Article

Antifungal agents vs Boric Acid for treating chronic myotic vulvovaginitis

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Abstract

Ninety-two 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.

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... IAVAZZO ET AL. identified as eligible for inclusion in this review. 13,[16][17][18][19][20][21][22][23][24][25][26][27][28] No additional studies were identified through hand-searching of references. The selection of studies to be included in this review is depicted graphically in Figure 1. ...
... In 13 of 14 studies, there were available data about dosage and duration of treatment. 13,[16][17][18][19][20][21][22][23][24][25][26]28 Boric acid was used as vaginal suppositories at a dose of 600 mg either once or twice per day for 14 days. Different pathogens were identified, including C. albicans, C. glabrata, Candida tropicalis, and Candida parapsilosis. ...
... Both clinical and mycologic outcomes were identical in 5 of the 9 case series examined. [23][24][25][26][27] Four of the 9 included case series reported statistically significant outcomes in cure rates. 13,22,23,25 The recurrence rates ranged from 0% to 45.5% in patients using boric acid. ...
Article
Recurrent vulvovaginal candidiasis (VVC) remains a challenge to manage in clinical practice. Recent epidemiologic studies indicate that non-albicans Candida spp. are more resistant to conventional antifungal treatment with azoles and are considered as causative pathogens of vulvovaginal candidiasis. We searched PubMed and Scopus for studies that reported clinical evidence on the intravaginal use of boric acid for vulvovaginal candidiasis. We identified 14 studies (2 randomized clinical trials [RCTs], 9 case series, and 4 case reports) as eligible for inclusion in this review. Boric acid was compared with nystatin, terconazole, flucytosine, itraconazole, clotrimazole, ketoconazole, fluconazole, buconazole, and miconazole; as monotherapy, boric acid was studied in 7 studies. The mycologic cure rates varied from 40% to 100% in patients treated with boric acid; 4 of the 9 included case series reported statistically significant outcomes regarding cure (both mycologic and clinical) rates. None of the included studies reported statistically significant differences in recurrence rates. Regarding the adverse effects caused by boric acid use, vaginal burning sensation (<10% of cases), water discharge during treatment, and vaginal erythema were identified in 7 studies. Our findings suggest that boric acid is a safe, alternative, economic option for women with recurrent and chronic symptoms of vaginitis when conventional treatment fails because of the involvement of non-albicans Candida spp. or azole-resistant strains.
... Boric acid (H 3 BO 3 ) has been used for over a hundred years for the treatment of vaginal infections and is commonly used by physicians and patients as an inexpensive, easy to use, accessible treatment of candidiasis and BV [22]. In addition to its proven effectiveness in the treatment of candidal infections, [22][23][24][25][26][27][28][29][30][31] including those that did not resolve with usual antifungal treatment [24][25][26][27][28], H 3 BO 3 use seemed to be associated with a reduced number of co-infections with BV [25]. A retrospective study suggests clinical improvement in seven of nine patients following treatment with 600 mg intravaginal H 3 BO 3 for 14 nights in women with a mixed infection of T. glabrata vaginitis and BV [25]. ...
... Boric acid (H 3 BO 3 ) has been used for over a hundred years for the treatment of vaginal infections and is commonly used by physicians and patients as an inexpensive, easy to use, accessible treatment of candidiasis and BV [22]. In addition to its proven effectiveness in the treatment of candidal infections, [22][23][24][25][26][27][28][29][30][31] including those that did not resolve with usual antifungal treatment [24][25][26][27][28], H 3 BO 3 use seemed to be associated with a reduced number of co-infections with BV [25]. A retrospective study suggests clinical improvement in seven of nine patients following treatment with 600 mg intravaginal H 3 BO 3 for 14 nights in women with a mixed infection of T. glabrata vaginitis and BV [25]. ...
Article
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Background: Bacterial vaginosis is associated with increased transmission of sexually transmitted infections, preterm labor, post-surgical infections, and endometritis. Current treatment for symptomatic bacterial vaginosis includes antibiotics, such as metronidazole, which are 70-80 % effective at one month after treatment and result in high recurrence rates and secondary candida infections. Intravaginal boric acid has been used for over a hundred years to treat vaginal infections, such as bacterial vaginosis. Boric acid is inexpensive, accessible, and has shown to be an effective treatment for other infections, such as vaginal candidiasis. To date, there has been no clinical trial evaluation of boric acid effectiveness to treat bacterial vaginosis. Methods/design: The BASIC (Boric Acid, Alternate Solution for Intravaginal Colonization) trial is a randomized, double-blinded, multicenter study. The study will enroll a minimum of 240 women of 16-50 years of age who are symptomatic with bacterial vaginosis. Eligible participants will have Amsel and Nugent scores confirming bacterial vaginosis. Women who are pregnant or menopausal or have other active co-infections will be excluded. Consenting participants who meet exclusion and inclusion criteria will be randomly assigned to one of three treatment groups: boric acid, metronidazole, or an inert placebo. Self-administration of treatment intravaginally for 10 days will be followed by clinical assessment at 7 and 30 days (days 17 and 40, respectively) after the end of the treatment phase. Primary outcome is a non-inferiority, per-protocol comparison of the effectiveness of boric acid with that of metronidazole at day 17, as measured by the Nugent score in 16-50 year olds. Secondary outcomes include: non-inferiority, intention-to-treat comparison of effectiveness of boric acid with that of metronidazole at day 17, analysis for both per-protocol and intention-to-treat at day 40, and safety considerations, including adverse effects requiring patient discontinuation of treatment. Discussion: This study will be the first to determine whether intravaginal boric acid is non-inferior to metronidazole in the treatment of bacterial vaginosis in symptomatic women. Trial registration: ClinicalTrials.gov NCT00799214, registered online Nov 10, 2008.
