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Abstract

Herbal remedies are globally accepted for treatment of several diseases including infections. Certain herbs possess traditional evidence to be used in vaginitis, especially bacterial vaginitis. This paper was designed to gather various data on the possible effec tiveness of herbal remedies on different types of vaginitis particularly bacterial vaginitis. By means of major electronic databases, all relevant studies on vaginitis and herbal remedies including research articles, review articles and conference papers published from 1962 to 2016 were used. The terms used in the search were "Herbal remedies", "vaginitis", "bacterial vaginitis", "herbal treatment of vagini tis", "types or varieties of vaginitis", "trichomoniasis", "yeast infections", and "candidiasis". This review exposes that vaginiti s is a global problem that affects women mainly in reproductive ages. Bacterial vaginitis occurs more frequently than the other forms of va ginitis, though two types can occur concurrently. Recurrence has been documented for all types of vaginitis. Several studies have been carried out to validate the traditional claim of herbal uses, which most of them have been shown to be effective against the three fo rms of infectious vaginitis. They have shown efficiency similar to metronidazole on both symptoms and recurrence, with a healthier side effect profile. Tea tree oil, Zataria multiflora, garlic, as well as Persian shallots have proven efficacy in vitro studies against wide the range of organisms implicated in these diseases. Non-infectious vaginitis can also be treated with phytoestrogens from plants such as Ribes nigrum. The use of herbal remedies in infectious vaginitis has been shown be effective. Therefore, the toxicity profile and t herapeutic doses of these plants should be determined to gain better effectiveness.
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CODEN [USA]: IAJPBB ISSN: 2349-7750
INDO AMERICAN JOURNAL OF
PHARMACEUTICAL SCIENCES
http://doi.org/10.5281/zenodo.1039875
Available online at: http://www.iajps.com Review Article
HERBAL REMEDIES USED IN TREATMENT OF BACTERIAL
VAGINITIS: A MINI-REVIEW
Nasrin Baery1, Gholamreza Amin 2, Mohsen Amin 3, Roshanak Mokaberinejad 4, Saeedeh Momtaz
5, Azizeh Ghasemi Nejad 6, Majid Anushiravani1, Zahra Gharazi 7, Samira Adhami 8*
1 Department of Traditional Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
2 Department of Traditional Pharmacy, Faculty of Traditional medicine, Tehran University of Medical
Sciences, Tehran, Iran
3 Department of Drug and Food Control, Pharmaceutical Quality Assurance Research Center, Faculty of
Pharmacy, Tehran University of Medical Science, Tehran, Iran
4 MD-PhD, Assistant Professor. Department of Traditional Medicine, School of Medical Science, Shahid
Beheshti University of Medical Sciences, Tehran, Iran
5 Medicinal Plants Research Center, Institute of Medicinal Plants, ACECR, Karaj, Iran.
6Department of Obstetrics and Gynecology, Faculty of medicine, Tehran University of Medical Sciences,
Tehran, Iran
7Traditional Medicine Researcher
8 M.SC Midwifery, Department of Traditional Medicine, School of Medical Science, Shahid Beheshti
University of Medical Sciences, Tehran, Iran
Abstract:
Herbal remedies are globally accepted for treatment of several diseases including infections. Certain herbs possess traditional evidence
to be used in vaginitis, especially bacterial vaginitis. This paper was designed to gather various data on the possible effec tiveness of
herbal remedies on different types of vaginitis particularly bacterial vaginitis. By means of major electronic databases, all relevant
studies on vaginitis and herbal remedies including research articles, review articles and conference papers published from 1962 to 2016
were used. The terms used in the search were “Herbal remedies”, “vaginitis”, “bacterial vaginitis”, “herbal treatment of vagini tis”,
“types or varieties of vaginitis”, “trichomoniasis”, “yeast infections”, and “candidiasis”. This review exposes that vaginiti s is a global
problem that affects women mainly in reproductive ages. Bacterial vaginitis occurs more frequently than the other forms of va ginitis,
though two types can occur concurrently. Recurrence has been documented for all types of vaginitis. Several studies have been carried
out to validate the traditional claim of herbal uses, which most of them have been shown to be effective against the three forms of
infectious vaginitis. They have shown efficiency similar to metronidazole on both symptoms and recurrence, with a healthier side effect
profile. Tea tree oil, Zataria multiflora, garlic, as well as Persian shallots have proven efficacy in vitro studies against wide the range of
organisms implicated in these diseases. Non-infectious vaginitis can also be treated with phytoestrogens from plants such as Ribes
nigrum. The use of herbal remedies in infectious vaginitis has been shown be effective. Therefore, the toxicity profile and therapeutic
doses of these plants should be determined to gain better effectiveness.
