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Lardenoije CMJG, van Riel SJJM, Peters LJF, Wassen MMLH, Cremers NAJ. Medical-Grade Honey as a Potential New Therapy for Bacterial Vaginosis. Antibiotics (Basel) 2024; 13:368. [PMID: 38667044 PMCID: PMC11047503 DOI: 10.3390/antibiotics13040368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/12/2024] [Accepted: 04/14/2024] [Indexed: 04/29/2024] Open
Abstract
The prevalence of bacterial vaginosis (BV) among women of reproductive age is 29%. BV arises from a vaginal imbalance marked by reduced levels of lactic acid-producing lactobacilli and an overgrowth of pathogenic anaerobes. The multifactorial nature of BV's pathogenesis complicates its treatment. Current antibiotic therapy exhibits a recurrence rate of about 60% within a year. Recurrence can be caused by antibiotic treatment failure (e.g., due to antimicrobial resistance), the persistence of residual infections (e.g., due to biofilm formation), and re-infection. Because of the high recurrence rates, alternative therapies are required. Medical-grade honey (MGH), known for its antimicrobial and wound healing properties in wound care, emerges as a potential novel therapy for BV. MGH exerts broad-spectrum antimicrobial activity, employing multiple mechanisms to eliminate the risk of resistance. For example, the low pH of MGH and the production of hydrogen peroxide benefit the microbiota and helps restore the natural vaginal balance. This is supported by in vitro studies demonstrating that MGH has an antibacterial effect on several pathogenic bacteria involved in the pathophysiology of BV, while lactobacilli and the vaginal microenvironment can be positively affected. In contrast to antibiotics, MGH exerts anti-biofilm activity, affects the microbiome as pre- and probiotic, and modulates the vaginal microenvironment through its anti-inflammatory, anti-oxidative, physicochemical, and immunomodulatory properties. More clinical research is required to confirm the positive effect of MGH on BV and to investigate the long-term cure rate.
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Affiliation(s)
- Céline M. J. G. Lardenoije
- Department of Gynecology and Obstetrics, Maastricht University Medical Centre+, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands; (C.M.J.G.L.); (S.J.J.M.v.R.)
| | - Senna J. J. M. van Riel
- Department of Gynecology and Obstetrics, Maastricht University Medical Centre+, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands; (C.M.J.G.L.); (S.J.J.M.v.R.)
- Department of Obstetrics & Gynecology, Zuyderland Medical Centre Heerlen, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands;
- VieCuri Medical Centre, Tegelseweg 210, 5912 BL Venlo, The Netherlands
- GROW Research Institute for Oncology and Reproduction, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | | | - Martine M. L. H. Wassen
- Department of Obstetrics & Gynecology, Zuyderland Medical Centre Heerlen, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands;
| | - Niels A. J. Cremers
- Department of Gynecology and Obstetrics, Maastricht University Medical Centre+, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands; (C.M.J.G.L.); (S.J.J.M.v.R.)
- Triticum Exploitatie BV, Sleperweg 44, 6222 NK Maastricht, The Netherlands;
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Hellier SD, Wrynn AF. Beyond fluconazole: A review of vulvovaginal candidiasis diagnosis and treatment. Nurse Pract 2023; 48:33-39. [PMID: 37643144 DOI: 10.1097/01.npr.0000000000000095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
ABSTRACT Vaginitis symptoms are among the most common reasons for patients to seek acute gynecological care. NPs who care for women and other patients with vaginas need to be up-to-date on diagnosis and treatment of vulvovaginal candidiasis (VVC) and recurrent VVC (RVVC). Two new antifungal medications for VVC are available. This article reviews vaginal physiology and provides an overview of VVC and RVVC pathophysiology, diagnosis, and treatment options.