... It is featured by its oval shape and propagates through cellular budding. The signal received from the environment through transduction leads to filamentous forms which form pseudohyphae and hyphae [7]. Beside significant role of hyphae in pathogenesis, also both forms are crucial for Candida mutants consisting capability of causing disease which have abnormal filamentation repressor Tup1 and locked in filamentous form. ...
Article
Full-text available
Fungal infections have become more frequent, due to its extension population are at higher risk of utilization and treatment mode that permits long lasting survival of the patients. The histopathological detection of tissues shows fungal invasion of tissues and vessels along with host reaction with fungi and it could be a crucial tool for defining detection significance of positive culture isolates. However, there is very little illustration about morphological features of fungi, which are specific. The histopathologic detection should illustrate fungi and must include presence or absence of tissue invasiveness and host reaction with infection. Although, fungal species associated to genus Candida could result in acute vulvovaginal infection, Candida albicans are significantly more prevalent etiological agent mainly for severe chronic condition named recurrent vulvovaginal candidiasis (RVVC). The recent advancement in pathogenic process and host immune system response to C. albicans had also been seen. Vaginal Candidiasis is known to be one of the common gynecological problems found in females. As it had been seen that half of the women in their lifetime experience suffer from vulvovaginal candidiasis and few with recurrent candidiasis. Cervical and vaginal secretion is the defending tool from ascendant infection pathway spreading. The component that could disturb vaginal environment is endogenous, infectious and iatrogenic factors and is most common factor susceptible for vulvovaginal candidiasis (VVC).
... Although boron and its compounds have been identified as growth stimulators for fish [5,6] in a relatively high concentration, they can also be used to control bacterial and fungal infection. Boric acid for example has been used as an effective and safe candidate for controlling yeast and fungal infections in humans and plants [7][8][9]. Generally, the exact mode of action of BA is still not fully known. However, some studies indicated that mitochondrial degeneration and consequent inhibition of oxidative metabolism were the most prominent features observed following boric acid treatment [7,10]. ...
Article
Full-text available
There has been a significant increase in the incidence of Saprolegnia infections over the past decades, especially after the banning of malachite green. Very often these infections are associated with high economic losses in salmonid farms and hatcheries. The use of boric acid to control the disease has been investigated recently both under in vitro and in vivo conditions, however its possible mode of action against fish pathogenic Saprolegnia is not known. In this study, we have explored the transformation in Saprolegnia spores/hyphae after exposure to boric acid (1 g/L) over a period 4–24 h post treatment. Using transmission electron microscopy (TEM), early changes in Saprolegnia spores were detected. Mitochondrial degeneration was the most obvious sign observed following 4 h treatment in about 20% of randomly selected spores. We also investigated the effect of the treatment on nuclear division, mitochondrial activity and function using confocal laser scanning microscopy (CLSM). Fluorescence microscopy was also used to test the effect of treatment on mitochondrial membrane potential and formation of reactive oxygen species. Additionally, the viability and proliferation of treated spores that correlated to mitochondrial enzymatic activity were tested using an MTS assay. All obtained data pointed towards changes in the mitochondrial structure, membrane potential and enzymatic activity following treatment. We have found that boric acid has no effect on the integrity of membranes of Saprolegnia spores at concentrations tested. It is therefore likely that mitochondrial dysfunction is involved in the toxic activity of boric acid against Saprolegnia spp.
... No RCTs were found investigating the use of gentian violet. Jovanic et al. 63 observed patients treated unsuccessfully with 12 days of gentian violet tampons, but the dilutions were not specified. Diehl 61 suggests that gentian violet is still effective for vulvovaginal candidiasis, having antifungal and antibacterial properties. ...
Article
Recurrent vulvovaginal candidiasis (VVC) is a condition what causes women a great deal of discomfort, inconvenience, and sometimes has psychological sequelae.1 This condition is notoriously difficult to manage. Conventional management is generally favoured by medical practitioners. Some practitioners prefer not to offer other options because of significant possible side-effects and the lack of research supporting alternative treatments. There are many studies and much available information surrounding uncomplicated VVC, including two systematic reviews.2,3 In the area of recurrent VVC however, quality conclusive studies are scarce, and recurrent VVC is featured infrequently in randomised controlled trials (RCTs). Systematic reviews that strongly support a particular pharmacological method of conventional management of recurrent VVC over another are absent from medical literature. Recommendations are largely formed on the basis of scanty RCTs and expert opinion. There is even less conclusive evidence in the area of alternative therapies; yet despite this, anecdotally many practitioners (both alternative and mainstream) continue to advocate certain treatments in the absence of any reliable cure that can be confidently prescribed. As the use of methods other than mainstream medicine becomes more widespread, it is important to be aware of both conventional and non-conventional management of recurrent vulvovaginal candidiasis. Practitioners need to ascertain their patient's preference and treatment history. It is difficult to find comprehensive literature assessing both approaches. Giving women the most up-to-date and relevant information, and different management options, is essential in allowing them to make informed decisions. This review critically assesses both mainstream and less conventional approaches in the management of recurrent VVC.
... Boric acid has not been extensively studied as treatment of fungal vaginitis. Several investigators [16][17][18] who used boric acid therapy for C. albicans vulvovaginitis reported cure rates of >90%. In our series, results of boric acid therapy were equivalent to those of azole therapy; however, prolonged therapy lasting 14 days was necessary. ...
Article
The charts of all patients who were seen at a vaginitis clinic between January 1989 and December 1994 were retrospectively reviewed; 80 patients whose vaginal cultures yielded Torulopsis glabrata were identified. Sixty of these patients experienced 75 symptomatic episodes of vaginitis attributed to T. glabrata, and these patients are the subject of this review. Of the 60 symptomatic patients, 40 had uncomplicated T. glabrata infection, and 20 had mixed infection, most commonly in association with bacterial vaginosis. Evaluation of treatment of T. glabrata vaginitis with vaginal boric acid (600 mg/d for 14 days) revealed clinical improvement or cure in 21 (81%) of 26 episodes and mycological eradication in 20 (77%) of 26 episodes. One-third of the patients received maintenance therapy with boric acid. The clinical response and mycological eradication rates associated with therapy with topical and systemic azoles were <50%. The rate of therapeutic response to boric acid administered to patients with mixed T. glabrata infection remained high. In conclusion, in this series of patients with T. glabrata vaginitis, for whom repeated courses of antimycotic therapy with azoles had previously failed, boric acid emerged as a promising modality of therapy.
