Vaginitis is a common problem in women. Candida albicans is responsible for more than 85% of vaginal fungal infections. The aim of this study was to compare the effects of probiotic and fluconazole on the treatment and recurrence of vulvovaginal candidiasis (VVC). This triple-blinded randomized controlled trial was conducted on 80 married women, aged 18–49 years, with VVC, as confirmed by clinical and laboratory diagnosis. The participants were allocated into two groups using blocked randomization method. The fluconazole-treated group received a single dose of fluconazole (150 mg) supplemented with 30 placebo capsules of probiotic, and the probiotic-treated group got 30 probiotic capsules containing 1 × 10 9 CFU/g LA-5 with 1 fluconazole placebo capsule. The samples were taken from patients to evaluate the vaginal pH and microbiological tests before, 30–35 days, and 60–65 days after starting the treatment. The signs and symptoms were assessed before the intervention and the first and second follow-ups. Chi-square, Fisher’s exact, independent t , and ANCOVA tests were then used for data analysis. There was no statistically significant difference between the two groups ( p = 0.127) in the frequency of negative culture 30–35 days after starting the treatment, but the frequency of negative culture 60–65 days after starting treatment in the fluconazole group was significantly higher than that of the probiotic group ( p = 0.016). The abnormal discharge and vulvovaginal erythema in the first and second follow-ups and also pruritus in the second follow-up in the fluconazole group were significantly lower than those in the probiotic group ( p < 0.05). There was, however, no statistically significant difference in burning, frequent urination, dysuria, and dyspareunia between the groups ( p > 0.05). Lactobacillus acidophilus supplementation had an effect similar to that of fluconazole in treating most symptoms of VVC, but it was less effective than the latter in preventing recurrence. Trial Registration : Iranian Registry of Clinical Trials (IRCT): IRCT20110826007418N5. Date of registration: 3 March 2021; URL: https://en.irct.ir/trial/50819 ; Date of first registration: 10 March 2021.

Background: Vulvovaginal candidiasis (VVC) is a common fungal infection of the vaginal area affecting 75% of women at least once in their lifetime. However, there is no clear evidence helping to choose the most effective treatment method to improve the symptoms of VVC. Objective: The objective of this study was to compare the effect of using honey with clotrimazole on the treatment of symptoms of VVC. Methods: All databases in English (Embase, MEDLINE, ProQuest, Google Scholar, Scopus, Cochrane Library, and Web of Science) and Persian (Irandoc, SID, and Magiran) were searched without time limitation. Evaluation of studies in terms of bias was performed using the Cochrane handbook. Four clinical trials were included in the present systematic review; however, only three of them were included in the meta-analysis. Results: The results of the meta-analysis demonstrated that the rate of positive culture after treatment (RR: 2.35; 95%CI: 1.45 to 3.82) was significantly higher in the honey group than in the clotrimazole one. The frequency of itching after treatment (RR: 0.25, 95%CI: 0.12 to 0.49) was significantly lower in the honey-receiving group than in the clotrimazole one. However, there was no statistically significant difference in the incidence of other symptoms of VVC, including vaginal discharge (RR: 0.26, 95%CI: 0.02 to 2.75), vaginal burning (RR: 0.35, 95%CI: 0.03 to 3.80) and dyspareunia (RR: 0.64, 95%CI: 0.27 to 1.50) between groups. Conclusion: Due to the low quality of the studies, more clinical trial studies with stronger designs in this field are needed to clearly identify the therapeutic effects of honey on improving the symptoms of VVC.