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Armstrong E, Kaul R, Cohen CR. Optimizing the vaginal microbiome as a potential strategy to reduce heterosexual HIV transmission. J Intern Med 2023; 293:433-444. [PMID: 36544257 DOI: 10.1111/joim.13600] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Bacterial vaginosis (BV) is a proinflammatory genital condition characterized by high vaginal bacterial diversity and a paucity of Lactobacillus species. BV has been linked to an elevated risk of HIV acquisition among HIV-negative women and of forward HIV transmission to male sex partners among women living with HIV (adjusted hazard ratios of 1.69 and 3.17, respectively), potentially by eliciting genital inflammation in women with BV and their male sex partners. BV is also highly prevalent among women in sub-Saharan Africa, suggesting that BV treatment may have potential as an HIV prevention strategy. BV is typically treated with antibiotics but recurrence rates are high, possibly because treatment does not directly promote Lactobacillus growth. More recently, BV treatment strategies incorporating live biotherapeutic lactobacilli have led to sustained optimization of the vaginal microbiome and a decrease in inflammatory biomarkers previously associated with HIV susceptibility. Future studies are urgently needed to evaluate BV treatment strategies that can optimize the vaginal microbiome in the long term through colonization with H2 O2 -producing vaginal lactobacilli and to assess whether vaginal microbiota optimization is able to reduce the risk of HIV transmission.
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Affiliation(s)
- Eric Armstrong
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Rupert Kaul
- Department of Medicine, University of Toronto, Toronto, Canada.,Department of Medicine, University Health Network, Toronto, Canada
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, USA
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Cooke G, Watson C, Deckx L, Pirotta M, Smith J, van Driel ML. Treatment for recurrent vulvovaginal candidiasis (thrush). Cochrane Database Syst Rev 2022; 1:CD009151. [PMID: 35005777 PMCID: PMC8744138 DOI: 10.1002/14651858.cd009151.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Recurrent vulvovaginal candidiasis (RVVC) affects up to 5% of women. No comprehensive systematic review of treatments for RVVC has been published. OBJECTIVES The primary objective was to assess the effectiveness and safety of pharmacological and non-pharmacological treatments for RVVC. The secondary objective was to assess patient preference of treatment options. SEARCH METHODS We conducted electronic searches of bibliographic databases, including CENTRAL, MEDLINE, Embase, and CINAHL (search date 6 October 2021). We also handsearched reference lists of identified trials and contacted authors of identified trials, experts in RVVC, and manufacturers of products for vulvovaginal candidiasis. SELECTION CRITERIA We considered all published and unpublished randomised controlled trials evaluating RVVC treatments for at least six months, in women with four or more symptomatic episodes of vulvovaginal candidiasis in the past year. We excluded women with immunosuppressive disorders or taking immunosuppressant medication. We included women with diabetes mellitus and pregnant women. Diagnosis of RVVC must have been confirmed by presence of symptoms and a positive culture and/or microscopy. We included all drug and non-drug therapies and partner treatment, assessing the following primary outcomes: • number of clinical recurrences per participant per year (recurrence defined as clinical signs and positive culture/microscopy); • proportion of participants with at least one clinical recurrence during the treatment and follow-up period; and • adverse events. DATA COLLECTION AND ANALYSIS Two authors independently reviewed titles and abstracts to identify eligible trials. Duplicate data extraction was completed independently by two authors. We assessed risk of bias as described in the Cochrane Handbook for Systematic Reviews of Interventions. We used the fixed-effects model for pooling and expressed the results as risk ratio (RR) with 95% confidence intervals (CI). Where important statistical heterogeneity was present we either did not pool data (I2 > 70%) or used a random-effects model (I2 40-70%). We used the GRADE tool to assess overall certainty of the evidence for the pooled primary outcomes. MAIN RESULTS Studies: Twenty-three studies involving 2212 women aged 17 to 67 years met the inclusion criteria. Most studies excluded pregnant women and women with diabetes or immunosuppression. The predominant species found on culture at study entry was Candida albicans. Overall, the included studies were small (<100 participants). Six studies compared antifungal treatment with placebo (607 participants); four studies compared oral versus topical antifungals (543 participants); one study compared different oral antifungals (45 participants); two studies compared different dosing regimens for antifungals (100 participants); one study compared two different dosing regimens of the same topical agent (23 participants); one study compared short versus longer treatment duration (26 participants); two studies assessed the effect of partner treatment (98 participants); one study compared a complementary treatment (Lactobacillus vaginal tablets and probiotic oral tablets) with placebo (34 participants); three studies compared complementary medicine with antifungals (354 participants); two studies compared 'dermasilk' briefs with cotton briefs (130 participants); one study examined Lactobacillus vaccination versus heliotherapy versus ciclopyroxolamine (90 participants); one study compared CAM treatments to an antifungal treatment combined with CAM treatments (68 participants). We did not find any studies comparing different topical antifungals. Nine studies reported industry funding, three were funded by an independent source and eleven did not report their funding source. Risk of bias: Overall, the risk of bias was high or unclear due to insufficient blinding of allocation and participants and poor reporting. Primary outcomes: Meta-analyses comparing drug treatments (oral and topical) with placebo or no treatment showed there may be a clinically relevant reduction in clinical recurrence at 6 months (RR 0.36, 95% CI 0.21 to 0.63; number needed to treat for an additional beneficial outcome (NNTB) = 2; participants = 607; studies = 6; I² = 82%; low-certainty evidence) and 12 months (RR 0.80, 95% CI 0.72 to 0.89; NNTB = 6; participants = 585; studies = 6; I² = 21%; low-certainty evidence). No study reported on the number of clinical recurrences per participant per year. We are very uncertain whether oral drug treatment compared to topical treatment increases the risk of clinical recurrence at 6 months (RR 1.66, 95% CI 0.83 to 3.31; participants = 206; studies = 3; I² = 0%; very low-certainty evidence) and reduces the risk of clinical recurrence at 12 months (RR 0.95, 95% CI 0.71 to 1.27; participants = 206; studies = 3; I² = 10%; very low-certainty evidence). No study reported on the number of clinical recurrences per participant per year. Adverse events were scarce across both treatment and control groups in both comparisons. The reporting of adverse events varied amongst studies, was generally of very low quality and could not be pooled. Overall the adverse event rate was low for both placebo and treatment arms and ranged from less than 5% to no side effects or complications. AUTHORS' CONCLUSIONS In women with RVVC, treatment with oral or topical antifungals may reduce symptomatic clinical recurrences when compared to placebo or no treatment. We were unable to find clear differences between different treatment options (e.g. oral versus topical treatment, different doses and durations). These findings are not applicable to pregnant or immunocompromised women and women with diabetes as the studies did not include or report on them. More research is needed to determine the optimal medication, dose and frequency.