... Boric acid vaginal suppositories are effective when used twice a day for 2 weeks and can be considered if there is a contraindication to other treatments. 44 Gentian violet has also been used, but many patients find it unacceptable, and there is a considerable rate of severe allergic reactions. 11 Prescription medications should be reserved for women with frequently recurring vaginitis who have failed to improve with over-the-counter medication or for patients with compliance issues for whom shorter, higherdose treatment schedules may improve outcome. ...
Article
OBJECTIVE: To evaluate recent advances in our understanding of the clinical relevance, diagnosis, and treatment of vaginal infections, and to determine an efficient and effective method of evaluating this clinical problem in the outpatient setting. DATA SOURCES: Relevant papers on vaginitis limited to the English language obtained through a MEDLINE search for the years 1985 to 1997 were reviewed. DATA SYNTHESIS: Techniques that enable the identification of the various strains of candida have helped lead to a better understanding of the mechanisms of recurrent candida infection. From this information a rationale for the treatment of recurrent disease can be developed. Bacterial vaginosis has been associated with complications, including upper genital tract infection, preterm delivery, and wound infection. Women undergoing pelvic surgery, procedures in pregnancy, or pregnant women at risk of preterm delivery should be evaluated for bacterial vaginosis to decrease the rate of complications associated with this condition. New, more standardized criteria for the diagnosis of bacterial vaginosis may improve diagnostic consistency among clinicians and comparability of study results. Use of topical therapies in the treatment of bacterial vaginosis are effective and associated with fewer side effects than systemic medication. Trichomonas vaginalis, although decreasing in incidence, has been associated with upper genital tract infection. Therapy of T. vaginalis infection has been complicated by an increasing incidence of resistance to metronidazole. CONCLUSIONS: Vaginitis is a common medical problem in women that is associated with significant morbidity and previously unrecognized complications. Research in recent years has improved diagnostic tools as well as treatment modalities for all forms of vaginitis.
... Boric acid is a fungistatic agent and has been used in the treatment of chronic vulvovaginal candidiasis (Van Slyke et al., 1981;Jovanovic et al., 1991;Prutting and Cerveny, 1998;Guaschino et al., 2001;Romano et al., 2005;Ray et al., 2007aRay et al., , 2007bDas Neves et al., 2008). It is effective against the infections caused by various Candida species (Candida albicans, Candida glabrata, Candida parapsilosis) (Sobel and Chaim, 1997;Sobel et al., 2003;Van Kessel et al., 2003;Romano et al., 2005;Nyirjesy et al., 2005;Deseta et al., 2008), and Aspergillus niger (Avino-Martinez et al., 2008). ...
Chapter
Boric acid and inorganic borates are important chemical compounds which are toxic in nature and show symptoms of poisoning on oral ingestion of as little as 5 g or on topical application to damaged skin. Boric acid induces reproductive and developmental toxicity in mice, rats and rabbits. It has been shown to produce cytotoxic, embryotoxic, genotoxic, ototoxic and phytotoxic effects. Boric acid is used as an antimicrobial agent for the treatment of Candida and Aspergillus infections. It is also used for the treatment of prostate cancer, deep wounds and ear infections. One of the major uses of boric acid, usually with sodium borate, in chemical and pharmaceutical studies is to act as a buffer for alkaline solutions. Borate ion has been found to catalyze the degradation of drugs such as atropine, benzylpenicillin, carbenicillin, cefotaxime, cephradine, hydrocortisone, indomethacin, methotrexate, oxytetracycline, phenylbutazone, minocycline, 5- fluorouracil, danazol, octastatin and methacholine chloride. It exerts a stabilizing effect on chloramphenicol, epinephrine, á-methyldope, riboflavin, ribose, glucose and ethyl glucuronide solutions on exposure to heat or light. Analytical methods have been developed for the determination of boric acid as glycerol/mannitol/sorbitol complexes. Boric acid has extensive applications as a complexing agent in the determination of diols, polyols, sugar alcohols, disaccharides, oligosaccharides, polysaccharides, glycosides, nucleotides, aminophylline, caffeic acid and other compounds using chromatographic, spectrometric, electrochemical and electrophoretic methods. Borate interactions with polysaccharides, nucleotides and cytochrome c have been investigated to determine the nature of their association. Amperometric glucose biosensors with extended concentration range are also based on the complexation effect of borate. Boric acid has been used in the determination of antimony, chromium, indium, rubidium and uranium by atomic absorption spectrometry and fluorimetry. A thin-layer chromatographic system using precoated plates impregnated with boric acid has been developed for the separation of phospholipid mixtures. Boric acid gel and boron containing chiral stationary phases are used for the chromatographic separation and determination of primary aminecontaining compounds. Boric acid and borates are widely used in various industrial processes, cosmetics, pharmaceuticals, agricultural products and as a preservative and insecticide. Further uses of boric acid and borates may be explored to extend their applications in chemical and pharmaceutical analysis.
... Boric acid is a fungistatic agent and has been used in the treatment of chronic vulvovaginal candidiasis (Van Slyke et al., 1981; Jovanovic et al., 1991; Prutting and Cerveny, 1998; Guaschino et al., 2001; Vazquez et al., 2004; Romano et al., 2005Sobel and Chaim, 1997; Otero et al., 1999; Singh et al., 2002; Sobel et al., 2003; Van Kessel et al., 2003; Romano et al., 2005; Nyirjesy et al., 2005; De Seta et al., 2009), non-Candida albicans (Sood et al., 2000; Otero et al., 2002), Trichosporon species (Makela et al., 2003), Trichomonas vaginalis (Aggarwal and Shier, 2008), and ...
