Antimicrobial Resistance in Vulvovaginitis.

Although antimicrobial resistance has had an enormous impact on selection and utilization of antibiotics in virtually all aspects of clinical medicine, both inpatient and community based, little attention has been directed at antimicrobial resistance occurring in vaginal infections. Little evidence exists that frequent relapses of bacterial vaginosis or vulvovaginal candidiasis are due to antimicrobial resistance. Similarly, metronidazole-resistant trichomoniasis remains rare. Nevertheless, abuse of over-the-counter antimycotics, as well as widespread prescription of systemic oral azoles, could result in spread of azole-resistant Candida albicans, and even more likely could lead to an increase in non-albicans Candida species with intrinsic azole resistance. Problematic species include Candida glabrata and rarely Candida krusei.