Keywords: Herbal Remedies, Vaginitis, Bacterial Vaginitis.
Correspondence author:
Samira Adhami,
M.SC Midwifery, Department of Traditional Medicine,
School of Medical Science,
Shahid Beheshti University of Medical Sciences,
Tehran, Iran.
Please cite this article in press as Samira Adhami et al , Herbal Remedies Used In Treatment of Bacterial
Vaginitis: A Mini-Review, Indo Am. J. P. Sci, 2017; 4(11).
QR code
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INTRODUCTION:
Herbal medicines (HM) have been and are still in use
by developing countries for treatment of several
ailments such as cough, cancer, bacterial and fungal
infections including vaginitis [1]. Folkloric uses of
herbs in the treatment of disease have been practiced
since ancient times. Different countries have their
specific treatment protocols mainly based on their
religious or traditional beliefs and cultures.
According to World Health Organization (WHO)
over 70% of the world population depend on HM for
their primary treatments, since they are readily
accessible and available in most cases. Literatures
have shown that the use of HM has been in practice
as long as 60,000 years ago in Iraq [2]. China also
has ancient and current history of traditional
medicines [3]. The United States Food and Drug
Administration (FDA) has approved about 1200 new
drugs from 1950 to date [4]. This has given HM large
popularity due to the lack of modern therapyused in
the treatment of certain ailments. Currently, modern
technologies are utilized by pharmaceutical
companies to evaluate the efficacy of certain herbals
as potential source of new drug candidates [5, 6].
Some plant species have been reported as potent
agents against infections especially culinary herbs as
well as several spices such as garlic, ginger,
cinnamon, and thyme [7]. Some of these showed a
broad activity against several organisms (bacteria,
parasites, and viruses), and are usually associated
with little side effects but not microbial resistance.
Extracts and essential oils of some species such as
dill, coriander, cilantro, and eucalyptus, have also
been reported to exhibit antimicrobial properties [8].
Vaginitis is an inflammation of the vagina that may
be triggered by bacteria, fungi, or parasites
characterized by irritation, itching, vaginal discharge
with odor, and a burning sensation [9]. Most common
types include; bacterial vaginitis, trichomoniasis, and
Vulvovaginal candidiasis. Bacterial vaginitis is
caused by bacteria such as Gardnerella vaginalis,
Mycoplasma hominis and anaerobic bacteria, while
V. candidiasis and Trichomonas vaginalis are caused
by fungi and parasites respectively [10]. The in vitro
potential of some plant species like tea tree oil and
garlic has been reported in the treatment of vaginitis
especially bacterial and fungal forms [11]. The aim of
this article was to profile the evidences and possible
effectiveness of a variety of herbal remedies on
different types of vaginitis especially bacterial
vaginitis.
MATERIALS AND METHODS:
Major electronic databases such as Google scholar,
Scopus, PubMed, and EMBASE were used to collect
various publications on vaginitis and herbal remedies.
Research and review articles, as well as conference
papers published from 1962 to 2016 were studied.
The terms used in the search were “Herbal
medicines”, “vaginitis”, “bacterial vaginitis”, V.
candidiasis”, “herbal treatment of vaginitis”, “herbal
treatment of bacterial vaginitis”, “types or varieties of
vaginitis”, “trichomoniasis”, “yeast infections”, and
“candidiasis”. Data were selected based on the
studies conducted in vitro and in vivo.
Review Process: Bibliographic search for the current
review was conducted on PubMed, Scopus and
Google scholar for articles on spontaneous DM in
small and wild animals. The term included “DM in
canine”, “DM in feline”, “Amyloidosis”,
“Pancreatitis”, “Classification of DM in small
animals”, “spontaneous diabetes in domestic
animals”, Spontaneous amyloidosis in wild
animals”, “Glucose intolerance”, “Hyperinsulinemia
in animals” and “Insulin resistance in laboratory
animals”.