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Affiliation(s)
- Georga Cooke
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Cathy Watson
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Laura Deckx
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Marie Pirotta
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Jane Smith
- Bond University Medical Program, Faculty of Health Sciences and Medicine, Centre for Research in Evidence-Based Practice (CREBP), Gold Coast, Australia
| | - Mieke L van Driel
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Zhao W, Wang X, Zhao C, Yan Z. Immunomodulatory mechanism of Bacillus subtilis R0179 in RAW 264.7 cells against Candida albicans challenge. Microb Pathog 2021; 157:104988. [PMID: 34044051 DOI: 10.1016/j.micpath.2021.104988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 12/26/2022]
Abstract
This study was aimed to explore the immunomodulatory and anti-Candida mechanisms of Bacillus subtilis (B. subtilis) R0179 in macrophages. RAW 264.7 cells were first challenged with B. subtilis R0179. B. subtilis R0179 was found to down-regulate the signals of Dectin-1, Card9, P-Iκ-Bα, Iκ-Bα, and NF-κB. Meanwhile, it reduced the levels of cytokines interleukin (IL)-1β, IL-6, IL-12, and tumor necrosis factor (TNF)-α, but increased the level of cytokine IL-10. Then RAW 264.7 cells were pretreated with B. subtilis R0179 before challenged with Candida albicans (C. albicans) or RAW 264.7 cells were co-treated with B. subtilis R0179 and C. albicans. In the presence of C. albicans, B. subtilis R0179 also showed the similar immunomodulatory effects on RAW 264.7 cells. Hence, this study provides the first insight into the immunomodulatory mechanisms of B. subtilis R0179 on the Dectin-1-related downstream signaling pathways in macrophages, which may prevent tissue damage caused by excessive pro-inflammatory response during the infection of C. albicans.
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Affiliation(s)
- Weiwei Zhao
- Department of Oral Medicine, Peking University School and Hospital of Stomatology, Beijing, 100081, PR China; Central Laboratory, Peking University School and Hospital of Stomatology, China; National Center of Stomatology, Peking University School and Hospital of Stomatology, China
| | - Xu Wang
- Department of Oral Medicine, Peking University School and Hospital of Stomatology, Beijing, 100081, PR China; Central Laboratory, Peking University School and Hospital of Stomatology, China; National Center of Stomatology, Peking University School and Hospital of Stomatology, China
| | - Chen Zhao
- Department of Oral Medicine, Peking University School and Hospital of Stomatology, Beijing, 100081, PR China; Department of Oral Medicine, The Affiliated Stomatology Hospital of Tongji University, Shanghai, 200070, PR China
| | - Zhimin Yan
- Department of Oral Medicine, Peking University School and Hospital of Stomatology, Beijing, 100081, PR China; Central Laboratory, Peking University School and Hospital of Stomatology, China; National Center of Stomatology, Peking University School and Hospital of Stomatology, China.
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Clinicians' Use of Intravaginal Boric Acid Maintenance Therapy for Recurrent Vulvovaginal Candidiasis and Bacterial Vaginosis. Sex Transm Dis 2020; 46:810-812. [PMID: 31663976 DOI: 10.1097/olq.0000000000001063] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A retrospective chart review characterized clinicians' use of maintenance intravaginal boric acid for women with recurrent vulvovaginal candidiasis or bacterial vaginosis. Average length of use was 13 months with high patient satisfaction and few adverse events. Prospective studies are needed to evaluate the efficacy of maintenance boric acid for these conditions.
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Faught BM, Reyes S. Characterization and Treatment of Recurrent Bacterial Vaginosis. J Womens Health (Larchmt) 2019; 28:1218-1226. [DOI: 10.1089/jwh.2018.7383] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Brooke M. Faught
- Division of Urology Associates, Women's Institute for Sexual Health (WISH), Nashville, Tennessee
| | - Sonia Reyes
- San Francisco Department of Public Health, San Francisco, California
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Beyer R, Jandric Z, Zutz C, Gregori C, Willinger B, Jacobsen ID, Kovarik P, Strauss J, Schüller C. Competition of Candida glabrata against Lactobacillus is Hog1 dependent. Cell Microbiol 2018; 20:e12943. [PMID: 30112857 PMCID: PMC6283251 DOI: 10.1111/cmi.12943] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 07/04/2018] [Accepted: 08/07/2018] [Indexed: 12/30/2022]
Abstract
Candida glabrata is a common human fungal commensal and opportunistic pathogen. This fungus shows remarkable resilience as it can form recalcitrant biofilms on indwelling catheters, has intrinsic resistance against azole antifungals, and is causing vulvovaginal candidiasis. As a nosocomial pathogen, it can cause life-threatening bloodstream infections in immune-compromised patients. Here, we investigate the potential role of the high osmolarity glycerol response (HOG) MAP kinase pathway for C. glabrata virulence. The C. glabrata MAP kinase CgHog1 becomes activated by a variety of environmental stress conditions such as osmotic stress, low pH, and carboxylic acids and subsequently accumulates in the nucleus. We found that CgHog1 allows C. glabrata to persist within murine macrophages, but it is not required for systemic infection in a mouse model. C. glabrata and Lactobacilli co-colonise mucosal surfaces. Lactic acid at a concentration produced by vaginal Lactobacillus spp. causes CgHog1 phosphorylation and accumulation in the nucleus. In addition, CgHog1 enables C. glabrata to tolerate different Lactobacillus spp. and their metabolites when grown in co-culture. Using a phenotypic diverse set of clinical C. glabrata isolates, we find that the HOG pathway is likely the main quantitative determinant of lactic acid stress resistance. Taken together, our data indicate that CgHog1 has an important role in the confrontation of C. glabrata with the common vaginal flora.
