Pathogenesis of idiopathic recurrent vulvovaginal candidiasis. For many years, recurrent vulvovaginal candidiasis was believed to be due to repeated reinfection from a gastrointestinal reservoir or possibly from sexual transmission. New evidence suggests that frequent reinfection is less likely to be responsible, and evidence instead points to frequent vaginal relapses resulting from subclinical persistence of yeasts in the vagina. Relapses occur because of the use of fungistatic antifungal agents and impaired local host defense mechanisms. Enhanced Candida virulence rarely may be due to antimycotic drug resistance. (From Sobel [3]; with permission.)