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van Riel SJJM, Lardenoije CMJG, Wassen MMLH, van Kuijk SMJ, Cremers NAJ. Efficacy of a medical grade honey formulation (L-Mesitran) in comparison with fluconazole in the treatment of women with recurrent vulvovaginal candidiasis: protocol for a randomised controlled trial (HONEY STUDY). BMJ Open 2023; 13:e070466. [PMID: 37640455 PMCID: PMC10462966 DOI: 10.1136/bmjopen-2022-070466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 08/09/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Recurrent vulvovaginal candidiasis (RVVC) affects up to 9% of women worldwide. This amount is expected to increase due to lifestyle changes, increased fungal resistance and biofilm formation. Treatment options are limited and in 57% of the cases, relapses occur within 12 months after starting fluconazole therapy (golden standard). The pathogenesis of RVVC is multifactorial and includes fungal biology, the vaginal microenvironment and the immune system. Fluconazole is antimicrobial and effective in inducing short-term remission but a long-term cure is hard to achieve. Medical grade honey (MGH) has antimicrobial, protective, antioxidative and immunomodulatory activity and may therefore be a good alternative treatment. This study aims to investigate the clinical cure rate and long-term efficacy of MGH compared with fluconazole in patients with RVVC. METHODS AND ANALYSIS This study is a multicentre, randomised controlled trial (Maastricht University Medical Centre+ and Zuyderland Medical Centre). A total of 252 eligible women will be randomly assigned to the fluconazole group (control) or the MGH group (L-Mesitran, treatment). The primary objective is to investigate the mycological cure rate after 1 month assessed through a vaginal culture. Secondary objectives are the clinical cure rate regarding symptoms, the prophylactic activity after 6 months of maintenance therapy and the number of relapses within 12 months. Moreover, information about side effects, discomfort and quality of life will be collected with the use of questionnaires. ETHICS AND DISSEMINATION Ethical approval from the Medical Ethics Review Committee of the academic hospital Maastricht/University Maastricht has been obtained (NL 73974.068.21, V.7 on 8 February 2022). Additional approval was obtained from the Ethics Committee of the Zuyderland Medical Centre Heerlen (Z2021141 on 4 March 2022). The first patient was randomised on 22 August 2022. Results will be made available to researchers and healthcare professionals via conferences, meetings and peer-reviewed international publications. TRIAL REGISTRATION NUMBER NCT05367089.
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Affiliation(s)
- Senna J J M van Riel
- Department of Obstetrics & Gynecology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
- Department of Gynecology and Obstetrics, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Céline M J G Lardenoije
- Department of Gynecology and Obstetrics, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Martine M L H Wassen
- Department of Obstetrics & Gynecology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Niels A J Cremers
- Department of Gynecology and Obstetrics, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Research, Triticum Exploitatie BV, Maastricht, The Netherlands
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Medical-Grade Honey Enhances the Healing of Caesarean Section Wounds and Is Similarly Effective to Antibiotics Combined with Povidone-Iodine in the Prevention of Infections-A Prospective Cohort Study. Antibiotics (Basel) 2023; 12:antibiotics12010092. [PMID: 36671293 PMCID: PMC9855001 DOI: 10.3390/antibiotics12010092] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/31/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
Caesarean sections (CS) are becoming increasingly popular. The antibiotic resistance crisis and relentless risk of infections, especially in developing countries, demand alternative treatment options. Medical-grade honey (MGH) exerts antimicrobial and healing properties. This study aims to evaluate the effect of MGH treatment on CS wound healing and postoperative complications when compared to conventional treatment (antibiotics in combination with povidone-iodine). In this prospective cohort study, 766 CS patients were included and evenly divided into two groups. The treatment group (n = 383) received an MGH-based formulation (L-Mesitran Soft) and the control group (n = 383) received antibiotics (Amoxicillin) combined with povidone-iodine. The wound healing time and complication rate were determined for both groups, and subsequently, predisposing factors for complications among the baseline characteristics and non-patient-related parameters were determined. The baseline characteristics were similar for both study groups, supporting a homogenous distribution. Postoperative complications were experienced by 19.3% of the patients in the control group and 18.8% in the treatment (MGH) group. The treatment group experienced significantly more superficial pus discharge than the control group, while the latter experienced significantly more deeper pus discharge. BMI, age, duration of hospitalization, anesthesia, and duration of CS could affect the complication risk. MGH significantly enhanced wound healing until day 42. On average, the healing time with MGH was 19.12 ± 7.760 days versus 24.54 ± 8.168 days in the control group. MGH is a potent alternative treatment to antibiotics and povidone-iodine because while the complication risk is similar, MGH has additional benefits. MGH promotes wound healing and does not bear the risk of resistance.
