The efficacy of the boric acid-based maintenance therapy in preventing recurrent vulvovaginal candidiasis

Current gold-standard treatment of recurrent vulvovaginal candidiasis (RVVC) is mainly based on maintenance with fluconazole. Moderate to high recurrence rates at long-term use and secondary fluconazole resistance emerge as reasons to seek for new topical maintenance regimens. In this study, it is aimed to assess the efficacy and safety of boric acid-based treatment approach to treat clinical RVVC. In this retrospective study, patients who were diagnosed with RVVC received a treatment package for six months that consist of induction with boric acid vaginal suppositories 600 mg daily for 14 nights followed by maintenance for five nights starting with every fifth day of the menstrual cycles; a vaginal estriol-lactobacilli combination; and several rigorous life-style changes. The success was defined as the absence of symptomatic recurrence during the follow-up. Success rate at the first year was found to be 94.8% in a total of 173 patients. Mild, reversible side effects were observed in five patients (2.9%). Boric acid, along with a vaginal estriol-lactobacilli combination and lifestyle changes can be a safe and effective alternative in lieu of potent systemic antifungal drugs as a first-line treatment for the patients referred with RVVC.

Compare the efficacy, safety and compliance of oral estradiol and vaginal estriol for urogenital problems in post-menopausal women

Background: Menopause is recognised to have occurred after 12 months of amenorrhoea for which there are no obvious pathological and physiological causes, it is retrospective diagnosis. Objective of this study was to compare the efficacy, safety and compliance of oral estradiol and vaginal estriol for urogenital problems in post-menopausal women.Methods: A total of 100 postmenopausal women having urogenital symptoms were selected for the prospective study. The selected patients were randomly allocated in 2 groups. Group A received 2 mg of estradiol OD for 4 weeks and then evaluated after 4 weeks. Group B received 0.5 mg of vaginal estriol cream continuously for 4 weeks at night and then evaluated after 4 weeks. Patients were followed after 1,3 and 6 months. Inclusion criteria were postmenopausal women, vaginal symptoms, urogenital symptoms. exclusion criteria were all patients having estrogen dependent neoplasia and comorbidities.Results: For urinary complaints, symptomatic relief was assessed by AUA Score in which after 6 months; in Group A the difference in mean from baseline was 19.64±1.63 and in Group B it was 21±2.52 and was statistically insignificant from each other. For genital complaints, symptomatic relief was graded as 1, 2, 3, 4 in which grade 4 means complete relief. After 6 months of therapy 88.2% got complete relief in Group A and 91.1% in Group B. In vaginal cytological smears; in both groups, parabasal cells were reduced and superficial cells were increased after 6 months of therapy and both groups were statistically insignificant from each other. After 6 months of therapy, increase in mean value of KPI from the baseline is 24.54±10.1 in Group A and 28.6±10.11 in Group B and both groups were statistically insignificant. Endometrial thickness remained unchanged in both the groups after 6 months of therapy.Conclusions: Both drugs were equally effective in alleviating the urogenital symptoms with no significant side effects.