Book
Borates are among the most widely used compounds in chemical and related fields. They have extensive applications in consumer products including pharmaceuticals, cosmetics, insecticides, preservatives, detergents, bleaching agents and enamels. This new book provides a thorough background of the chemical, pharmaceutical and pharmacological aspects of borates and their industrial applications. It contains extensive information for academic and industrial research workers in their fields of interest and gives them a collective view of the importance and current state of knowledge in this vastly growing subject.
... Boron exists in nature in the form of boric acid (H 3 BO 3 ) or borates, mainly sodium borate (Na 2 B 4-O 7 ·10H 2 O), also known as borax. Boric acid and sodium borates are considered to be medicinally important compounds and they are classified by the United States Pharmacopeia-National Formulary [2] and the British Pharmacopeia [3] as two pharmaceutical necessities, where they are used as antibacterial [4] and antifungal agents [5][6][7], as well as components of dental cement [8]. Despite the fact that boron exists in fertilizers, where it is described as an essential constituent for the growth of plants and vegetation, boron contamination is a serious threat to crops, because they are very sensitive to high levels of boron in the irrigation waters [9]. ...
Article
Several studies have been reported over the last two decades to improve the analysis of boron and to determine its isotopic composition. The isotopic composition of boron is of significance to SWRO because second pass processes result in a boron isotopic shift in the permeate, thereby creating a unique process signature. This paper reviews the different boron detection and quantification techniques ranging from plasma-based techniques, to thermal ionization mass spectrometry (TIMS), and other MS-based and non-MS based techniques. The most recent precision and detection levels are reported, and the complexity of analysis and sample preparation, as well as the major disadvantages and limitations associated with the measurements of boron and its isotopic composition (e.g., spectral and isobaric interferences, mass fractionation, and memory effect) are compared among analysis techniques. While positive-TIMS (PTIMS) has been reported as the most precise, and the negative-TIMS (NTIMS) as the most sensitive, plasma-based techniques such as multi-collector inductively coupled plasma-mass spectrometry (MC-ICP-MS) are characterized by their fast speed of analysis and high sample throughput. Several recent improvements have increased precision and lowered the detection level of the MC-ICP-MS, making it capable of competing with PTIMS and NTIMS.
... In the Arabian Gulf, boron levels have been reported to be as high as 7 ppm [4]. While boric acid and borates are two pharmaceutical necessities [5,6], and considered to be medicinally important compounds as antibacterial and antifungal agents [7][8][9][10], high boron concentrations have been observed to constitute a threat to crops and several animal species [11]. ...
Article
Full-text available
Boron removal using new generation RO membranes from several leading manufacturers under a second-pass configuration and without pH adjustment was studied. The study was conducted using seawater from the Arabian Gulf (higher salinity and temperatures than average seawater). Membranes from several manufacturers were tested under similar operational conditions and the same feed water source. It was found that significant boron rejections, as high as 96%, were successfully achieved, using readily-available commercial RO membranes under a two-pass configuration and without any pH adjustment. Moreover, single-pass configurations exhibited high salt and boron rejection results reaching 99% and 91%, respectively. First pass permeates had boron levels below 1.4 ppm, which are adequate to comply with the new WHO guidelines (2.4 ppm) and those of other countries such as Australia, Canada, and UAE, whose boron guideline thresholds are above 1.4 ppm. The paper also assesses the influence of several operational parameters such as feed water salinity, flow velocity, temperature and feed pressure in second pass on boron removal in this process. It was found that higher boron removals were obtained with higher feed velocity, higher second-pass pressures, and lower feed temperatures.
... immune-compromised persons) may be counseled regarding the rational use of patient -initiated antifungal therapy. [7] fluid/electrolyte Balance SGLT2i create an osmotic diuresis which has the potential to cause volume depletion and hypotension. Clinical trial data reveals that this is an uncommon adverse event. ...
... The diagnosis should be confirmed by physical examination, direct microscopy of the vaginal secretions and, of course, fungal culture. Characteristic budding mycelia are seen in fewer than 30% of positive candida cultures (6). ...
Article
Full-text available
Background: Vulvovaginal candidiasis (VVC) is a fungal infection of the vagina and vulva. It is usually caused by Candida albicans, however, occasionally other candida species are responsible. The optimal treatment of VVC has not yet been defined. The present study was designed to compare the efficacy and safety of a single oral dose of fluconazole with clotrimazole vaginal cream as the treatment of choice for recurrent VVC. Materials and methods: We conducted a clinical trial study on 124 women with RVVC. Sampling of vaginal discharge was achieved for clinically suspected patients, then, observed with KOH for vaginal candidiasis. Sample culture was performed for cases in whom the result of direct examination was negative but there was high clinical suspicion of the disease. For laboratory examination, swab specimens were placed on sabourauds agar plus chloramphenicol and cyclohexamide with natural PH. For treatment, patients were randomized systematically in 2 equal groups, one receiving clotrimazole vaginal cream 5g/day for 7 days for acute episode and 5g twice a week for 6 months as a prophylaxis. The second group was prescribed single oral dose of fluconazole capsule 150 mg for acute episode followed by prophylactic regimen of 150 mg weekly for 6 months. Results: A total of 124 women with RVVC were enrolled and assigned in 2 groups of fluconazole and clotrimazole with the mean age of 32±5 years (a range, 18-50 years) and 32±2 years (a range, 19-49 years), respectively. Of 117 cases, the recurrence rate was 8.6% in fluconazole and 8.5% in clotrimazole group. Recurrence rate in follow up period (second 6 months) was 38.3% and 40%, respectively (NS). Conclusion: Response to treatment and reduction in recurrence rate of VVC were similar among fluconazole and long-term users of azole vaginal creams.
