Prolonged (3-month) mycological cure rate after boric acid suppositories in diabetic women with vulvovaginal candidiasis

Abstract

Objective: Patients with diabetes mellitus (DM) are at increased risk of vulvovaginal candidiasis (VVC) due to C. glabrata. In our previous study we had shown that patients with diabetes mellitus and VVC show an overall superior mycological cure rate (74% versus 51%) with boric acid therapy at 15th day as compared to fluconazole. Present study was carried out to assess long term response to boric acid in diabetic women with VVC. Material and methods: Subjects included 40 consecutive diabetic women (type 2 DM = 26 and type 1 DM = 14) who had achieved mycological cure (high vaginal swab culture negativity) on day 15 of therapy following single-dose oral-150 mg fluconazole (n = 21) or 600 mg of boric acid suppositories given daily for 14 days (n = 19). At third month of follow up, patients were assessed for signs and symptoms of VVC and a repeat HVS was collected for fungal culture. HbA1c was measured to assess glycaemic control. Results: The mean age, BMI, HBA1c and frequency of various Candida species isolated at initial diagnosis were comparable in the fluconazole and boric acid treatment groups. Fifteen of 21 (71.4%) and 12 of 19 (63.1%) women who achieved mycological cure at 15 day remain cured at three months in the fluconazole and boric acid treated groups, respectively (P = 0.83). With 74% mycological cure at 15th day, this would indicate that on an average only 46.6% of diabetic women with VVC would remain cured at 3 months after a course of 14 days boric acid therapy. Most of the patients relapsed with no change in Candida species. The demographic profile and mean HbA1c (8.6 ± 2.2 versus 8.8 ± 2.4%, P = 0.83) were comparable in patients with (n = 27) and without mycological cure (n = 13). Conclusion: The results of the current study indicating comparable mycological cure rate at 3 months between fluconazole and boric acid treated patients would support use of boric acid in the acute management of VVC in view of its superior short term response in diabetic women with C. glabrata infections. However, there is need to explore other therapeutic regimens which are effective in achieving long term mycological cure in diabetic women with VVC.