Vaginitis:
The vagina is usually acidic and contains normal
flora of organisms such as bacteria, which are served
as a protective cover against overgrowth of normal
flora or invasion from external organisms. Certain
conditions such as menstrual cycle, pregnancy, use of
cosmetic/hygienic agents (shampoos or shaving
creams) can interfere with the acidic environment or
normal flora and can cause severe inflammation of
vagina and also discharge [12]. Vaginitis is an
inflammation of the vagina that can be caused by
bacterial, fungal, viral infections, or chemical and
physical irritation [9]. Women may have recurrent
episodes of vaginitis from use of certain
contraceptive methods especially tubal ligation,
multiple sex partners, as well as improper hygiene
[13]. There are three major types of vaginitis;
bacterial (most common), candidial, and trichomonal
[10].
Bacterial Vaginitis:
Bacterial vaginitis (BV) is an inflammation of the
vagina caused by several bacterial species including
G. vaginalis and Mobiluncus curtisii [10]. It is known
to affect high number of women, and is usually
associated with other complications such as, pelvic
inflammatory disease, preterm labor, low birth
weight among others [14, 15]. Women with BV may
remain asymptomatic except for the vaginal
discharge accompanied by foul odor [16]. BV may
result from imbalance in the normal vaginal flora,
due to the loss of lactobacilli from sexual intercourse
with condoms, use of certain antibiotics, or excessive
growth of anaerobic bacteria [17]. BV may reoccur in
about 60% of women from one to six months [18].
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Symptoms and Diagnosis:
Most cases of BV are asymptomatic which majorly
affect women of reproductive ages, however itching,
burning sensation, and vaginal discharge may occur
[9]. Due to the presence of bacterial species indicated
in BV in patients not diagnosed with the disease,
cultivation of bacteria from vaginal fluid has not been
considered an effective way of diagnosis [19].
According to the Nugent score, BV can be diagnosed
from Gram staining of vaginal fluid or discharge to
differentiate between normal flora and gram negative
morphotypes [20]. Another widely used method in
BV diagnosis is that by Amsel et al, where a criteria
must be fulfilled to ascertain the occurrence of the
disease [21]. A slight modification has been made in
addition to these criteria by Amsel; where three
grades were defined as normal (I), intermediate (II),
and consistent with BV (III) [22]. The analysis was
carried out qualitatively on Gram stained smears
from vaginal fluid. New grades added 0 and IV are
epithelial cells with no bacteria and Gram positive
cocci only which fell into normal category. Another
method made BV diagnosis from urine sample
possible by the use of fluorescence in situ
hybridization (FISH) based on the analysis of
desquamated vaginal epithelial cells found in urine
sediment [23]. BV can also be diagnosed using
molecular methods such as real time polymerase
chain reaction (RT-PCR) method to detect and
quantify target organisms such as lactobacilli and
other species [19].
Complications of BV:
BV has been associated with several complications or
is known to increase the risk of acquiring certain
disease including sexually transmitted diseases
(STDs) such as gonorrhea, chlamydial infection,
trichomoniasis and human immunodeficiency
virus (HIV), as well as reproductive complications
[25, 27](Table 1). Different studies have indicated the
association between BV and pregnancy
complications such as preterm labor and delivery,
even miscarriage especially in young women [15,
26]. It has also been related to the reproductive
problems such as infertility and pelvic inflammatory
diseases, post-operative infection, cervicitis, cervical
intraepithelial neoplasia as well as increased risk of
STDs [24, 27]. A causative agent of BV
(Mageeibacillus indolicus) found in the endocervix
was reported to increase the clinical manifestation of
cervicitis [28]. Rather, BV has been strongly allied
with female infertility, and may be a reason of
unexplained infertility usually underestimated [29].
Table 1: Risks and Complications associated with BV
Risk/Complications
References
Sexually transmitted diseases
(Chlamydia, Gonorrhea, HIV)
(25,27)
Miscarriage, preterm labor and delivery
(26,27)
Pelvic inflammatory diseases
(24,27)
Cervicitis
(27,28)
Infertility
(24,29)
Prevention:
Presumptive treatments (metronidazole and
miconazole) have been reported to reduce the
incidence of vaginal infections including BV and
complications of STDs associated with BV [30].