... Boron exists in nature in the form of boric acid (H 3 BO 3 ) or borates, mainly sodium borate (Na 2 B 4-O 7 ·10H 2 O), also known as borax. Boric acid and sodium borates are considered to be medicinally important compounds and they are classified by the United States Pharmacopeia-National Formulary [2] and the British Pharmacopeia [3] as two pharmaceutical necessities, where they are used as antibacterial [4] and antifungal agents [5][6][7], as well as components of dental cement [8]. Despite the fact that boron exists in fertilizers, where it is described as an essential constituent for the growth of plants and vegetation, boron contamination is a serious threat to crops, because they are very sensitive to high levels of boron in the irrigation waters [9]. ...
... In the Arabian Gulf, boron levels have been reported to be as high as 7 ppm [4]. While boric acid and borates are two pharmaceutical necessities [5,6], and considered to be medicinally important compounds as antibacterial and antifungal agents [7][8][9][10], high boron concentrations have been observed to constitute a threat to crops and several animal species [11]. ...
... Boron exists in nature in the form of boric acid (H 3 BO 3 ) or borates, mainly sodium borate (Na 2 B 4-O 7 ·10H 2 O), also known as borax. Boric acid and sodium borates are considered to be medicinally important compounds and they are classified by the United States Pharmacopeia-National Formulary [2] and the British Pharmacopeia [3] as two pharmaceutical necessities, where they are used as antibacterial [4] and antifungal agents [5][6][7], as well as components of dental cement [8]. Despite the fact that boron exists in fertilizers, where it is described as an essential constituent for the growth of plants and vegetation, boron contamination is a serious threat to crops, because they are very sensitive to high levels of boron in the irrigation waters [9]. ...
... In the Arabian Gulf, boron levels have been reported to be as high as 7 ppm [4]. While boric acid and borates are two pharmaceutical necessities [5,6], and considered to be medicinally important compounds as antibacterial and antifungal agents [7][8][9][10], high boron concentrations have been observed to constitute a threat to crops and several animal species [11]. ...
... Boron exists in nature in the form of boric acid (H 3 BO 3 ) or borates, mainly sodium borate (Na 2 B 4-O 7 ·10H 2 O), also known as borax. Boric acid and sodium borates are considered to be medicinally important compounds and they are classified by the United States Pharmacopeia-National Formulary [2] and the British Pharmacopeia [3] as two pharmaceutical necessities, where they are used as antibacterial [4] and antifungal agents [5][6][7], as well as components of dental cement [8]. Despite the fact that boron exists in fertilizers, where it is described as an essential constituent for the growth of plants and vegetation, boron contamination is a serious threat to crops, because they are very sensitive to high levels of boron in the irrigation waters [9]. ...
... Pseudohyphae are elongated ellipsoidal cells attached to one another, hyphae are cylindrical elongated forms separated by septal walls. On a native microscopic sample, hyphae are found in about 10% of positive findings, and characteristic mycelial forms in about 30% (11). ...
Article
Full-text available
Vaginal candidiasis (VC) is one of the most common reasons for consultations with a gynecologist, with an increasing trend in occurrence in female patients. It is estimated that 75% of all women experience an episode of vulvovaginal candidiasis in their lifetime, 50% of them experience at least a second episode, and 5% have recurrent candidiasis. Cervical and vaginal secretions act as the last line of defense from ascendant infection pathway spreading. Factors that may disturb vaginal ecosystem are: endogenous factors, way of life, infectious factors and iatrogenic factors. The most common cause of VC in 85-90% of cases is C. albicans, but other Candida species tend to be more likely to cause VVC (Candida tropicalis , Candida glabrata , C particulary, C crusei and so on). These non-albicans species have been found to be fluconazole and antimycotics resistant in more than 70% of cases. This is especially true for C. glabrata. There are several predisposing factors that have been associated with VC recurrence and resistance, such as Candida genotypes, resistance and virulence, immunodeficiency, unregulated hyperglycemia, use of oral contraceptives, long-term use of antibiotics. Therapy approach should be individual, including local and oral antimycotics until the symptoms disappear. The maintenance dose can be continuous or intermittent. Due to hormone concentration increase, increase in local glycogen, alternations of vaginal flora, VC incidence in pregnancy is two times higher in comparison to other female population. The problem of vaginal candidiasis requires individual approach, taking into account all the risk factors and accompanying physiological conditions or diseases in female patients.
Article
Full-text available
Approximately three-quarters of all women will experience an episode of vulvovaginal candidosis at least once in their life and 5-10% of them will have more than one attack. Women suffering from three to four attacks within 12 months will be diagnosed with recurrent vulvovaginal candidosis (RVVC). This review covers the large number of proposed aetiological factors for RVVC. The diagnosis of the condition made by conventional means by health providers is often false and is also often misdiagnosed by the affected woman herself. The review covers various methods of diagnosing RVVC and the current knowledge on potential pathogenetic mechanisms proposed for genital candida infections. Treatment of RVVC, including local and systemic antimicrobial therapy and behaviour modification to decrease the risk of recurrences, are discussed. Recent knowledge on drug resistance in candida is also included.