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de Souza ANV, Faria MGI, da Rocha CE, Philippsen GS, Silva GCC, da Silva GR, Inumaro RS, Gonçalves JE, Gazim ZC, Wietzikoski S, Lívero FADR, Seixas FAV, Wietzikoski Lovato EC. Bioactive compounds with antifungal activity against pathogens isolated from pregnant woman: Gallesia integrifolia (garlic wood) is a promising treatment for vulvovaginal candidiasis. JOURNAL OF ETHNOPHARMACOLOGY 2022; 295:115403. [PMID: 35643209 DOI: 10.1016/j.jep.2022.115403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/20/2022] [Accepted: 05/22/2022] [Indexed: 06/15/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The leaves, bark, and roots of Gallesia integrifolia are consumed in folk medicine through infusion, decoction, and topical preparation by crushing because of its pharmacological properties in several peripheral system disorders, including microbial infections. The presence of various molecules in different parts of the plant likely confers this species' fungicidal action, but scientific evidence is lacking. Vulvovaginal candidiasis mainly affects women of reproductive age. When left untreated, it can cause pregnancy complications. Currently available antifungals often cause undesirable side effects. New alternative therapeutic strategies based on medicinal plants have been proposed. AIM To investigate the antifungal activity of G. integrifolia against vulvovaginal candidiasis secretion in pregnant women. MATERIALS AND METHODS Antifungal activity was determined by the minimum inhibitory concentration (MIC), determined by broth microdilution method using Candida spp (NEWP1210), C. albicans (CCCD-CC001), C. tropicalis (CCCD-CC002) standard and clinical isolates from pregnant women with vulvovaginal candidiasis. Nystatin and fluconazole were used as positive controls. The chemical composition of essential oils that were extracted from leaves, flowers, and fruits of G. integrifolia was determined by gas chromatography coupled to mass spectrometry. Reverse docking was used to suggest a possible target in Candida. Conventional docking was used to identify the most probable compound that inhibits fungal growth. RESULTS A total of 24 compounds were identified, accounting for ∼99% of volatile constituents in the essential oils. Leaves of G. integrifolia contained 3,5-dithiahexanol-5,5-dioxide (40.93%), flowers contained methionine ethyl ester (46.78%), and fruits contained 2,8-dithianonane (54.01%) as the most abundant compounds. The MICs of essential oils of leaves, flowers, and fruits of G. integrifolia against standard strains of Candida spp, C. albicans, and C. tropicalis ranged from 13.01 to 625.00 μg/mL. The essential oil of flowers more effectively inhibited Candida spp. Essential oils of leaves and flowers were similar to fluconazole against C. albicans. Essential oils of flowers and fruits were similar to fluconazole against C. tropocalis. In Candida yeast species that were isolated from vaginal secretion samples from pregnant patients, the MICs of leaves and flowers ranged from 52.08 to 5000.00 μg/mL. The essential oil of leaves (277.77 μg/mL) was the most active against C. albicans. No significant differences were found between the essential oils of leaves and flowers against C. glabrata. Docking simulations suggested that phytol in leaves and flowers was responsible for the antimicrobial effect. CONCLUSION The present results suggest the potential therapeutic use of G. integrifolia, especially its leaves and flowers, against Candida and vulvovaginal candidiasis.
