Use of Intravaginal Cooling to Provide Symptom Relief in Women With Vulvovaginal Candidiasis and Reduce Immunopathology in an Accompanying Mouse Model.

Abstract

BACKGROUND: Vulvovaginal candidiasis (VVC), caused primarily by Candida albicans, is treated with anti-fungal drugs, often with variable efficacy and relapses. New therapeutic strategies, including drug-free alternatives, are needed. Upon overgrowth or environmental triggers, C. albicans commensal yeast transitions into hyphae resulting in an aberrant immunopathologic neutrophil response that contributes to the characteristic signs and symptoms of vaginitis. The purpose of this study was to evaluate the efficacy of an intravaginal cooling device (Vlisse) in women with VVC to provide symptom relief via putative reversal of C. albicans hyphae to yeast, with additional proof of principle in an animal model. METHODS: Five women with VVC were instructed to use the device twice daily for 3 days. Vulvovaginal symptoms were monitored and scored for each use, followed by pelvic examination at 30 days. A mouse model of VVC employed cooled micro stir rods to evaluate the cooling effect on fungal morphology and vaginal immunopathology. RESULTS: Clinical cure was achieved in all women. In the mouse model, the insertion of pre-cooled magnetic rods intravaginally for short periods over 3 days, reduced the immunopathogenic neutrophil infiltration and hyphae. CONCLUSIONS: Intravaginal cooling provides clinical cure for VVC and proof of principle in an animal model.