Reviewer ’s report  
 
Title:  Current patient perspectives of vulvovaginal candidiasis: incidence, symptoms, 
management and post -treatment outcomes  
 
Version: 0 Date: 19 Aug 2018 
 
Reviewer:  Werner  Mendling  
 
Reviewer’s report:  
 
Dear authors,  
 
congratulations for an excellently researched and critically discussed article! I have no 
recommendations for corrections. But I have two proposals/comments:  
 
- you could add the some days before published article of Denning DW, Kneale M, Sobel JD and 
Rautemaa -Richardson: Global burden of recurrent vulvovaginal candidiasis: a systematic review. 
Lancet Infect Dis 2018, in the references and add a short sentence in the  introduction or 
discussion to the global burden of this disease.  
 
- you mention the clinical outcomes of VVC/RVVC: relief rate considerably lower in women 
with OTC treatment (15.6% no -relief treatment by a physician vs. 42.6% no -relief by treatment 
of the  patient). You mention, that the diagnosis could be incorrect. Denning et al. (2018) (see 
above) pronounce this fact clearer and mention also "vulvar vestibulitis" as cause for burning...".  
 
 Farmer et al. (Farmer et al.: Repeated vulvovaginal fungal infections cause persistent pain in a 
mouse model of vulvodynia.  
 
Sci Transl Med 2011; 3: 101ra91) showed, that Candida albicans can trigger persistent 
pain/burning and so cause vestibulodynia, wh ich is often (in my personal experience mostly!) 
misdiagnosed as Candida vulvovaginitis. It is probable, that a high amount of the no -relief cases 
are misdiagnosed by patients, but also physicians, and indeed vestibulodynia, but also possible, 
that both (r ecurrent) Candida vulvovaginitis in the beginning  and later vestibulodynia exist 
together.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the stati stics 
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that m ay in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, fund ing, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
1. Yes: Admiral A.A. Barcelona/Spain and Galderma R&D Sophia Antipolis/France spent fees 
for scie ntific advice in antifungal therapy  
 
2.- 6. no  
 
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