Frequent consumption of probiotics has also been
shown to reduce the occurrence and reoccurrence of
BV by normalizing the vaginal flora and pH [31].
These products can be taken orally (metronidazole)
or administered directly to the vagina (Lactobacilli
impregnated vaginal tampons) [32]. Prevention and
reduction in the occurrence of BV will consequently
reduce the development of its related complications
and risks.
Yeast Infections (Candidiasis):
Candida (C) species (C. albicans) are the major cause
of yeast infection and are present in the normal
vaginal flora though in small numbers. Conditions
that can alter their quantities might result in infection
[33]. The risk of developing vaginitis due to the C
can be increased by the presence of few or
combination of the following; disease (diabetes),
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condition (pregnancy), agents (antibiotics and
intrauterine device), weak body immunity, and use of
clothing (underwear) that do not allow free flow of
air [34,35]. Symptoms may include vulva swelling
and redness, itching and burning sensation; which
may also be accompanied with thick, whitish vaginal
discharge. Apart from the vagina, C can also be
found in human mouth and digestive tract [36]. Yeast
infection has been a burden on especially developing
countries which mostly affect women within the
reproductive ages [35]. Similar to BV, candidiasis
can also reoccur in both males and females as a result
of masturbation with saliva and in lower ages at first
intercourse [37, 38]. Yeast infections can also result
from non-candida species such as C. glabrata, C.
krusei, C. tropicalis and others, which are mainly
associated with therapeutic failure or resistance [38].
Symptoms and Diagnosis:
Common symptoms associated with yeast infection
such as painful urination, vulva swelling, itching, and
vaginal discharge may also aid in diagnosis [39].
Confirmatory tests for diagnosis are usually
conducted in patients with symptoms. This include a
wet mount, which is consist of 10% potassium
hydroxide (KOH) and saline used to detect the
presence of yeast and mycelia; and vaginal cultures
to detect different causative organisms [35].
CHROMagar is another method capable of
differentiating C and non-candida species [40]. Other
advanced molecular methods that are considered to
be more sensitive and specific are also available for
diagnosis such as polymerase chain reaction (PCR)
and random amplification polymorphism DNA
(RAPD)[41]. Candidiasis may also increase the risk
of preterm birth [42]. Recurrent vaginal candidiasis
can be prevented by the use of probiotics, and also
clothing (cotton)[43].
Trichomoniasis:
This form of vaginitis is caused by a protozoon
Trichomonas vaginalis, and the common mode of
transmitting the disease is via sexual intercourse.
Similar to BV, it is associated with infertility,
pregnancy complications, post-operative infections,
and increased risk of other STDs [44]. Symptoms are
usually vaginal irritation and redness, yellowish
vaginal discharge, as well as elevated pH [45].
Certain factors may increase the risk of developing
Trichomoniasis such as multiple sex partners, current
or previous STDs, as well as unprotected sex with
infected partners [46]. This disease has become a
public health concern especially in the US where it is
said to affect over 5 million women, mostly sexually
active [47]. It can also occur in men mostly without
symptoms. Infected men may experience painful
urination and urethral discharge [48]. The main
method for diagnosis of Trichomoniasis is the wet
mount method performed on vaginal discharge [45].
Trichomoniasis can occur concurrently with BV or
candidiasis [49].
Symptoms and Diagnosis:
Trichomoniasis may occur with or without symptoms
in humans which may vary from vaginal discharge,
itching, irritation, swelling, redness, as well as
painful urination [45, 50]. Specimens used in
diagnosis are obtained from vaginal discharge,
urethral secretions or urine samples. Wet mount
microscopy is the frequent method used in
diagnosing Trichomoniasis; however it cannot be
used in infected men due to the poor sensitivity [51].
Culture techniques can last for 3 5 days, however
limitation may be bacterial contamination [52].
Nucleic acid testing or PCR has been used in
diagnosis, but is associated with less sensitivity and
false positive results [53]. Antibody based technique
has been unable to differentiate between current and
previous infection [54]. Others are susceptibility
testing, which determine resistant strains of T.
vaginalis, and pH evaluation to differentiate
Trichomoniasis from candidiasis [54].
