title: Boric acid for recurrent vulvovaginal candidiasis: the clinical evidence.
abstract: BACKGROUND
  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.
  
  
  METHODS
  We searched PubMed and Scopus for studies that reported clinical evidence on the intravaginal use of boric acid for vulvovaginal candidiasis.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Alfa Institute of Biomedical Sciences, 9 Neapoleos Street, Marousi, Athens, Greece..
authors.forename: Christos
authors.initials: C
authors.lastname: Iavazzo
authors.forename: Ioannis D
authors.initials: ID
authors.lastname: Gkegkes
authors.forename: Ioanna M
authors.initials: IM
authors.lastname: Zarkada
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Falagas
mesh_terms: D000282:Administration, Intravaginal; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D000935:Antifungal Agents / Q000627:therapeutic use; D001393:Azoles / Q000627:therapeutic use; D001682:Biological Availability; D001888:Boric Acids / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D002175:Candida / Q000187:drug effects / Q000472:pathogenicity; D002181:Candidiasis, Vulvovaginal / Q000188:drug therapy / Q000382:microbiology / Q000503:physiopathology; D016022:Case-Control Studies; D026141:Drug Resistance, Multiple, Fungal; D005260:Female; D005437:Flucytosine / Q000627:therapeutic use; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D055502:Secondary Prevention; D013488:Suppositories / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D016896:Treatment Outcome; D014623:Vaginal Diseases / Q000139:chemically induced
chemical_list: D000891:Anti-Infective Agents, Local; D000935:Antifungal Agents; D001393:Azoles; D001888:Boric Acids; D013488:Suppositories; D005437:Flucytosine