Treatment features of recurrent vulvovaginal candidiasis on the basis of papillomavirus infection

Authors

DOI:

https://doi.org/10.15574/PP.2025.1(101).5866

Keywords:

recurrent vulvovaginal candidiasis, papillomavirus infection, boric acid, Centella asiatica

Abstract

Aim - evaluation of effectiveness of vaginal suppositories containing boric acid and centella asiatica (Centella asiatica) for treatment in recurrent vulvovaginal candidiasis (RVVC) on the basis of papillomavirus infection.

Materials and methods. The effectiveness of vaginal suppositories containing boric acid and centella asiatica (Centella asiatica) in treatment of RVVC in patients with papillomavirus infection was carried out. The study included 38 patients of the "Nova Medical" medical center (Vasylkiv) with RVVC, who had 3-5 repeated VVC episodes during the last year, on the basis of papillomavirus infection (confirmed by PCR). All patients received vaginal suppositories in the treatment regimen during 14 days. Statistical analysis was performed using the SPSS Statistics software (Statistica 6.0). Differences at p<0.05 are considered statistically significant.

Results. All patients before treatment had inflammatory changes of the vaginal and cervical epithelium with the confirmed candidal nature: minor reaction - 28.9%, moderate - 63.2% and severe - 7.9%. The data obtained after using vaginal suppositories containing boric acid and centella asiatica (Centella asiatica) demonstrate a significant reduction in hyperemia of the vulvovaginal zone - 84.2% and -10.5% - slight hyperemia after treatment and the disappearance of microcracks (p<0.05). The colposcopic features indicates a significant decrease in the severity of the inflammatory process of the vagina and exocervix - 86.8% (p<0.05). Microscopic examination indicates 100% presence of candidal infection before treatment versus 13.2% after treatment. (p<0.05).

Conclusions. Vulvovaginal candidiasis occurs in 59.4% of patients with papillomavirus infection. Combination of boric acid and centella asiatica (Centella asiatica) shows significant effectiveness of treatment RVVC. Clinical recovery was a total of 89.4%. Microbiological recovery was 86.8%. (p<0.05). The occurrence of repeated relapses after treatment did not have statistical significance, 13.2% of asymptomatic carriers of candidal infection required an extension of course up to 8 weeks.

The study was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Сommittee on bioethics and deontology of these institutions. Informed consent of the patients was obtained for the study.

No conflict of interests was declared by the authors.

References

Arribas-López E, Zand N, Ojo O, Snowden MJ, Kochhar T. (2022, Mar 10). A Systematic Review of the Effect of Centella asiatica on Wound Healing. Int J Environ Res Public Health. 19(6): 3266. https://doi.org/10.3390/ijerph19063266; PMid:35328954 PMCid:PMC8956065

Arya NR, Rafiq NB. (2023, Jan). Candidiasis. 2023 May 29. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. PMID: 32809459.

Bardova KO, Barynova ME. (2017). Vulvovahinalnyi kandydoz: osoblyvosti perebihu ta korektsii. Klinichna imunolohiia. Alerholohiia. Infektolohiia. - 6(103): 12-14.

Bobrytska VV, Holovina OV, Kozub TO, Aralov OM. (2023). Efektyvne likuvannia rezystentnykh form vulvovahinalnoho kandydozu. Medychni aspekty zdorovia zhinky. 5(152): 11-16.

Cassone A. (2015). Vulvovaginal Candida albicans infections: pathogenesis, immunity and vaccine prospects. BJOG. 122(6): 785-794. https://doi.org/10.1111/1471-0528.12994; PMid:25052208

Compendium. Boric acid. URL: https://compendium.com.ua/info/3565/bornaja-kislota/.

Diniz LRL, Calado LL, Duarte ABS et al. (2023) Centella asiatica and іts Metabolite Asiatic Acid:Wound Healing Effects and Therapeutic Potential. Metabolites. 13(2): 276. https://doi.org/10.3390/metabo13020276; PMid:36837896 PMCid:PMC9966672

Farr A, Effendy I, Tirri BF et al. (2021). Guideline: Vulvovaginal candidosis (AWMF 015/072, level S2k). Mycoses. 64: 583-602. https://doi.org/10.1111/myc.13248; PMid:33529414 PMCid:PMC8248160

File В, Sobel R, Becker M, Nyirjesy P. (2023, Jul). Fluconazole-Resistant Candida albicans Vaginal Infections at a Referral Center and Treated With Boric Acid. Journal of Lower Genital Tract Disease. 27(3): 262-265. https://doi.org/10.1097/LGT.0000000000000733; PMid:36961480

Ghoshа I, Muwonge R, Mittal S, Banerjee D, Kundu P, Mandal R et al. (2017, Feb). Association between high risk human papillomavirus infection and co-infection with Candida spp. and Trichomonas vaginalis in women with cervical premalignant and malignant lesions. Journal of Clinical Virology. 87: 43-48. https://doi.org/10.1016/j.jcv.2016.12.007; PMid:27992790

Hashemi SE, Shokohi T, Abastabar M, Aslani N, Ghadamzadeh M, Haghani I. (2019). Species distribution and susceptibility profiles of Candida species isolated from vulvovaginal candidiasis, emergence of C. lusitaniae. Curr Med Mycol. 5(4): 26-34. https://doi.org/10.18502/cmm.5.4.2062

Iavazzo C, Gkegkes ID, Zarkada IM, Falagas ME. (2011). Boric acid for recurrent vulvovaginal candidiasis: the clinical evidence. J Womens Health (Larchmt). 20(8): 1245-1255. https://doi.org/10.1089/jwh.2010.2708; PMid:21774671

Kosei NV. (2022). Suchasni problemy likuvannia vulvovahinalnoho kandydozu. Medychni aspekty zdorovia zhinky. 5(146): 1-4.