Non Infectious Vaginitis:
This is a type of vaginal inflammation caused by
agents other than bacteria, fungus, or protozoa. This
can happen by utilization of substances that can
irritate the cervix such as spermicides, perfumes,
soaps, certain antifungal drugs and creams, as well as
condoms [55]. However, symptoms are similar to
other types of vaginitis, which may include itching,
irritation, burning sensation, pain during intercourse,
and vaginal discharge. Atrophic vaginitis is caused
by very low hormonal (estrogen) levels that may
appear due to the exclusion of ovaries, radiation and
menopause [56]. Diagnosis of this type of vaginitis
can be based on the signs and symptoms. Vaginal pH
dictator is used to determine any alteration in the
vaginal pH; additionally, a pelvic exam can be
carried out to detect the levels of vaginal dryness,
redness, and tissue thinning [57].
Herbal Remedies:
Herbs have been used to treat several ailments in
different category of people ranging from infants,
children, men, and women. These remedies like
conventional drugs are also controlled and assessed
for safety, quality, and efficacy [58]. Diseases such as
diabetes, neurological disorders, fertility, gastro-
intestinal system disorders, and several others have
documented history of successful therapy with herbal
preparations [59-61]. About 53,000 species of herbal
medicines are available, but due to their exaggerated
use, some are facing the threat of extinction [62].
Some medical practitioners recommend herbal
medicines or complementary and alternative
medicines for the effective treatment of certain
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diseases [63]. As stated in the introduction, several
herbal remedies are available for treatment of
infections ranging from bacterial, fungal, parasitic,
and viral. The efficacy of some plant extracts and
essential oils has been evaluated [8]. Sexually
transmitted diseases are of public concern due to it
contagious nature and high cost of treatment.
Researches are going on these herbs to establish
scientific evidence and determine the active principle
responsible for the antimicrobial effects [64]. The use
of Smilax officinalis herb in the treatment of STDs in
Europe, has dated back to six centuries ago [65],
where it was used in the treatment of syphilis. Best
remedies available for long term prevention of
infections include cranberry, mannose, and
probiotics, while berberine and uva ursi can be
effective at first sign of infective or prophylaxis [66].
Herbal Remedies in Vaginitis:
The aim of treatment of vaginitis is to restore the
vaginal pH below 4.5, as well preserve normal flora
such as lactobacillus species. Several plant species
have been reported to prevent the risk of transmission
and to treat vaginal infections. As mentioned, G.
vaginalis, M. hominis, C. albicans, Trichomonads, as
well as Herpes simplex virus, C trichomatis, and.
Neisseria gonorrhea are microbial agents responsible
for infectious vaginitis [10, 65]. Non-infectious
vaginitis has also been shown to be treated with
phytoestrogens obtained from plants such as Ribes
nigrum, Foeniculum vulgare, Panax ginseng, and
others [65]. In a study conducted on indigenous
plants from Tanzania, some species possessed
antibacterial and antifungal activity against C.
albicans and Staphylococcus aureus [67]. All forms
of infectious vaginitis are considered STDs and
different herbs have been screened against the
causative organisms. The efficacy of the
combination of radix of Saphorae flavescentis, cortex
of fellodendri, and fructus of Cnidii on microbial and
fungal isolates has been shown in vitro [68].
Herbal remedies for BV:
Culinary herbs and spices also have documented
history of use in the prevention and treatment of
infections including STDs [10]. The promising
activity of lemon grass, tea tree, lavender, and
palmarosa oils against both bacteria and fungi
isolated from infected vagina has been reported [69].
Most available herbal remedies are effective against
the three common types of vaginitis. The use of some
herbs such as lemon has been discouraged due to the
potential toxicity to vagina based on the
concentrations used. Some herbs with established
activity against vaginitis have been reported (Table
2).
Tea Tree Oil (TTO):
TTO is known as an essential oil isolated from
the leaves of the tea tree, Melaleuca alternifolia
(Maiden & Betche) Cheel (Myrtaceae). Several
studies conducted on TTO have proven its
effectiveness on different organisms implicated in
vaginitis especially lactobacilli species, C, and T.
vaginalis (Table 2). TTO has been shown to be very
effective as an antibacterial, antifungal, especially
against T. vaginalis [70]. The in vitro activity of TTO
has been reported against both C and non-candida
isolates [71]. Evaluation of the products containing
tea tree oil revealed minimum inhibitory
concentrations and fungicidal concentrations
compared to non-tea tree products, which indicated
its anti-candida activity. TTO vaginal pessary was
reported to cure anaerobic vaginosis in a patient who
treated herself for five days with pessary containing
200 mg TTO in a vegetable oil base. Microscopic
tests for susceptible pathogens were negative, which
indicates the effectiveness of the treatment [72]. The
activity of TTO against lactobacilli and a range of
organisms implicated in BV were also evaluated.