Article
Unlabelled: This article is a systematic review of the literature regarding the most commonly used complementary and alternative medicine (CAM) therapies for yeast vaginitis and bacterial vaginosis. A search was conducted of all published literature on conventional search engines (PubMed, EMBASE, the Cochrane Registry, CINAHL, LILACS) and alternative medicine databases (Natural Medicines Comprehensive Database, Longwood Herbal Taskforce, and Alternative Medicine Alert), for all studies of the five most commonly used CAM treatments of vaginitis. Inconsistencies in definition of vaginitis, type of intervention, control groups, and outcomes prevented performance of a meta-analysis, and paucity of high-quality studies made ranking by evidence-based scales unsuitable. Lactobacillus recolonization (via yogurt or capsules) shows promise for the treatment of both yeast vaginitis and bacterial vaginosis with little potential for harm. Boric acid can be recommended to women with recurrent vulvovaginal Candidal infections who are resistant to conventional therapies, but can occasionally cause vaginal burning. Because of associated risks in the absence of well-documented clinical benefits, douching remains a practice that should not be recommended for the treatment of vaginitis. Finally, tea tree oil and garlic show some in vitro potential for the treatment of vaginitis, but the lack of in vivo studies preclude their recommendation to patients for the time-being. The available evidence for CAM treatments of vaginitis is of poor quality despite the prevalent use of these therapies. Well-designed randomized, controlled trials investigating the efficacy and safety of these therapies for vaginitis are needed before any reliable clinical recommendations can be made. Target audience: Obstetricians & Gynecologists, Family Physicians. Learning objectives: After completion of this article, the reader will be able to list the most common complementary and alternative medicine therapies for vaginitis, summarize the data surrounding the efficacy of each therapy, describe the adverse affects of each therapy, and outline which therapies are recommended and not recommended for vaginitis.
Article
The purpose of this study was to review the treatment outcome and safety of topical therapy with boric acid and flucytosine in women with Candida glabrata vaginitis. This was a retrospective review of case records of 141 women with positive vaginal cultures of C glabrata at two sites, Wayne State University School of Medicine and Ben Gurion University. The boric acid regimen, 600 mg daily for 2 to 3 weeks, achieved clinical and mycologic success in 47 of 73 symptomatic women (64%) in Detroit and 27 of 38 symptomatic women (71%) in Beer Sheba. No advantage was observed in extending therapy for 14 to 21 days. Topical flucytosine cream administered nightly for 14 days was associated with a successful outcome in 27 of 30 of women (90%) whose condition had failed to respond to boric acid and azole therapy. Local side effects were uncommon with both regimens. Topical boric acid and flucytosine are useful additions to therapy for women with azole-refractory C glabrata vaginitis.
Article
The vulvovaginal candidiasis represents, after the bacterial vaginosis, the most frequent cause of vaginal affection. It is esteemed that around the 75% of the women of reproductive age suffered from an episode of vulvovaginitis from candida and 40-45% have had more episodes, of which 10-20% in complicated form. The kind of candida more frequently isolated in the vagina of symptomatic women is the Candida albicans: in the 10-20% of the cases the agent is present in absence of symptomatology, and we can almost consider it a saprophytic. On the other hand, always with greater frequency fetterses can be isolated of not albicans Candida, particularly the tropicalis and the glabrata kind, usually resistant to the common therapies. The classification of the vulvovaginal candidiasis proposed by Sobel, and by now universally approved, foresees 2 clinical forms of vulvovaginal candidiasis, the vulvovaginitis from not complicated candida (VVC) and the vulvovaginitis from complicated candida (VVCC): different for pathogenesis, elapsed clinical, symptomatology and frequency. They have to be considered in the substance 2 different nosological entities, and they request a diagnostic approach and a well different therapeutic appointment. In this study we will shortly reassume the principal characteristics of it, detaining us on the most recent acquisitions in theme of therapy. The base medicines of ac. boric, to parity of effectiveness, seem to introduce the most contained cost and the best compliance, and they offer him to a complementary use or, in some cases, alternative to the more you consolidate therapies with azoli.
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A large proportion of vulvovaginal candidiasis (VVC) in diabetes is due to non-albicans Candida species such as C. glabrata and C. tropicalis. Observational studies indicate that diabetic patients with C. glabrata VVC respond poorly to azole drugs. We evaluated the response to oral fluconazole and boric acid vaginal suppositories in diabetic patients with VVC. A total of 112 consecutive diabetic patients with VVC were block randomized to receive either single-dose oral 150-mg fluconazole or boric acid vaginal suppositories (600 mg/day for 14 days). The primary efficacy outcome was the mycological cure in patients with C. glabrata VVC in the two treatment arms. The secondary outcomes were the mycological cure in C. albicans VVC, overall mycological cure irrespective of the type of Candida species, frequencies of yeast on direct microscopy, and clinical symptoms and signs of VVC on the 15th day of treatment. Intention-to-treat (ITT; n = 111) and per-protocol (PP; n = 99) analyses were performed. C. glabrata was isolated in 68 (61.3%) and C. albicans in 32 (28.8%) of 111 subjects. Patients with C. glabrata VVC showed higher mycological cure with boric acid compared with fluconazole in the ITT (21 of 33, 63.6% vs. 10 of 35, 28.6%; P = 0.01) and PP analyses (21 of 29, 72.4% vs. 10 of 30, 33.3%; P = 0.01). The secondary efficacy outcomes were not significantly different in the two treatment arms in the ITT and PP analyses. Diabetic women with C. glabrata VVC show higher mycological cure with boric acid vaginal suppositories given for 14 days in comparison with single-dose oral 150-mg fluconazole.
Article
The objective of this study was to establish the relationship between Candida vaginalis and (pre)neoplasia and the prevalence of Candida and (pre)neoplasia related to age and ethnicity. Data were collected from 445,671 asymptomatic women invited for mass screening between 1995 and 2002 and coded according to the Dutch cervical smear coding system (KOPAC) with six grades for (pre)neoplastic changes. Prevalence and relative risks (RRs) were established for Candida and squamous abnormalities in Dutch women and four groups of immigrants. The prevalence of Candida is significantly higher in the cohort of 30-year-old women and lower in the cohorts of 45-, 50-, 55-, and 60-year-old women. The RR of having Candida was higher for Surinamese women (1.24; CI 1.08-1.42). Furthermore, the RR of having mild dysplasia was higher for Surinamese women (1.47; CI 1.14-1.89) and for women born in other countries than in The Netherlands, Turkey, and Morocco (1.36; CI 1.13-1.62). No statistically significant relationship between (pre)neoplasia and Candida was observed. C. vaginalis is more frequent among Surinamese women. Presence of Candida is not associated with an increased risk for squamous abnormalities; therefore, women carrying Candida are not at an increased risk of developing cervical cancer.