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Affiliation(s)
- Reinhard Beyer
- Department of Applied Genetics and Cell Biology (DAGZ)University of Natural Resources and Life Sciences, Vienna (BOKU)TullnAustria
| | - Zeljkica Jandric
- Department of Applied Genetics and Cell Biology (DAGZ)University of Natural Resources and Life Sciences, Vienna (BOKU)TullnAustria
| | - Christoph Zutz
- Department of Farm Animal and Veterinary Public HealthInstitute of Milk Hygiene, Milk Technology and Food ScienceViennaAustria
- Platform Bioactive Microbial Metabolites (BiMM)
| | - Christa Gregori
- Department of Applied Genetics and Cell Biology (DAGZ)University of Natural Resources and Life Sciences, Vienna (BOKU)TullnAustria
| | - Birgit Willinger
- Division of Clinical Microbiology, Department of Laboratory MedicineMedical University of ViennaViennaAustria
| | - Ilse D. Jacobsen
- Research Group Microbial Immunology, Leibniz Institute for Natural Product Research and Infection BiologyHans‐Knöll‐Institute (HKI)JenaGermany
| | - Pavel Kovarik
- Max F. Perutz LaboratoriesUniversity of Vienna, Vienna Biocenter (VBC)ViennaAustria
| | - Joseph Strauss
- Department of Applied Genetics and Cell Biology (DAGZ)University of Natural Resources and Life Sciences, Vienna (BOKU)TullnAustria
- Platform Bioactive Microbial Metabolites (BiMM)
| | - Christoph Schüller
- Department of Applied Genetics and Cell Biology (DAGZ)University of Natural Resources and Life Sciences, Vienna (BOKU)TullnAustria
- Platform Bioactive Microbial Metabolites (BiMM)
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Xie HY, Feng D, Wei DM, Mei L, Chen H, Wang X, Fang F. Probiotics for vulvovaginal candidiasis in non-pregnant women. Cochrane Database Syst Rev 2017; 11:CD010496. [PMID: 29168557 PMCID: PMC6486023 DOI: 10.1002/14651858.cd010496.pub2] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Vulvovaginal candidiasis (VVC) is estimated to be the second most common form of infection after bacterial vaginosis. The ability of probiotics in maintaining and recovering the normal vaginal microbiota, and their potential ability to resist Candidas give rise to the concept of using probiotics for the treatment of VVC. OBJECTIVES To assess the effectiveness and safety of probiotics for the treatment of vulvovaginal candidiasis in non-pregnant women. SEARCH METHODS We searched the following databases to October 2017: Sexually Transmitted Infections Cochrane Review Group's Specialized Register, CENTRAL, MEDLINE, Embase and eight other databases. We searched in following international resources: World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov, Web of Science and OpenGrey. We checked specialty journals, reference lists of published articles and conference proceedings. We collected information from pharmaceutical companies and experts in the field. SELECTION CRITERIA Randomized controlled trials (RCT) using probiotics, alone or as adjuvants to conventional antifungal drugs, to treat VVC in non-pregnant women. Trials recruiting women with recurrent VVC, coinfection with other vulvovaginal infections, diabetes mellitus, immunosuppressive disorders or taking immunosuppressant medication were ineligible for inclusion. Probiotics were included if they were made from single or multiple species and in any preparation type/dosage/route of administration. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for eligibility and quality and extracted data. We resolved any disagreements through consensus. The quality of the evidence was assessed using the GRADE approach. MAIN RESULTS Ten RCTs (1656 participants) met our inclusion criteria, and pharmaceutical industry funded none of these trials. All trials used probiotics as adjuvant therapy to antifungal drugs. Probiotics increased the rate of short-term clinical cure (risk ratio (RR) 1.14, 95% confidence interval (CI) 1.05 to 1.24, 695 participants, 5 studies, low quality evidence) and mycological cure (RR 1.06, 95% CI 1.02 to 1.10, 969 participants, 7 studies, low quality evidence) and decreased relapse rate at one month (RR 0.34, 95% CI 0.17 to 0.68, 388 participants, 3 studies, very low quality evidence). However, this effect did not translate into a higher frequency of long-term clinical cure (one month after treatment: RR 1.07, 95% CI 0.86 to 1.33, 172 participants, 1 study, very low quality evidence; three months after treatment: RR 1.30, 95% CI 1.00 to 1.70, 172 participants, one study, very low quality evidence) or mycological cure (one month after treatment: RR 1.26, 95% CI 0.93 to 1.71, 627 participants, 3 studies, very low quality evidence; three months after treatment: RR 1.16, 95% CI 1.00 to 1.35, 172 participants, one study, very low quality evidence). Probiotics use did not increase the frequency of serious (RR 0.80, 95% CI 0.22 to 2.94; 440 participants, 2 studies, low quality evidence). We found no eligible RCTs for outcomes as time to first relapse, need for additional treatment at the end of therapy, patient satisfaction and cost effectiveness. AUTHORS' CONCLUSIONS Low and very low quality evidence shows that, compared with conventional treatment, the use of probiotics as an adjuvant therapy could increases the rate of short-term clinical and mycological cure and decrease the relapse rate at one month but this did not translate into a higher frequency of long-term clinical or mycological cure. Probiotics use does not seem to increase the frequency of serious or non-serious adverse events. There is a need for well-designed RCTs with standardized methodologies, longer follow-up and larger sample size.
