Management of recurrent vulvovaginal candidiasis and bacterial vaginosis: focus on maintenance therapy

Background. The high-frequency recurrence of vulvovaginal candidiasis and bacterial vaginosis, bacterial biofilm formation, and the growing resistance to azole antifungal treatment compromise the efficacy of standard therapy and necessitate the search for pathogenesisoriented strategies for relapse prevention. Intravaginal boric acid is known to maintain healthy vaginal pH, suppress Candida and anaerobic bacteria growth, and affect biofilm formation, which play a pivotal role in persistent, chronic recurrent infections.
Objective. This study aims to analyze real-world data to evaluate the clinical efficacy of boric acid (600 mg) medical device when used in maintenance therapy. Long-term administration of 600 mg boric acid promoted the maintenance of a balanced vaginal pH, reduced the risk of recurrent episodes, and improved the efficacy of standard antimicrobial and antifungal therapy.
Materials and methods. A retrospective medical record review allowed for the identification of the specific patterns of physician prescribing habits regarding maintenance therapy with a boric acid (600 mg) medical device in patients with recurrent vulvovaginal candidiasis and bacterial vaginosis. It was established that the integration of this medical device into comprehensive treatment regimens after an induction antifungal or antibacterial therapy promotes long-term stability of the vaginal microbiota and reduces the incidence of disease recurrence.
Conclusion. The mean duration of use for the boric acid (600 mg) medical device was 13 months, reflecting an unmet clinical need for longterm maintenance therapy for persistent vaginal infections. A high level of patient satisfaction with the treatment was reported, alongside with a favorable safety profile and reduced rates of adverse events. The pooled data confirmed the clinical rationale for the integration of this medical device into comprehensive anti-relapse therapy for vaginal dysbiosis.

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