Article
Vaginitis is the most common gynecologic diagnosis in the primary care setting. In approximately 90 percent of affected women, this condition occurs secondary to bacterial vaginosis, vulvovaginal candidiasis or trichomoniasis. Vaginitis develops when the vaginal flora has been altered by introduction of a pathogen or by changes in the vaginal environment that allow pathogens to proliferate. The evaluation of vaginitis requires a directed history and physical examination, with focus on the site of involvement and the characteristics of the vaginal discharge. The laboratory evaluation includes microscopic examination of a saline wet-mount preparation and a potassium hydroxide preparation, a litmus test for the pH of vaginal secretions and a "whiff" test. Metronidazole is the primary treatment for bacterial vaginosis and trichomoniasis. Topical antifungal agents are the first-line treatments for candidal vaginitis.
Article
The objective of this study was to investigate whether the presence of vaginal Candida or dysbacteriosis predisposes women to an increased susceptibility for (pre)neoplasia over time. A retrospective, longitudinal, cohort study was performed and was conducted in a population of 100,605 women, each of whom had 2 smears taken over a period of 12 years as part of the Dutch Cervical Screening Program. From these women, a cohort of 1439 women with Candida and a cohort of 5302 women with dysbacteriosis were selected as 2 separate study groups. The control cohort consisted of women who had completely normal cervical smears (n = 87,903 women). These groups were followed retrospectively over time. The odds ratios (OR) for squamous abnormalities in the follow-up smear for the women in these 3 cohorts were established. The dysbacteriotic cohort was significantly more likely to have low-grade squamous intraepithelial lesions (LSIL) and high-grade squamous intraepithelial lesions (HSIL+) in their follow-up smear (OR, 1.85; 95% confidence interval [95% CI], 1.28-2.67 and OR, 2.00; 95% CI, 1.31-3.05, respectively) compared with women in the control group. In contrast, the Candida cohort had no significantly increased or decreased risk of developing SIL. The equivocal diagnosis 'atypical squamous cells of undetermined significance' was rendered significantly more often in the follow-up smear of both study cohorts (Candida cohort: OR, 1.42; 95% CI, 1.03-1.95; dysbacteriotic cohort: OR, 1.44; 95% CI, 1.22-1.71). The results from this study indicated that the presence of Candida vaginalis was not associated with an increased risk for SIL over time. In contrast, women with dysbacteriosis had a significantly increased risk of developing (pre)neoplastic changes. These findings should be taken into account in further research concerning predisposing factors for cervical carcinogenesis.
Article
To determine the accuracy of the microscopic diagnosis of vulvovaginal candidiasis (presence of [pseudo] hyphae and blastospores) in stained vaginal smears in clinical practice. General practitioners trained in diagnosing vulvovaginal candidiasis performed microscopy of 324 stained vaginal smears. These smears were sent to the pathologist for confirmation of the microscopic diagnosis of the clinician; cytologic diagnosis by the pathologist was considered the gold standard. In 104 of the 342 cases Candida was established by the pathologist. The clinicians made 24 false positive and 50 false negative diagnoses of Candida. Sensitivity and specificity of the microscopic diagnoses of the clinicians were 52% and 89%, respectively. The most frequent reason for a false positive diagnosis was presence of hairs, whereas the most frequent reason for a false negative diagnosis was understaining of the smear. This study shows that even in stained smears it is difficult for clinicians to recognize blastospores and (pseudo)hyphae. Efforts are clearly needed to improve the quality of the clinical diagnosis of vulvovaginal candidiasis.
Article
Our purpose was to examine the efficacy of a topical long-term treatment with boric acid versus an oral long-term treatment (itraconazole) in the cure and prevention of recurrent vulvovaginal candidiasis. A prospective, nonrandomized study of patients affected by recurrent vulvovaginal candidiasis was undertaken. In 3 years we recruited 22 consecutive patients who underwent therapy with itraconazole (group 1) or boric acid (group 2). Women were followed up for 1 year, with clinic and microbiologic controls after 1, 3, 6, and 12 months after the first visit. During the treatment, the positive culture results (15.1% vs 12.1%) and the signs and symptoms (33.3% vs. 24.2%) were similar within the 2 groups, with no significant statistical difference. With the withdrawal, after 6 months relapses were common in the 2 groups (54.5%). Boric acid seems to be a valid and promising therapy both in the cure of the vaginal infection and in the prevention of relapses of recurrent vulvovaginal candidiasis, but its efficacy ends with the suspension of the therapy.
Article
Vulvovaginal candidiasis is considered recurrent when at least four specific episodes occur in one year or at least three episodes unrelated to antibiotic therapy occur within one year. Although greater than 50 percent of women more than 25 years of age develop vulvovaginal candidiasis at some time, fewer than 5 percent of these women experience recurrences. Clinical evaluation of recurrent episodes is essential. Patients who self-diagnose may miss other causes or concurrent infections. Known etiologies of recurrent vulvovaginal candidiasis include treatment-resistant Candida species other than Candida albicans, frequent antibiotic therapy, contraceptive use, compromise of the immune system, sexual activity and hyperglycemia. If microscopic examination of vaginal secretions in a potassium hydroxide preparation is negative but clinical suspicion is high, fungal cultures should be obtained. After the acute episode has been treated, subsequent prophylaxis (maintenance therapy) is important. Because many patients experience recurrences once prophylaxis is discontinued, long-term therapy may be warranted. Patients are more likely to comply when antifungal therapy is administered orally, but oral treatment carries a greater potential for systemic toxicity and drug interactions.