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Affiliation(s)
- Huan Yu Xie
- People's Hospital of Deyang CityDepartment of Obstetrics and GynecologyNo. 173, Tai Shan North RoadDeyangSichuanChina618000
| | - Dan Feng
- Cheng du Women & Children's Central HospitalDepartment of Obstetrics and GynecologyNo. 1617, Riyue AvenueChengduSichuanChina610091
| | - Dong Mei Wei
- West China Second University Hospital, West China Women's and Children's HospitalDepartment of Obstetrics and GynecologyNo. 17, Section Three, Ren Min Nan Lu AvenueChengduSichuanChina610041
| | - Ling Mei
- West China Second University Hospital, West China Women's and Children's HospitalDepartment of Obstetrics and GynecologyNo. 17, Section Three, Ren Min Nan Lu AvenueChengduSichuanChina610041
| | - Hui Chen
- West China Second University Hospital, West China Women's and Children's HospitalDepartment of Obstetrics and GynecologyNo. 17, Section Three, Ren Min Nan Lu AvenueChengduSichuanChina610041
| | - Xun Wang
- West China Second University Hospital, West China Women's and Children's HospitalDepartment of Obstetrics and GynecologyNo. 17, Section Three, Ren Min Nan Lu AvenueChengduSichuanChina610041
| | - Fang Fang
- West China Second University Hospital, Sichuan UniversityDepartment of Obstetrics and GynecologyNo. 17, Section Three, Ren Min Nan Lu AvenueChengduSichuanChina610041
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Ebrahimy F, Dolatian M, Moatar F, Majd HA. Comparison of the therapeutic effects of Garcin(®) and fluconazole on Candida vaginitis. Singapore Med J 2016; 56:567-72. [PMID: 26512149 DOI: 10.11622/smedj.2015153] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION This study aimed to determine and compare the effects of garlic tablets (Garcin(®)) and fluconazole on Candida vaginitis in women who presented to a health centre in Koohdasht, Iran, from August 2011 to March 2012. METHODS The clinical trial was conducted on 110 married women (aged 18-44 years) who had complaints of itching or a burning sensation in the vaginal area. Candida vaginitis was diagnosed by pH measurement of vaginal secretions, direct microscopic evaluation and Sabouraud dextrose agar cultures of the vaginal discharge. On confirmation of diagnosis, the patients were randomly divided into two groups (n = 55). One group received 1,500 mg of Garcin tablets daily and the other received fluconazole tablets 150 mg daily, over a period of seven days. Four to seven days after the completion of treatment, patients were examined for treatment response and possible side effects. RESULTS Complaints related to the disease improved by about 44% in the Garcin group and 63.5% in the fluconazole group (p < 0.05). The overall symptoms of the disease (i.e. redness of vulva and vagina, cheesy discharge, pustulopapular lesions and abnormal cervix) improved by about 60% in the Garcin group and 71.2% in the fluconazole group (p > 0.05). Results of microscopic evaluation and vaginal discharge culture showed significant differences before and after intervention in both groups (p < 0.05). CONCLUSION The present study shows that Garcin tablets could be a suitable alternative to fluconazole for the treatment of Candida vaginitis.
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Affiliation(s)
- Farzaneh Ebrahimy
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahrokh Dolatian
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariborz Moatar
- Department of Pharmacognosy, Faculty of Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Alavi Majd
- Department of Biostatistics, Faculty of Paramedicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Saffari E, Mohammad-Alizadeh-Charandabi S, Adibpour M, Mirghafourvand M, Javadzadeh Y. Comparing the effects of Calendula officinalis and clotrimazole on vaginal Candidiasis: A randomized controlled trial. Women Health 2016; 57:1145-1160. [DOI: 10.1080/03630242.2016.1263272] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Elnaz Saffari
- Students’ Research Committee, Department of Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Mohammad Adibpour
- Department of Parasitology, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Yousef Javadzadeh
- Department of Pharmaceutics, Tabriz University of Medical Sciences, Tabriz, Iran
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Palmeira-de-Oliveira R, Palmeira-de-Oliveira A, Martinez-de-Oliveira J. New strategies for local treatment of vaginal infections. Adv Drug Deliv Rev 2015; 92:105-22. [PMID: 26144995 DOI: 10.1016/j.addr.2015.06.008] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 06/15/2015] [Accepted: 06/24/2015] [Indexed: 01/07/2023]
Abstract
Vaginal infections are extremely prevalent, particularly among women of reproductive age. Although they do not result in high mortality rates, these infections are associated with high levels of anxiety and reduction of quality of life. In most cases, topical treatment of vaginal infections has been shown to be at least as effective as oral treatment, resulting in higher local drug concentrations, with fewer drug interactions and adverse effects. Furthermore, the emergence of microbial resistance to chemotherapeutics and the difficulties in managing infection recurrences sustain the need for more effective local treatments. However, conventional dosage forms have been associated with low retention in the vagina and discomfort. Formulation strategies such as the development of bioadhesive, thermogelling systems and microtechnological or nanotechnological approaches have been proposed to improve delivery of traditional drugs, and other treatment modalities such as new drugs, plant extracts, and probiotics are being studied. This article reviews the recent strategies studied to improve the treatment and prevention of the commonest vaginal infections-namely, vaginal bacteriosis, aerobic vaginitis, vulvovaginal candidosis, and trichomoniasis-through the intravaginal route.
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Bradshaw CS, Brotman RM. Making inroads into improving treatment of bacterial vaginosis - striving for long-term cure. BMC Infect Dis 2015. [PMID: 26219949 PMCID: PMC4518586 DOI: 10.1186/s12879-015-1027-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Bacterial vaginosis (BV) is one of the great enigmas in women's health, a common condition of unknown aetiology, which is associated with significant morbidity and unacceptably high recurrence rates. While it remains unclear whether BV recurrence is predominantly due to failure of current antibiotic regimens to eradicate BV-associated bacteria (BVAB) and biofilm, a failure of some women to re-establish a resilient Lactobacillus-dominant vaginal microbiota, reinfection from sexual partners, or a combination of these factors, it is inherently challenging to make significant inroads towards this goal. In this review, we will outline why BV is such a clinical and epidemiologic conundrum, and focus on several key approaches that we believe merit discussion and clinical research, including strategies to: i) prevent reinfection (partner treatment trials), ii) boost favourable vaginal Lactobacillus species and promote a Lactobacillus-dominant vaginal microbiome (hormonal contraceptive and probiotic trials) and iii) disrupt vaginal BV-associated biofilm.
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Affiliation(s)
- Catriona S Bradshaw
- Melbourne Sexual Health Centre, 580 Swanston Street, Carlton, VIC, 3053, Australia. .,Central Clinical School, Monash University, Melbourne, VIC, Australia.
| | - Rebecca M Brotman
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA.