Łaniewski P, Ilhan ZE, Herbst-Kralovetz MM. (2020). The microbiome and gynaecological cancer development, prevention and therapy. Nat. Rev. Urol. 17(4): 232-250. https://doi.org/10.1038/s41585-020-0286-z; PMid:32071434 PMCid:PMC9977514

Makanjuola O, Bongomin F, Fayemiwo SA. (2018, Oct 31). An update on the roles of non-albicans candida species in vulvovaginitis. J Fungi (Basel). 4(4): 121. https://doi.org/10.3390/jof4040121; PMid:30384449 PMCid:PMC6309050

Marks MA,Viscidi RP, Chang K et al. (2011). Differences in the concentration and correlation of cervical immunemarkers among HPV positive and negative perimenopausal women. Cytokine. 56(3): 798-803. https://doi.org/10.1016/j.cyto.2011.09.012; PMid:22015106 PMCid:PMC3831521

Mitra A, MacIntyre DA, Marchesi JR et al. (2016). The vaginal microbiota, human papillomavirus infection and cervical intraepithelial neoplasia: what do we know and where are we going next? Microbiome. 4(1): 58. https://doi.org/10.1186/s40168-016-0203-0; PMid:27802830 PMCid:PMC5088670

Pappas РG, Kauffman CA, Andes DR et al. (2016). Clinical Practice Guideline for the Management of Candidiasis: Update by the Infectious Diseases Society of America, Clinical Infectious Diseases. 62(4); 15: e1-e50. https://doi.org/10.1093/cid/civ933; PMid:26679628 PMCid:PMC4725385

Phillips NA, Bachmann G, Haefner H, Martens M, Stockdale C. (2022, Jan 31). Topical Treatment of Recurrent Vulvovaginal Candidiasis: An Expert Consensus. Womens Health Rep (New Rochelle). 3(1): 38-42. https://doi.org/10.1089/whr.2021.0065; PMid:35136875 PMCid:PMC8812501

Powell AM, Gracely E, Nyirjesy P. (2016). Nonalbicans candida vulvovaginitis: treatment experience at a tertiary care vaginitis center. J Low Genit Tract Dis. 20(1): 85-89. https://doi.org/10.1097/LGT.0000000000000126; PMid:26083330

Rodríguez-Cerdeira C, Gregorio MC, Molares-Vila A et al. (2019). Biofilms and vulvovaginal candidiasis. Colloids Surf. B. Biointerfaces. 174: 110-125. https://doi.org/10.1016/j.colsurfb.2018.11.011; PMid:30447520

Satora M, Grunwald A, Zaremba B, Frankowska K, Żak K et al. (2023). Treatment of Vulvovaginal Candidiasis-An Overview of Guidelines and the Latest Treatment Methods. J Clin Med. 12(16): 5376. https://doi.org/10.3390/jcm12165376; PMid:37629418 PMCid:PMC10455317

Saxon Lead Author GDGC, Edwards A, Rautemaa-Richardson R, Owen C et al. (2020). British Association for Sexual Health and HIV national guideline for the management of vulvovaginal candidiasis. Int J STD AIDS. 31(12): 1124-1144. https://doi.org/10.1177/0956462420943034; PMid:32883171

Sobel JD. (2007) Vulvovaginal candidosis. Lancet. 369(9577): 1961-1971. https://doi.org/10.1016/S0140-6736(07)60917-9; PMid:17560449

Sun B, Wu L, Wu Y, Zhang C et al. (2020). Therapeutic Potential of Centella asiatica and Its Triterpenes: A Review. Front Pharmacol. 4(11): 568032. https://doi.org/10.3389/fphar.2020.568032; PMid:33013406 PMCid:PMC7498642

Torres-Poveda K, Bahena-Román M, Delgado-Romero K et al. (2018). A prospective cohort study to evaluate immunosuppressive cytokines as predictors of viralpersistence and progression to pre-malignan lesion in the cervix in women infected with HR-HPV:study protocol. BMC Infect. Dis. 18(1): 582. https://doi.org/10.1186/s12879-018-3490-1; PMid:30453958 PMCid:PMC6245844

Vodstrcil LA, Hocking JS, Law M et al. (2013). Hormonal contraception is associated with a reduced risk of bacterial vaginosis: a systematic review and meta-analysis. PLoS One. 8(9): e73055. https://doi.org/10.1371/journal.pone.0073055; PMid:24023807 PMCid:PMC3762860

Published

2025-03-28