Chitosan-based bioactive polymer systems for the treatment of vulvovaginitis: advances in vaginal drug delivery

Vulvovaginitis is an inflammation of the vulva and vagina that is commonly caused by yeast infections, bacterial vaginosis, or sexually transmitted illnesses affecting approximately 70-75% of women at least once during their lifetime, with recurrence rates reaching 30-40%. Vulvovaginal candidiasis (VVC) is an infection of the vulva and vagina caused by an overabundance of Candida yeast. Available therapy is not always effective, and resistance to several antifungal drugs therefore there is a need for advanced drug delivery systems. In recent decades, chitosan, a biopolymer having intrinsic antimicrobial activity (reported inhibition efficiencies exceeding 80-90% against <i>Candida albicans</i>), It has been considered as one of the most promising bioactive polymers; its antibacterial action, mucoadhesion, mucopenetration, immunomodulatory qualities, and longer drug retention have made it a potentially useful polymer. Chitosan-based vaginal delivery systems have demonstrated a 2-3-fold improvement in vaginal residence time and sustained drug release for up to 24-72 h. Which make this polymer ideal for the treatment of vaginitis. This review is looking at new drug delivery methods like hydrogels, films, and composite formulations for the treatment of vulvovaginitis. Furthermore, chitosan has been suggested as a bioactive polymer that may enhance current methods to develop hydrogels appropriate for VVC gynecological drug delivery systems. The shortcomings of conventional drugs, such as inadequate retention, systemic adverse effects, and drug resistance, demand more specific therapy options. Overall, chitosan-based systems represent a promising strategy for effective, safe, and targeted management of vulvovaginitis.