Both anaerobic and anaerobic bacteria associated
with BV were susceptible to TTO, while lactobacilli
tested were resistant [73]. Different components of
TTO such as terpinen-4-ol, α-terpineol, linalool, α-
pinene, and β-pinene have shown promising
antifungal activities [74].
Table 2: Herbs and their active components effective on vaginitis
Herbs and parts Used
Type of Extract
Type of vaginitis
Ref
Tea tree oil (Melaleuca
alternifolia)
Oil
BV, Candidiasis, and
Trichomoniasis
[70,71,74]
Garlic (Allium sativum)
Aqueous
BV and Candidiasis
[77,78]
Persian shallot (Allium
hirtifolium)
Alcoholic
BV, candidiasis, and
Trichomoniasis
[82-85]
Zataria multiflora
Oil and cream
BV, Candidiasis, and
Trichomoniasis
[80,81]
Goldenseal (Hydrastis
canadensis)
-
BV, candidiasis,
Trichomoniasis
[88]
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Garlic (Allium sativum L. fam. Alliaceae):
Garlic preparations have been used in treating several
diseases including infections [10]. It’s antibacterial,
antifungal, and antiviral activities have been reported
extensively [64]. It has been stated to be either
chewed or inserted in the vagina against BV [75].
Garlic tablets have been shown to decrease Amsel
criteria with similar efficacy but fewer side effects
compared with metronidazole in treating BV [76].
The in vitro antibacterial and antifungal activity of
Allium sativum has been reported [77]. Aqueous
garlic extract was also effective against 24 strains of
C. albicans isolated from vaginal, cervix, and buccal
swabs [78].
Shirazi thyme (Zataria multiflora (ZM) Boiss.
Lamiaceae):
ZM has been shown to be effective as a vaginal
cream in BV similar to metronidazole [79]. Both ZM
and metronidazole reduced patient’s complication
and Amsel criteria following five nights of treatment.
ZM cream was found to be active against BV and
clinical symptoms associated with trichomoniasis
[80]. The in vitro activity of ZM oil against T.
vaginalis has been reported [81]. The ZM cream
exhibited a better efficacy comparing to clotrimazole
cream [82]. The cream reduced all symptoms except
vaginal irritation and burning, and its effect on
gynecological signs was superior compared to
clotrimazole [82].
Persian Shallot (Allium hirtifolium Boiss.
Alliaceae):
This plant has been used as a spice in Iran for a long
time. Its activity against gram negative and positive
bacilli, protozoa and yeast has been reported [83].
The hydroalcoholic and dichloromethanic extracts
have been shown to decrease oxygen uptake and
growth of the organisms (T. vaginalis), inhibit lipids,
proteins and nucleic acid synthesis, and induce
damage to membranes in vitro. This effect was
comparable to metronidazole [84]. The alcoholic and
aqueous extracts were also tested for anti-candidal
activity, where displayed activity against 33 species
of candida isolated from a patient with chronic
candidiasis [85]. Nevertheless, the effect of Persian
shallot on bacterial vaginitis have not reported, it has
been reported to exhibit activity against bacteria such
as, S aureus, methicilin resistance S. aureus (MRSA),
methicilin sensitive S. aureus (MSSA), Escherichia
coli, Proteus mirabilis, Klebsiella pneumonia, and
many others [86].
Goldenseal (Hydrastis Canadensis L.
Ranunculaceae):
The isolated constituents (berberine and hydrastine)
of this plant has demonstrated promising
antimicrobial activity against wide range of bacteria
such as Streptococcus mutans and Fusobacterium
nucleatum [87]. Berberine sulphate has been shown
to inhibit and induce morphological changes in
parasites such T. vaginalis and the other species [88].