Article
The frequency of vulvovaginal candidiasis rises recently. The majority of these cases are caused by Candida albicans. An increasing number of infections caused by other Candida species like C. tropicalis, C. glabrata and C. krusei is observed. Recurrent vulvovaginal candidosis is also a problem for certain group of patients. New azole antifungals which are used in treatment of vulvovaginal candidosis cause the therapy more effective. Nevertheless, therapeutic failures may occur due to resistance of particular Candida species to antifungals.
The return of the Columbians from the New World in 1492 marked the beginning of a virulent epidemic of syphilis that was to shape European attitudes towards the sexuality of women for centuries. The genital discharges of women were henceforth linked to disease and death and in the absence of a coherent discipline of infectious diseases, considerable mythology, prejudice and divine attributions were invoked. Physicians were not immune to this dread of female genital loss. Gideon Harvey, physician to William III of England, in 1672 wrote of 'contageous clots, diseased with a triplicated manginess and conceived in foul scorbutick wounds, scattering with filthy and infectious menstrues'. In 1708, John Marten in his treatise on venereal diseases suggested that men should make intercourse brief and avoid exciting women because this would 'attract the venom' (Davenport-Hines, At the close of the twentieth century, the traces of that heritage can still be identified. Even now, ignorance and prejudice shape our approach to women and their infections. But although the metaphors of dirt, sin and promiscuity are giving way to science, a certain reserve and coyness still makes an understanding of the anatomical, physiological, pathological and sexological aspects of the genital tract a specialized 'discipline' which continues to receive less than ideal management from the 'average' practitioner. The aim of this chapter is to outline the keys and the common traps in evaluating the causes of female genital tract discharge.
Article
A review of recurrent vulvovaginal candidiasis and the possibility of its treatment. Original study. Department of Obstetrics and Gynaecology, Medical Faculty Hradec Králové, Charles University, Prague. Department of Clinical Microbiology, Medical Faculty Hradec Králové, Charles University, Prague. Department of Biological and Medical Sciences, Faculty of Pharmacy Hradec Králové, Charles University, Prague. Department of Clinical Imunology and Allergology, Medical Faculty Hradec Králové, Charles University, Prague. Department of Psychiatry, Medical Faculty Olomouc, Palacky University, Olomouc. Analysis and discussion focused especially on our results and experience in a long time followup of patients with confirmed recurrent vulvovaginal candidiasis. Owing to the multifactorial character of etiopathogenesis, the management of recurrent vulvovaginal candidiasis would be taken into consideration the complexity of the disease, not only the treatment of individual episodes with antimycotics.
Article
Vulvovaginal candidiasis remains one of the most frequently diagnosed inflammatory diseases of the vagina, which affects most sexually active women. In most patients, it is manifested as acute inflammation which is easy to diagnose and treat. However, in the susceptible population, it may be characterized by recurrent episodes, usually with an unknown cause or exacerbating moment. These facts complicate the diagnosis and therapy. This is highlighted by both non-specific symptoms shared with many other vaginal infections and paucity of reliable signs for diagnosis. Under these circumstances, it is difficult to associate vaginal complaints with yeasts and, vice versa, the presence of yeasts does not necessarily confirm fungal aetiology. Therefore, it is better to regard the condition as a syndrome and the chronic problems as vulvovaginal discomfort. It is a prerequisite for an unbiased diagnostic approach, increasing the probability of finding the real cause of the problem and the chances of treating or even curing the disease. The article is concerned with controversial and problematic aspects of diagnosis and treatment of vulvovaginal candidiasis with a focus on laboratory diagnosis, terminology, epidemiology and ecology of yeasts in relation to vaginal microbiota and, last but not least, on alternative therapeutic approaches.
Article
A retrospective chart review characterized clinicians' use of maintenance intravaginal boric acid (BA) for women with recurrent vulvovaginal candidiasis or bacterial vaginosis. Average length of use was 13 months with high patient satisfaction and few adverse events. Prospective studies are needed to evaluate the efficacy of maintenance BA for these conditions.
Article
This chapter describes the epidemiology, causal organisms, disease presentation, and predisposing factors of common systemic mycoses, both opportunistic and endemic. Most fungal infections do not differ in their epidemiology, pathogenesis, or clinical manifestations between men and women. This chapter discusses some relevant gender-specific issues, such as genital tract infection, the effect of pregnancy on some fungal infections, and the use of antifungal agents in special situations. Antifungal agents can act on the cell membrane (polyenes, azoles, allylamines), cell wall (echinocandins), nuclear division (griseofulvin), or nucleic acid synthesis (5-FC). The chapter briefly describes currently available antifungal agents and discusses their use in special situations such as pregnancy. Antifungal treatment in pregnancy requires careful attention to risks and benefits of therapy as well as knowledge of the effect on mother and fetus.
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To establish how general practitioners (GPs) in the Netherlands diagnose and treat vaginal candidiasis. Questionnaires were sent to 1160 Dutch GPs. The GPs were asked to make an inventory of the annual number of consultations for vulvovaginal candidiasis. Furthermore, information was requested with regard to diagnostic examinations performed and preferred treatment when dealing with vulvovaginal candidiasis. 380 (32.87%) GPs returned the questionnaire, of which 189 GPs worked in single-person practices (n=189). The group of 380 GPs consisted of 269 (70.8%) males and 111 (29.2%) females. On average, GPs reported 105.6 consultations concerning vaginal candidiasis per practice per year. Only 61 (16.1%) Dutch GPs always or often performed microscopy when diagnosing candidiasis, while 143 (37.6%) GPs never used a microscope to confirm their diagnosis. Furthermore, only 30 (7.9%) GPs regularly took Candida cultures, whereas 154 GPs (40.5%) never took a vaginal swab to diagnose acute candidiasis. Treatment of choice was mostly miconazole (50%) or clotrimazole (24%). GPs often diagnose "vulvovaginal candidiasis" in their practices, but often do not perform the laboratory examinations required to confirm their putative diagnosis. This may lead to wrong diagnoses and maltreatment with antimycotics, without cure of the patients' vaginal complaints.
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