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Affiliation(s)
- Amanda Nascimento Vasques de Souza
- Laboratory of Preclinical Research of Natural Products, Paranaense University, Umuarama, PR, Brazil; Postgraduate Program in Medicinal Plants and Phytotherapics in Basic Attention, Paranaense University, Umuarama, PR, Brazil
| | - Maria Graciela Iecher Faria
- Laboratory of Chemistry of Natural Products, Paranaense University, Umuarama, PR, Brazil; Postgraduate Program in Biotechnology Applied to Agriculture, Paranaense University, Umuarama, PR, Brazil
| | - Cristiane Edna da Rocha
- Laboratory of Preclinical Research of Natural Products, Paranaense University, Umuarama, PR, Brazil
| | | | | | - Gustavo Ratti da Silva
- Laboratory of Preclinical Research of Natural Products, Paranaense University, Umuarama, PR, Brazil; Postgraduate Program in Animal Sciences with Emphasis on Bioactive Products, Paranaense University, Umuarama, PR, Brazil
| | - Rodrigo Sadao Inumaro
- Postgraduate Program in Clean Technologies and Cesumar Institute of Science, Technology and Innovation, Cesumar University, Maringá, PR, Brazil
| | - José Eduardo Gonçalves
- Postgraduate Program in Clean Technologies and Cesumar Institute of Science, Technology and Innovation, Cesumar University, Maringá, PR, Brazil
| | - Zilda Cristiani Gazim
- Laboratory of Chemistry of Natural Products, Paranaense University, Umuarama, PR, Brazil; Postgraduate Program in Biotechnology Applied to Agriculture, Paranaense University, Umuarama, PR, Brazil
| | - Samantha Wietzikoski
- Laboratory of Preclinical Research of Natural Products, Paranaense University, Umuarama, PR, Brazil
| | - Francislaine Aparecida Dos Reis Lívero
- Laboratory of Preclinical Research of Natural Products, Paranaense University, Umuarama, PR, Brazil; Postgraduate Program in Medicinal Plants and Phytotherapics in Basic Attention, Paranaense University, Umuarama, PR, Brazil; Postgraduate Program in Animal Sciences with Emphasis on Bioactive Products, Paranaense University, Umuarama, PR, Brazil; Postgraduate Program in Biotechnology Applied to Agriculture, Paranaense University, Umuarama, PR, Brazil
| | | | - Evellyn Claudia Wietzikoski Lovato
- Laboratory of Preclinical Research of Natural Products, Paranaense University, Umuarama, PR, Brazil; Postgraduate Program in Medicinal Plants and Phytotherapics in Basic Attention, Paranaense University, Umuarama, PR, Brazil.
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Donders G, Sziller IO, Paavonen J, Hay P, de Seta F, Bohbot JM, Kotarski J, Vives JA, Szabo B, Cepuliené R, Mendling W. Management of recurrent vulvovaginal candidosis: Narrative review of the literature and European expert panel opinion. Front Cell Infect Microbiol 2022; 12:934353. [PMID: 36159646 PMCID: PMC9504472 DOI: 10.3389/fcimb.2022.934353] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/08/2022] [Indexed: 11/19/2022] Open
Abstract
Recurrent vulvovaginal candidosis (RVVC) is a chronic, difficult to treat vaginal infection, caused by Candida species, which affects women of all ages and ethnic and social background. A long-term prophylactic maintenance regimen with antifungals is often necessary. In most clinical practice guidelines, oral fluconazole is recommended as the first-line treatment. Although clinical resistance to antifungal agents remains rare, overexposure to azoles may increase the development of fluconazole-resistant C. albicans strains. In addition, non-albicans Candida species are frequently dose-dependent susceptible or resistant to fluconazole and other azoles, and their prevalence is rising. Available therapeutic options to treat such fluconazole-resistant C. albicans and low susceptibility non-albicans strains are limited. Ten experts from different European countries discussed problematic issues of current RVVC diagnosis and treatment in two audiotaped online sessions and two electronic follow-up rounds. A total of 340 statements were transcribed, summarized, and compared with published evidence. The profile of patients with RVVC, their care pathways, current therapeutic needs, and potential value of novel drugs were addressed. Correct diagnosis, right treatment choice, and patient education to obtain adherence to therapy regimens are crucial for successful RVVC treatment. As therapeutic options are limited, innovative strategies are required. Well- tolerated and effective new drugs with an optimized mechanism of action are desirable and are discussed. Research into the impact of RVVC and treatments on health-related quality of life and sex life is also needed.