Herbal suppositories containing myrrh, Echinacea,
slippery elm, golden seal root, and yarrow have been
shown to be effective against BV. Products obtained
from dried root of this plant have been traditionally
used in treating infections such gonorrhea, eye
infections, infectious diarrhea, and vaginitis [89].
Natural remedies rather than herbs: Probiotics:
Probiotics are not considered as herbal remedies, but
they are a natural way of treating or preventing
vaginitis. In a clinical trial, Falagas et al., has
reported the ability of some strains of lactobacilli to
prevent the adherence of Gardnerella vaginalis to the
vaginal epithelium, and also hydrogen peroxide,
lactic acid, and bacteriocins which inhibit the growth
of bacteria that causes BV. They also described that
the intra-vaginal administration of probiotics
(Lactobacillus acidiphillus, L. rhamnosus, and L.
fermentum) can cure and prevent reappearance of
BV, by increasing the vaginal lactobacilli and
restoring normal vaginal microbiota [90].
CONCLUSION AND RECOMMENDATION:
Herbal remedies have been mostly considered safe
and effective especially in developing countries. HM
has been used for centuries to treat various chronic
diseases including infections. Vaginitis is the main
cause of multiple hospital visits by women, generally
in reproductive ages. In vitro and in vivo
investigations on some plants have proven their
effectiveness on the different types of vaginitis
similar to some conventional therapies such as
metronidazole on symptoms and recurrence, with a
better side effect profile. Non-infectious vaginitis has
also been treated using phytoestrogens from plants.
Most of these herbs have been formulated into
pessaries or suppositories, which makes them more
accessible. Further studies on the mechanisms of
their action would be imperative for adequate drug
delivery and minimized toxicity. Probiotics are also
natural resources that can treat or prevent
reappearance of vaginitis.
Conflict of Interest: The authors declare that there is
no conflict of interests regarding the publication of
this paper.
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... Common antibiotics including clindamycin, metronidazole and tinidazole are wildly used for treatment of BV. But recurrence often occurs following the primary response to therapy [8]. Complications caused by chemical drugs have encouraged both patients and researchers to examine the efficacy and safety of probiotics [9,10] or herbal medicines against various diseases including BV [11]. ...
Article
Full-text available
Objectives As pelvic inflammatory disease (PID) aetiology is not completely understood, we examined the relationship between select novel bacteria, PID and long-term sequelae. Methods Fastidious bacterial vaginosis (BV)-associated bacteria (Sneathia (Leptotrichia) sanguinegens, Sneathia amnionii, Atopobium vaginae and BV-associated bacteria 1 (BVAB1)), as well as Ureaplasma urealyticum and Ureaplasma parvum were identified in cervical and endometrial specimens using organism-specific PCR assays among 545 women enrolled in the PID Evaluation and Clinical Health study. Risk ratios and 95% CIs were constructed to determine associations between bacteria, histologically confirmed endometritis, recurrent PID and infertility, adjusting for age, race, gonorrhoea and chlamydia. Infertility models were additionally adjusted for baseline infertility. Results Persistent detection of BV-associated bacteria was common (range 58% for A. vaginae to 82% for BVAB1) and elevated the risk for persistent endometritis (RRadj 8.5, 95% CI 1.6 to 44.6) 30 days post-cefoxitin/doxycycline treatment, independent of gonorrhoea and chlamydia. In models adjusted for gonorrhoea and chlamydia, endometrial BV-associated bacteria were associated with recurrent PID (RRadj 4.7, 95% CI 1.7 to 12.8), and women who tested positive in the cervix and/or endometrium were more likely to develop infertility (RRadj 3.4, 95% CI 1.1 to 10.4). Associations between ureaplasmas and PID sequelae were modest. Conclusions To our knowledge, this is the first prospective study to demonstrate that S. sanguinegens, S. amnionii, BVAB1 and A. vaginae are associated with PID, failure of the Centers for Disease Control and Prevention-recommended treatment to eliminate short-term endometritis, recurrent PID and infertility. Optimal antibiotic regimens for PID may require coverage of novel BV-associated microbes.