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Comparison of the Effect of Vaginal Zataria multiflora Cream and Oral Metronidazole Pill on Results of Treatments for Vaginal Infections including Trichomoniasis and Bacterial Vaginosis in Women of Reproductive Age. BIOMED RESEARCH INTERNATIONAL 2015; 2015:683640. [PMID: 26266260 PMCID: PMC4523647 DOI: 10.1155/2015/683640] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 06/09/2015] [Indexed: 11/17/2022]
Abstract
Effect of Zataria multiflora on bacterial vaginosis and Trichomonas vaginalis is shown in vivo and in vitro. We compare the effectiveness of Zataria multiflora cream and oral metronidazole pill on results of treatment for vaginal infections including Trichomonas and bacterial vaginosis; these infections occur simultaneously. The study included 420 women with bacterial vaginosis, Trichomonas vaginalis, or both infections together, who were randomly divided into six groups. Criteria for diagnosis were wet smear and Gram stain. Vaginal Zataria multiflora cream and placebo pill were administered to the experiment groups; the control group received oral metronidazole pill and vaginal placebo cream. Comparison of the clinical symptoms showed no significant difference in all three vaginitis groups receiving metronidazole pill and vaginal Zataria multiflora cream. However, comparison of the wet smear test results was significant in patients with trichomoniasis and bacterial vaginosis associated with trichomoniasis in the two treatment groups (p = 0.001 and p = 0.01). Vaginal Zataria multiflora cream had the same effect of oral metronidazole tablets in improving clinical symptoms of all three vaginitis groups, as well as the treatment for bacterial vaginosis. It can be used as a drug for treatment of bacterial vaginosis and elimination of clinical symptoms of Trichomonas vaginitis.
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Position of the Spanish Menopause Society regarding vaginal health care in postmenopausal women. Maturitas 2014; 78:146-50. [DOI: 10.1016/j.maturitas.2014.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 03/10/2014] [Indexed: 12/14/2022]
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Kaur R, Jaiswal ML, Jain V. Protective effect of Lannea coromandelica Houtt. Merrill. against three common pathogens. J Ayurveda Integr Med 2014; 4:224-8. [PMID: 24459389 PMCID: PMC3891178 DOI: 10.4103/0975-9476.123706] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 04/15/2013] [Accepted: 05/19/2013] [Indexed: 11/30/2022] Open
Abstract
Background: Ayurvedic text reports suggested Lannea coromandelica is used in various microbial origin disorders like dysentery, sore eyes and leprosy, genital wounds. Objective: The present study was designed to investigate the antimicrobial effect of L. coromandelica Houtt. Merrill. (Anacardiaceae) on microbes which cause female reproductive tract infection. Materials and Methods: Ethanolic and aqueous bark extract (Ext.) of L. coromandelica were screened against strains of Streptococcus pyogens, Staphylococcus aureus, and Candida albicans. Antimicrobial assay had been done with agar well diffusion method. Results: Ethanolic extracts [100% (16 mg), 75% (12 mg) and 50% (8 mg)] of L. coromandelica exhibited zone of inhibition (ZI) 19.21 mm, 18.45 mm, 16.41 mm and 18.12 mm, 17.35 mm, 16.35 mm against S. aureus and S. pyogens, respectively. However, only 100% and 75% ethanolic extract showed (ZI-19.18 mm, 16.29 mm) activity against C. albicans. Nevertheless, aqueous extract (100%) showed higher antifungal activity (ZI-16.97 mm). Ciprofloxacin and amphotericin B were used as a standard drugs in the present study. Conclusion: The results demonstrated that L. coromandelica Houtt. Merrill. have antibacterial activity against S. pyogens, S. aureus and antifungal property against C. albicans. Our findings corroborate the ethnobotanical use of L. coromandelica in traditional medicine system (Ayurveda) of India.
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Affiliation(s)
- Rupinder Kaur
- Department of Dravyaguna, National Institute of Ayurveda, Jaipur, India
| | - Mohan Lal Jaiswal
- Department of Dravyaguna, National Institute of Ayurveda, Jaipur, India
| | - Vivek Jain
- Department of Pharmacy, Faculty of Science and Technology, Banasthali Vidhyapith, Tonk, Rajasthan, India
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Watson CJ, Grando D, Fairley CK, Chondros P, Garland SM, Myers SP, Pirotta M. The effects of oral garlic on vaginal candida colony counts: a randomised placebo controlled double-blind trial. BJOG 2013; 121:498-506. [DOI: 10.1111/1471-0528.12518] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2013] [Indexed: 11/29/2022]
Affiliation(s)
- CJ Watson
- Department of General Practice and Primary Health Care Academic Centre; University of Melbourne; Carlton Vic. Australia
- Gynaecology Assessment Clinic; Royal Women's Hospital; Flemington Melbourne Vic. Australia
| | - D Grando
- School of Applied Sciences; RMIT University; Bundoora Vic. Australia
| | - CK Fairley
- School of Population Health; University of Melbourne; Carlton Vic. Australia
- Melbourne Sexual Health Centre; Alfred Health; Melbourne Vic. Australia
| | - P Chondros
- Department of General Practice and Primary Health Care Academic Centre; University of Melbourne; Carlton Vic. Australia
| | - SM Garland
- Department of Microbiology and Infectious Diseases; Royal Women's Hospital; Flemington Melbourne Vic. Australia
- Department of Obstetrics and Gynaecology; University of Melbourne; Carlton Vic. Australia
| | - SP Myers
- NatMed-Research; Southern Cross University; East Lismore NSW Australia
| | - M Pirotta
- Department of General Practice and Primary Health Care Academic Centre; University of Melbourne; Carlton Vic. Australia
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Garsin DA, Lorenz MC. Candida albicans and Enterococcus faecalis in the gut: synergy in commensalism? Gut Microbes 2013; 4:409-15. [PMID: 23941906 PMCID: PMC3839987 DOI: 10.4161/gmic.26040] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The fungus Candida albicans and the gram-positive bacterium Enterococcus faecalis are both normal residents of the human gut microbiome and cause opportunistic disseminated infections in immunocompromised individuals. Using a nematode infection model, we recently showed that co-infection resulted in less pathology and less mortality than infection with either species alone and this was partly explained by an interkingdom signaling event in which a bacterial-derived product inhibits hyphal morphogenesis of C. albicans. In this addendum we discuss these findings in the contest of other described bacterial-fungal interactions and recent data suggesting a potentially synergistic relationship between these two species in the mouse gut as well. We suggest that E. faecalis and C. albicans promote a mutually beneficial association with the host, in effect choosing a commensal lifestyle over a pathogenic one.
