Vulvovaginitis: Additional Therapies
Boric acid is a common OTC treatment for vulvovaginal candidiasis and recurrent vulvovaginal candidiasis that is both self-prescribed and recommended by health practitioners. Although it has not been widely studied, four studies have shown positive outcomes, even compared with conventional antifungal therapy, and it is considered an effective therapy for the treatment of vaginal candidiasis. In one study, 92 women with chronic mycotic vaginal infections were followed with microscopic examination of the vaginal discharge during prolonged therapy with antifungal agents and boric acid. A microscopic picture unique to chronic mycotic vaginitis was observed, representing the cytologic reaction of the mucous membrane to chronic yeast infection. This diagnostic tool proved extremely effective in detecting both symptomatic and residual, subclinical mycotic infection and provided a highly predictive measure of the probability of relapse. The ineffectiveness of conventional antifungal agents appeared to be the main reason for chronic mycotic infections. In contrast, boric acid was effective in curing 98% of the patients who had previously failed to respond to the most commonly used antifungal agents and was clearly indicated as the treatment of choice for prophylaxis. In a double-blinded, randomized study, 108 VVC-positive college students used boric acid or Nystatin capsules once daily for 2 weeks. Boric acid cure rates were 92% at 7 to 10 days posttreatment and 72% at 30 days, a statistically significant improvement over the Nystatin capsules, which only had a cure rate of 64% at 7 to 10 days posttreatment, and 50% at 30 days posttreatment. In a case series of 40 patients with vulvovaginitis, 95% of patients remained symptom-free at 30 days post-boric acid treatment, and in another study, boric acid was tested against an azole-resistant strain of yeast, more commonly seen in women with recurrent yeast infections and yielded clinical improvement occurred in 81% of cases, with mycological eradication in 77% of the women. The standard recommended dose and application is 600 mg of boric acid placed in a size “0” gelatin capsule and inserted vaginally. For acute treatment, one capsule is inserted nightly for 14 days, followed by a maintenance treatment of twice weekly insertion. Some women report mild to moderate burning as the capsule dissolves. If intercourse occurs during the treatment period, males may report dyspareunia. Serious side effects have not been reported from treatment. Boric acid, available in drug stores, can be considered a safe, effective, accessible, and affordable treatment for vaginal candidiasis.
Reducing exposure to the personal, sexual, chemical, and allergenic factors described in the preceding can be beneficial in preventing and reducing vulvovaginitis and infection. Wearing clean cotton underwear or “breathable” fabrics, changing underwear more often if there is copious vaginal discharge or dampness, sleeping without underwear, wearing loose-fitting pants, and observing hand-washing before and after genital contact may reduce the incidence and frequency of vulvovaginitis. Wearing a thong may cause irritation or facilitate the transmission of anorectal organism to the vulvovaginal area. Regular bathing and showering with gentle soap, keeping the vulvar area dry, and regular use of sitz baths also may be helpful, the latter particularly in candidal vulvovaginitis.
Sex Education and Empowerment
It is optimal for women to abstain from sexual activity while undergoing treatment for vulvovaginitis. Not all women feel comfortable addressing intimate sexual matters with their partners; therefore, it may be important to help patients develop skills and confidence to tell partners what they need, encourage partners to obtain treatment when relevant, and make healthy sexual lifestyle choices that prevent infection.