Book
Covering fundamentals and new developments in phytotherapy, this book combines pharmaceutical sciences and chemistry with clinical issues. • Helps readers better understand phytotherapy and learn the fundamentals of and how to analyze phytotherapeutic agents • Discusses phytotherapy in modern medicine, chemoprevention of disease, and alternatives to western medicines for specific diseases • Chapters summarizes the uses and applications of phytomedicines, by type like Chinese, Greco-Arab, Indian, European, and Ayurvedic • Includes international regulatory perspectives and discusses emerging regulations for various established and emerging markets.
Article
Bacterial vaginosis, trichomoniasis, and vulvovaginal candidiasis are the most common infectious causes of vaginitis. Bacterial vaginosis occurs when the normal lactobacilli of the vagina are replaced by mostly anaerobic bacteria. Diagnosis is commonly made using the Amsel criteria, which include vaginal pH greater than 4.5, positive whiff test, milky discharge, and the presence of clue cells on microscopic examination of vaginal fluid. Oral and topical clindamycin and metronidazole are equally effective at eradicating bacterial vaginosis. Symptoms and signs of trichomoniasis are not specific; diagnosis by microscopy is more reliable. Features of trichomoniasis are trichomonads seen microscopically in saline, more leukocytes than epithelial cells, positive whiff test, and vaginal pH greater than 5.4. Any nitroimidazole drug (e.g., metronidazole) given orally as a single dose or over a longer period resolves 90 percent of trichomoniasis cases. Sex partners should be treated simultaneously. Most patients with vulvovaginal candidiasis are diagnosed by the presence of vulvar inflammation plus vaginal discharge or with microscopic examination of vaginal secretions in 10 percent potassium hydroxide solution. Vaginal pH is usually normal (4.0 to 4.5). Vulvovaginal candidiasis should be treated with one of many topical or oral antifungals, which appear to be equally effective. Rapid point-of-care tests are available to aid in accurate diagnosis of infectious vaginitis. Atrophic vaginitis, a form of vaginitis caused by estrogen deficiency, produces symptoms of vaginal dryness, itching, irritation, discharge, and dyspareunia. Both systemic and topical estrogen treatments are effective. Allergic and irritant contact forms of vaginitis can also occur. (Am Fam Physician. 2011;83(7):807-815. Copyright 2011 American Academy of Family Physicians.)
Article
Background: Bacterial vaginosis (BV) may increase women's susceptibility to sexually transmitted infections (STIs). In a randomized trial of periodic presumptive treatment (PPT) to reduce vaginal infections, we observed a significant reduction in BV. We further assessed the intervention effect on incident Chlamydia trachomatis (CT), Neisseria gonorrhoeae (GC), and Mycoplasma genitalium (MG). Methods: Non-pregnant, HIV-uninfected women from the US and Kenya received intravaginal metronidazole 750mg plus miconazole 200mg or placebo for 5 consecutive nights each month for 12 months. Genital fluid specimens were collected every other month. Poisson regression models were used to assess the intervention effect on STI acquisition. Results: Of 234 women enrolled, 221 had specimens available for analysis. Incidence of any bacterial STI (CT, GC, or MG) was lower in the intervention arm compared to placebo (incidence rate ratio [IRR]=0.54, 95% CI 0.32-0.91). When assessed individually, reductions in STIs were similar but not statistically significant (CT:IRR=0.50, 95% CI 0.20-1.23; GC:IRR=0.56, 95% CI 0.19-1.67; MG:IRR=0.66, 95% CI 0.38-1.15). Conclusions: In addition to reducing BV, this PPT intervention may also reduce women's bacterial STI risk. Because BV is highly prevalent, often persists, and frequently recurs after treatment, interventions that reduce BV over extended periods could play a role in decreasing STI incidence globally.
Article
Shallots are an important part of the diet of many populations and there is long-held belief in their health enhancing properties. The aim of this study was to determine anti-candidal activity of shallot against chronic candidiasis agents. Alcoholic and aqueous extracts of shallot (Allium hirtifolium) were tested for in vitro antifungal activities against 33 candida species isolated from patient with chronic candidiasis who were referred to Mirza-Kochak-Khan and Lolagar Hospitals. Minimal inhibitory concentration (MIC) was determined using broth microdilution method. Allium hirtifoliumshowed antifungal activity against all the candida species tested and anti-candidal activity of the alcoholic extract was very better than aqueous extract. The results indicate that crude juice of shallot has anti-candidal activity and might be promising in treatment of candidiasis.