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Xie HY, Feng D, Wei DM, Chen H, Mei L, Wang X, Fang F. Probiotics for vulvovaginal candidiasis in non-pregnant women. Hippokratia 2013. [DOI: 10.1002/14651858.cd010496] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Huan Yu Xie
- People's Hospital of Deyang City; Department of Obstetrics and Gynecology; No. 173, Tai Shan North Road Deyang Sichuan China 618000
| | - Dan Feng
- West China Second University Hospital, West China Women's and Children's Hospital; Department of Obstetrics and Gynecology; No. 17, Section Three, Ren Min Nan Lu Avenue Chengdu Sichuan China 610041
| | - Dong Mei Wei
- West China Second University Hospital, West China Women's and Children's Hospital; Department of Obstetrics and Gynecology; No. 17, Section Three, Ren Min Nan Lu Avenue Chengdu Sichuan China 610041
| | - Hui Chen
- West China Second University Hospital, West China Women's and Children's Hospital; Department of Obstetrics and Gynecology; No. 17, Section Three, Ren Min Nan Lu Avenue Chengdu Sichuan China 610041
| | - Ling Mei
- West China Second University Hospital, West China Women's and Children's Hospital; Department of Obstetrics and Gynecology; No. 17, Section Three, Ren Min Nan Lu Avenue Chengdu Sichuan China 610041
| | - Xun Wang
- West China Second University Hospital, West China Women's and Children's Hospital; Department of Obstetrics and Gynecology; No. 17, Section Three, Ren Min Nan Lu Avenue Chengdu Sichuan China 610041
| | - Fang Fang
- West China Second University Hospital, West China Women's and Children's Hospital; Department of Obstetrics and Gynecology; No. 17, Section Three, Ren Min Nan Lu Avenue Chengdu Sichuan China 610041
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18
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Safety and efficacy of an intravaginal prebiotic gel in the prevention of recurrent bacterial vaginosis: a randomized double-blind study. Obstet Gynecol Int 2012; 2012:147867. [PMID: 23316237 PMCID: PMC3536433 DOI: 10.1155/2012/147867] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 11/26/2012] [Indexed: 01/10/2023] Open
Abstract
Objective. This study was performed to evaluate the efficacy and safety of a prebiotic treatment in the balance recovery of the vaginal flora in subjects previously treated for bacterial vaginosis (BV). Study Design. A randomized trial was carried out on 42 subjects with an active prebiotic group compared to a placebo group. The main evaluation criterion was the quantification of the vaginal flora measured by the Nugent score. Secondary criteria included vaginal pH and BV recurrence. Results. After 8 days of treatment, all subjects who received the prebiotic had a normal Nugent score, whereas 33% of the subjects treated with placebo had an intermediate or positive Nugent score. After 16 days of application, a normal Nugent score was maintained in all subjects treated with the prebiotic, whereas in the placebo group 24% of the subjects still had an elevated Nugent score. Moreover, the maintenance of (or reversion to) a normal flora was associated with the maintenance of (or reversion to) physiological pH values. Conclusions. The intravaginal gel treatment improves the recovery of a normal vaginal flora after the treatment of a BV episode, which should warrant a reduction in the risk of further recurrences.
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Li YC, Liang HC, Chen HM, Tan LR, Yi YY, Qin Z, Zhang WM, Wu DW, Li CW, Lin RF, Su ZR, Lai XP. Anti-Candida albicans activity and pharmacokinetics of pogostone isolated from Pogostemonis Herba. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2012; 20:77-83. [PMID: 23159370 DOI: 10.1016/j.phymed.2012.08.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 07/08/2012] [Accepted: 08/23/2012] [Indexed: 06/01/2023]
Abstract
The present work was designed to evaluate the in vitro and in vivo anti-Candida activity of pogostone (PO), a natural product isolated from Pogostemon cablin (Blanco) Benth. PO showed potent in vitro activity against clinical Candida spp. isolates tested in this study. PO and the reference drug voriconazole (VRC) were equally effective against all the fluconazole-resistant Candida albicans strains, with MIC ranging from 3.1 μg/ml to 50 μg/ml. Besides, PO was fungicidal against all Candida isolates with MFC ranging from 50 μg/ml to 400 μg/ml. By contrast, VRC was fungistatic as it failed to elicit a fungicidal effect against the Candida spp. isolates at the highest tested concentration (400 μg/ml). Furthermore, oral and topical PO administration effectively reduced the fungal load in vagina of vulvovaginal candidiasis mouse models. Topical PO administration (1.0-4.0 mg/kg) demonstrated higher activity against the vulvovaginal candidiasis than VRC (4.0 mg/kg). The pharmacokinetics and safety profile of PO were also investigated. The pharmacokinetics assay revealed that PO was easily absorbed after oral administration in mice, which might account for its in vivo anti-Candida effect. The acute toxicity test showed that the median lethal dose of PO in mice was 355 mg/kg, which was much higher than the daily dose used for the therapeutic experiments. This study demonstrated the potential of PO as a promising candidate for the treatment of Candida infections, particularly for vulvovaginal candidiasis.
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Affiliation(s)
- Yu-Cui Li
- College of Chinese Medicines, Guangzhou University of Chinese Medicine, Guangzhou, PR China
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Gura M, Baresic D. Respect yourself, protect yourself: an educational campaign about vaginitis in the Dominican Republic. Nurs Womens Health 2012; 15:522-8. [PMID: 22900693 DOI: 10.1111/j.1751-486x.2011.01684.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Mary Gura
- Parkview Noble Hospital, Kendallville, IN, USA
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21
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Abstract
OBJECTIVES To describe the use of complementary alternative medicines in women with chronic vaginitis and to evaluate epidemiologic factors associated with these treatments. METHODS In this prospective cohort study, patients with chronic vaginitis completed a questionnaire about past diagnoses and treatments. Information regarding demographics, medical and social history, perceived mental and emotional stress, and current symptoms was collected. All patients underwent a standard physical examination and laboratory testing and were assigned a specific diagnosis. RESULTS A total of 481 women were enrolled; 64.9% used complementary alternative medicines. The most common treatments were yogurt and acidophilus pills. In univariate analysis, compared with nonusers, users of complementary alternative medicines were younger (83.4% younger than 50 compared with 73.1%; P=.032), not African American (11.9% compared with 21.3%; P=.018), had increased measures of perceived stress (P=.008), and reported that their symptoms interfered with both work (59.1% compared with 40.6%; P=.001) and social lives (57.9% compared with 40.2%; P=.001). Patients using complementary alternative medicines had seen more doctors (median 2 compared with 1; P<.001) and were more likely to report a history of vulvovaginal candidiasis (98.4% compared with 90.5%; P<.001) or bacterial vaginosis (34.3% compared with 22.8%; P=.007). In the multivariable analysis, interference with social life, higher number of doctors seen, symptoms of itching or burning, and previous diagnoses of yeast infection remained associated with alternative medicine use. A current diagnosis of vulvovaginal candidiasis was not associated with alternative medicine use. CONCLUSION Complementary alternative medicine use is common in women with chronic vaginitis, particularly in those who are young, have more disruptive symptoms, and report greater stress. LEVEL OF EVIDENCE II.
