevalent human Candida infection affecting 75% of women at least once in their lifetime.
  Several risk factors are associated with developing an infection.
• Symptoms and severity of infection are influenced by physiology, fungal biology, and the person’s immune response
• Incidence of infections are underreported as effective over-the-counter treatments are available
• C. auris, not associated with vaginitis, has been shown to have 93% resistance against the antifungal medication fluconazole
• Global incidence of infections is predicted to rise by tens of millions of infections in the next decade
• Novel therapies are needed to effectively treat Candida infections.

Vulvovaginal candidiasis (VVC), commonly known as candidal vaginitis, thrush, or a yeast infection, is most often (>90%) caused by the fungus Candida albicans. Although C. albicans is a normal member of the human microbiome that lives on skin and inside the body in places like the mouth, throat, gut, and vagina, disruption to its environment can encourage opportunistic growth to cause a symptomatic infection.

Several risk factors associated with developing an infection include antibiotic use, sexual activity, high-oestrogen oral contraceptives, pregnancy, use of sodium glucose cotransporter 2 (SGLT2) inhibitors, uncontrolled diabetes, and a lack of vaginal lactobacilli.

While thrush is non-lethal, the symptoms and severity of infection are influenced by the intersection of physiology, fungal biology, and the person’s immune response. Because of this, infections can arise and vanish spontaneously or develop into a chronic or recurrent disease.

With effective over-the-counter treatment options available, acute Candida infections are underreported making the actual incidence impossible to estimate. But as the most prevalent human Candida infection, it estimated that 75% of all women will at least once in their lifetime experience the hallmark symptoms of itching, burning, and soreness in the vulvar and vaginal region as well as the abnormal vaginal discharge typical of thrush.

The global medical cost of thrush is estimated at USD $1.8 billion each year. Adding lost work hours to the equation increases the economic impact by another USD $1 billion per annum in the US alone.

Although current medications used to treat thrush infections are mostly effective, resistance is present and inevitable. C. albicans is the fourth most common cause of hospital-acquired infections, and 7% of all Candida blood-stream infections are resistant to antifungals. Of the other Candida species not associated with vaginitis, Candida auris, which is the most recent fungal pathogen to be recognised more globally, has been shown to have 93% resistance against fluconazole, a widely-used antifungal medication. 

The topical treatment in development is not a classical anti-fungal/antibiotic and therefore does not target the same mechanisms as the current antifungals that are used to treat topical or systemic Candida albicans infections. The product that we are working on causes cells to rupture and has been shown to be effective against all five Candida species that cause candidal vaginitis.

As the global incidence of candidal vaginitis is predicted to rise by tens of millions of infections in the next decade, novel treatments, improved diagnostic methods, and studies into the resistance and virulence of Candida will be required to lessen the impact of this disease.