Advances in vulvovaginal candidiasis research: a comprehensive review from epidemiology, diagnosis, treatment to resistance mechanisms

infections, escalating azole resistance, and the challenge of biofilm formation. This review systematically summarizes recent advances in VVC research, with a focus on evolving epidemiology, innovations in diagnostics, current and emerging therapies, and an in-depth analysis of resistance mechanisms. Key molecular pathways underpinning antifungal resistance-including biofilm development, efflux pump overexpression, target-site gene mutations, and alterations in transcriptional regulators-are examined. The findings of this review support several actionable strategies for future practice. First, routine use of molecular diagnostics (PCR, MALDI-TOF MS) is essential for species identification and resistance detection, enabling a shift from empirical to precision-based therapy. Second, antifungal susceptibility testing should be interpreted with attention to vaginal pH conditions, and non-azole alternatives (boric acid, nystatin, ibrexafungerp, oteseconazole) should be prioritized when azole resistance is confirmed or suspected. Third, emerging approaches-including biofilm-disrupting agents, probiotic microbiome modulation, and nanotechnology-enhanced drug delivery-offer promising adjunctive and preventive strategies, particularly for recurrent VVC. By integrating these contemporary findings, this review provides a translational framework to optimize diagnosis, guide therapeutic decision-making, and inform future research priorities in VVC management. Notably, several novel agents-including ibrexafungerp and oteseconazole-have already received FDA approval and are entering clinical practice, with multiple ongoing trials evaluating boric acid, probiotics, and novel oral antifungals, underscoring the accelerating translation of mechanism-informed therapies into patient care.