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22
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Palmeira-de-Oliveira A, Gaspar C, Palmeira-de-Oliveira R, Silva-Dias A, Salgueiro L, Cavaleiro C, Pina-Vaz C, Martinez-de-Oliveira J, Queiroz JA, Rodrigues AG. The anti-Candida activity of Thymbra capitata essential oil: effect upon pre-formed biofilm. JOURNAL OF ETHNOPHARMACOLOGY 2012; 140:379-383. [PMID: 22310557 DOI: 10.1016/j.jep.2012.01.029] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 01/02/2012] [Accepted: 01/18/2012] [Indexed: 05/31/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE [corrected] Thymbra capitata essential oil is traditionally considered to exhibit powerful antiseptic properties, thus being used to treat cutaneous infections. The aim of the present study was to evaluate the effect of Thymbra capitata essential oil upon pre-formed biofilm of different Candida strains while comparing it with the activity against planktonic cells. MATERIALS AND METHODS Fifteen Candida isolates were included, corresponding to clinical and collection type strains. Essential oil was obtained by hydrodistillation and its composition analysed by GC/MS. Activity upon planktonic cells was evaluated according to M27-A3 macromethod. Its effect upon 24h preformed biofilm biomass was determined using the crystal violet procedure and the metabolic activity was studied applying the XTT/menadione technique. RESULTS Biofilm biomass and metabolic activity of all tested species were reduced up to 50% at MIC values. The effect was more pronounced at double MIC values, achieving >80% reduction, except for Candida albicans that presented a more resistant profile (62%). CONCLUSION Thymbra capitata essential oil presented an important effect upon Candida biofilms. It is proposed as a valuable antifungal product to be used in an appropriate pharmaceutical formulation for the management of resistant mucocutaneous candidosis.
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Affiliation(s)
- A Palmeira-de-Oliveira
- CICS-UBI, Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.
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23
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Cooke G, Watson C, Smith J, Pirotta M, van Driel ML. Treatment for recurrent vulvovaginal candidiasis (thrush). Hippokratia 2011. [DOI: 10.1002/14651858.cd009151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Georga Cooke
- Bond University; Faculty of Health Sciences and Medicine; University Dr. Gold Coast Queensland Australia 4229
| | - Cathy Watson
- University of Melbourne; Department of General Practice; 200 Berkeley St. Carlton Victoria Australia 3053
| | - Jane Smith
- Bond University; Faculty of Health Sciences and Medicine; University Dr. Gold Coast Queensland Australia 4229
| | - Marie Pirotta
- University of Melbourne; General Practice; 200 Berkeley St. Carlton Victoria Australia 3053
| | - Mieke L van Driel
- Bond University; Faculty of Health Sciences and Medicine; University Dr. Gold Coast Queensland Australia 4229
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24
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Spence D. Candidiasis (vulvovaginal). BMJ CLINICAL EVIDENCE 2010; 2010:0815. [PMID: 21718579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/28/2022]
Abstract
INTRODUCTION Vulvovaginal candidiasis is estimated to be the second most common cause of vaginitis after bacterial vaginosis. Candida albicans accounts for 85% to 90% of cases. METHODS AND OUTCOMES We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of drug treatments for acute vulvovaginal candidiasis in non-pregnant symptomatic women? What are the effects of alternative or complementary treatments for acute vulvovaginal candidiasis in non-pregnant symptomatic women? What are the effects of treating a male sexual partner to resolve symptoms and prevent recurrence in non-pregnant women with symptomatic acute vulvovaginal candidiasis? What are the effects of alternative or complementary treatments for symptomatic recurrent vulvovaginal candidiasis in non-pregnant women? What are the effects of treating a male sexual partner in non-pregnant women with symptomatic recurrent vulvovaginal candidiasis? What are the effects of treating asymptomatic non-pregnant women with a positive swab for candidiasis? We searched: Medline, Embase, The Cochrane Library, and other important databases up to March 2009 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS We found 61 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS In this systematic review, we present information relating to the effectiveness and safety of the following interventions: alternative or complementary treatments; douching; drug treatments; garlic; intravaginal preparations (boric acid, nystatin, imidazoles, tea tree oil); oral fluconazole; oral itraconazole; treating a male sexual partner; and yoghurt containing Lactobacillus acidophilus (oral or vaginal).
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Affiliation(s)
- Des Spence
- General Practice, Glasgow University, Glasgow, Scotland
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25
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Dugoua JJ, Machado M, Zhu X, Chen X, Koren G, Einarson TR. Probiotic safety in pregnancy: a systematic review and meta-analysis of randomized controlled trials of Lactobacillus, Bifidobacterium, and Saccharomyces spp. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2009; 31:542-552. [PMID: 19646321 DOI: 10.1016/s1701-2163(16)34218-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Our objective in this study was to review systematically the evidence for safety of Lactobacillus, Bifidobacterium and Saccharomyces spp. during pregnancy and to conduct a meta-analysis of randomized controlled trials (RCTs). Eleven databases were searched from inception to September 2007 for RCTs of probiotic use during pregnancy. Two independent reviewers searched databases. Random-effects models combined data. Eleven studies on Lactobacillus and/or Bifidobacterium examined 1505 patients for four outcomes with no data heterogeneity; no miscarriage data were reported. Five studies reported Caesarean section outcomes (OR 0.88; 95% CI 0.65 to 1.19). Six studies reported birth weight (weighted difference 45 g; 95% CI -181 to 271). Three studies reported gestational age (weighted difference 0.4 weeks; 95%CI -0.4 to 1.2). No malformations were reported in the probiotic group. No RCTs were available for Saccharomyces during pregnancy. Lactobacillus and Bifidobacterium had no effect on the incidence of Caesarean section, birth weight, or gestational age. The safety of Saccharomyces during pregnancy is unknown.
