Can intimate hygiene practices help manage vulvovaginal candidiasis?

Between 70-75% of women in their childbearing years face the unpleasant symptoms of candidiasis infections.¹ Fillipo Murina, MD, of the lower genital tract disease unit in the obstetrics and gynecology department at the V. Buzzi Hospital-University of the Study of Milan in Milan, Italy and colleagues conducted research to discover if adding a feminine wash was more efficient in treating itching and burning symptoms associated with the infection than using an anti-fungal cream alone. The study was published in the journal Health Care for Women International.

Researchers conducted an observational, randomized, controlled, open-label trial at multiple centers at 4 private and public medical centers in Italy. They compared an acid pH thymol and zinc-containing cleansing wash with additional azole therapy to the sole use of topical azole therapy in treating itching and burning associated with yeast infections.

Researchers randomly assigned 200 women age 18-45 with vulvovaginal candidiasis (VVC) to 2 groups. One hundred ninety-two women completed the study. VVC was confirmed by a positive vaginal culture for candida or by seeing hyphae or blastospheres in a fresh sample under a microscope, and by a score ≥2 on the Sobel scale, which measures vulvar or vaginal erythema, edema, pruritis, and excoriation/fissure formation.¹ “Women who were pregnant, lactating, postmenopausal, had trichomonas vaginitis, a history of repeated vaginal candidiasis, or had taken contraceptive pills, broad-spectrum antibiotics, or oral vaginal-related vaginitis drugs in the past two weeks were excluded,” Murin and colleagues reported.

Ninety-seven Group 1 participants were given 1 canister of a cleansing wash containing acid pH thymol and zinc to use twice daily for 15 days in the vulvar area and a tube of 2% clotrimazole cream to be applied once daily at bedtime for 6 days. Group 2, which had 95 participants, was just given the 2% clotrimazole cream at bedtime for 6 days.

The women completed 2 visits during the study: the first collected participants’ demographic information and screened them for VVC. Women were asked to record their symptoms of itching and burning at home through the end of the study. “During visit 2 (15 ± 3 days after visit 1), a physical examination was conducted, diaries were returned, and women were asked about adverse events (AEs) experienced during the treatment period,” the researchers reported.1 In addition, all incidences of any adverse effects were recorded on a chart.

“In both groups, pruritus and burning VAS scores improved from baseline at Days 6, 10 and 15. On Day 10 and Day 15, the pruritus score was significantly lower in Group 1 versus Group 2 (P <0.005 at both timepoints), suggesting acid pH thymol and zinc-containing cleansing wash ameliorates VVC-associated pruritus as part of a female hygiene regimen,” researchers reported.¹

Murin and colleagues said similar side effects were reported for both groups, and no adverse effects occurred that required participants to stop the treatment. Two patients in Group 1 did report a mild burning sensation that resolved after 2-3 days according to researchers.

“An acid pH thymol and zinc-containing cleansing wash may be an appropriate adjuvant to pharmacological therapy for the management of VVC,” researchers concluded.¹

Lubna Mohammed, MBBS, lecturer of research at the California Institute of Behavioral Neurosciences and Psychology in Fairfield, California spoke with Contemporary OB/GYN® as researcher who is unaffiliated with the study. She said that the most important takeaway from this study for providers in practice is that a zinc and thymol containing vaginal wash could be a good adjuvant alongside clotrimazole for the treatment of vulvovaginal candidiasis (VVC). “What is most significant about this particular study is that it had relatively larger sample sizes in each of the 2 study groups that compared the results of treatment of VVC with and without the usage of the vaginal wash,” Mohammed said.

She added that a next step that can be considered in this field of research is to find out the exact effects that a vaginal wash can have on a healthy vaginal microbiome if it is considered to be used on a daily basis. “An important limitation of this study is that there was no comparable intervention in the second group, so a possibility of the placebo effect of wash usage needs to be considered,” she said.

Reference

1. Murina F, Lubrano C, Cappelli E, Campo M, Taraborrelli S. The role of female intimate hygiene practices in the management of vulvovaginal candidiasis: A randomized, controlled open-label trial [published online ahead of print, 2022 Jun 27]. Health Care Women Int. 2022;1-12. doi:10.1080/07399332.2022.2061972