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Affiliation(s)
- Gilbert Donders
- Femicare VZW, Clinical Research for Women, Tienen, Belgium
- Department of Obstetrics and Gynecology, University Hospital Antwerp, Antwerp, Belgium
- Department of Obstetrics and Gynecology, Regional Hospital Tienen, Tienen, Belgium
| | - István Oszkár Sziller
- Dél-budai Centrumkórház, Szent Imre Egyetemi Oktatókórház, Szülészet és Nőgyógyászati Osztály, Budapest, Hungary
| | - Jorma Paavonen
- Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland
| | - Phillip Hay
- Guys and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Francesco de Seta
- Department of Medical, Surgical and Health Sciences, Institute for Maternal and Child Health, University of Trieste, IRCCS Burlo Garofolo, Trieste, Italy
| | - Jean Marc Bohbot
- Department of Sexually Transmitted Infections, Institut Alfred Fournier, Paris, France
| | - Jan Kotarski
- Department of Oncological Gynecology and Gynecology, Medical University of Lublin, Lublin, Poland
| | - Jordi Antoni Vives
- Department of Gynecology and Obstetrics, Hospital CIMA, Barcelona, Spain
| | - Bela Szabo
- Department of Obstetrics-Gynecology, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology, Targu-Mures, Romania
| | - Ramona Cepuliené
- Gedeon Richter Plc., Budapest, Hungary
- *Correspondence: Ramona Cepuliené,
| | - Werner Mendling
- Deutsches Zentrum für Infektionen in Gynäkologie und Geburtshilfe, Helios Universitätsklinikum Wuppertal, Wuppertal, Germany
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Palmieri B, Condemi L, Bertozzi E, Garoia F, Vadalà M. Relapsing Vulvovaginal Candidiasis: Treatment with Oxygen Therapy and Hyaluronic Acid. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE. The aim of our open, anecdotical, retrospective, spontaneous trial has been to evaluate the efficacy of the association between high concentration oxygen and hyaluronic acid for treatment of relapsing candidiasis.METHODS. 45 women (30.9 ±4.4 years) with relapsing candidiasis, and complaining of dryness, dyspareunia, pain, appealing to our Second Opinion Medical Consultation Network, signed an informed consent form and were treated with oxygen/hyaluronic acid therapy treatment, once a week, for a total of five weeks at the outpatient clinic (Healthy Center, Sirio, Fidenza, Italy). The physicians of the Second Opinion Network followed up weekly from remote (WhatsApp, Skype) each treated patient as to state the effectiveness, tolerability, and side effects of the treatment.RESULTS. The mean VAS and VuAS scores measured at first visit were 2,660 and 2,622 and significantly (p<0,0001) reduced to 1,311 and 0,77 at last visit. The measurements of the vaginal pH and of the vaginal swab after the last treatment session confirmed significantly (p<0.0001) the absence of candidiasis. Three months later in the follow-up, the percentage of patients who had had only one VVC relapse was 4,44% (2/45), a percentage that increased just to 8,8% at six months (4/45). The elastography index was significantly (p<0.0001) increased after the last treatment session (2,55 ± 0,545 vs 4,48 ± 0,505).CONCLUSIONS. The combined oxygen therapy with hyaluronic acid gave definite therapeutic benefits in this cohort of relapsing candidiasis in the acute phase of the infection. The 6-month follow up, also detected a lower reinfection rate compared with the historical available data. The procedure is totally painless with excellent compliance by patients and no untoward effects.
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