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Affiliation(s)
- Jean-Jacques Dugoua
- Graduate Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto ON; Motherisk Program, Hospital for Sick Children, Toronto ON
| | - Marcio Machado
- Toronto Health Economics and Technology Assessment Collaborative (THETA), University of Toronto, Toronto ON
| | - Xu Zhu
- Graduate Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto ON
| | - Xin Chen
- Graduate Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto ON
| | - Gideon Koren
- Graduate Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto ON; Motherisk Program, Hospital for Sick Children, Toronto ON; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto ON
| | - Thomas R Einarson
- Graduate Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto ON; Motherisk Program, Hospital for Sick Children, Toronto ON; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto ON
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Simbar M, Azarbad Z, Mojab F, Majd HA. A comparative study of the therapeutic effects of the Zataria multiflora vaginal cream and metronidazole vaginal gel on bacterial vaginosis. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2008; 15:1025-31. [PMID: 18824338 DOI: 10.1016/j.phymed.2008.08.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Revised: 08/19/2008] [Accepted: 08/19/2008] [Indexed: 05/21/2023]
Abstract
Bacterial vaginosis (BV) is one of most prevalent complications among reproductive-aged women. Metromidazole prescription, which is considered as the first-line treatment of BV, is usually followed by a few side effects. Besides, there is a growing tendency toward herbal medicines for the treatment of vaginitis. Antibacterial and antifungal effects of Zataria multiflora (Z. multiflora) have been demonstrated in vitro and in vivo. This study aimed to compare the therapeutic effects of the Z. multiflora vaginal cream and metronidazole vaginal gel on bacterial vaginosis. This was a randomized clinical trial on 90 married women aged 18-40 affected by BV who attended for treatment to the gynecology clinic of Shabih-Khani Hospital. They randomly divided to two groups of 45 participants. Diagnostic criteria were Amsel's criteria and Gram stain. Z. multiflora vaginal cream or metronidazole vaginal gel for five-night usage were prescribed to each group, and after 2-7 days therapeutic effects on participants' complications and their Amsel criteria were assessed. Data analysis was performed by McNemar and Fisher exact tests. Patients' complication and their Amsel's criteria were significantly decreased after treatment with Z. multiflora or metronidazole (p<0.05). Relative risk for unresponsiveness to treatment with Z. multiflora, to unresponsiveness to metronidazole was 1.5, which was not significant. Therapeutic effects of Z. multiflora vaginal cream are similar to metronidazole vaginal gel on BV. Therefore it could be an appropriate choice to BV treatment for those interested in herbal medicines or those affected by side effects of metronidazole.
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Affiliation(s)
- M Simbar
- School of Midwifery, Shahid Beheshti Medical Science University, Tehran, Iran.
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Watson C, Calabretto H. Comprehensive review of conventional and non-conventional methods of management of recurrent vulvovaginal candidiasis. Aust N Z J Obstet Gynaecol 2007; 47:262-72. [PMID: 17627679 DOI: 10.1111/j.1479-828x.2007.00736.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Recurrent vulvovaginal candidiasis (VVC) is a condition what causes women a great deal of discomfort, inconvenience, and sometimes has psychological sequelae.(1) This condition is notoriously difficult to manage. Conventional management is generally favoured by medical practitioners. Some practitioners prefer not to offer other options because of significant possible side-effects and the lack of research supporting alternative treatments. There are many studies and much available information surrounding uncomplicated VVC, including two systematic reviews.(2,3) In the area of recurrent VVC however, quality conclusive studies are scarce, and recurrent VVC is featured infrequently in randomised controlled trials (RCTs). Systematic reviews that strongly support a particular pharmacological method of conventional management of recurrent VVC over another are absent from medical literature. Recommendations are largely formed on the basis of scanty RCTs and expert opinion. There is even less conclusive evidence in the area of alternative therapies; yet despite this, anecdotally many practitioners (both alternative and mainstream) continue to advocate certain treatments in the absence of any reliable cure that can be confidently prescribed. As the use of methods other than mainstream medicine becomes more widespread, it is important to be aware of both conventional and non-conventional management of recurrent vulvovaginal candidiasis. Practitioners need to ascertain their patient's preference and treatment history. It is difficult to find comprehensive literature assessing both approaches. Giving women the most up-to-date and relevant information, and different management options, is essential in allowing them to make informed decisions. This review critically assesses both mainstream and less conventional approaches in the management of recurrent VVC.
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Affiliation(s)
- Cathy Watson
- Gynaecology Assessment Clinic, Royal Women's Hospital, Melbourne, Victoria, Australia.
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Imhof M, Lipovac M, Kurz C, Barta J, Verhoeven HC, Huber JC. Propolis solution for the treatment of chronic vaginitis. Int J Gynaecol Obstet 2005; 89:127-32. [PMID: 15847875 DOI: 10.1016/j.ijgo.2005.01.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2004] [Revised: 01/12/2005] [Accepted: 01/12/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the efficacy of 5% propolis solution in recurrent vaginitis. METHOD Fifty-four patients with recurrent vaginal infections having undergone at least one cycle of antibiotic treatment were instructed to apply a 5% aqueous propolis solution as a vaginal douche for seven days. Vaginal smears and specific symptoms were evaluated at baseline and 14 days after treatment. Long-term well-being was assessed by telephone interview six months after follow-up. RESULT At the follow-up, the vaginal smears of 41 patients (75.9%) had improved. Forty-seven patients (87%) reported reliefs concerning at least one complaint. Associated improvement of smear and well-being was observed in 36 women (66.7%). After 6 months, 33 patients (61.1%) were satisfied with their condition without having undergone further treatment. CONCLUSION Propolis may have a role as an alternative treatment for chronic vaginal infection.
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Affiliation(s)
- M Imhof
- Department of Obstetrics and Gynecology, AKH Vienna, University of Vienna, Vienna, Austria.
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