Uncomplicated infections such as candidiasis, bacterial vaginosis (BV), or trichomoniasis are easy to diagnose and treat. However, about 8% of patients will have a more complicated course with failure to respond to treatment or rapid recurrence of symptoms. There are many suggestions in Traditional Persian Medicine like myrtle (Myrtus communis L.) and oak gall (Quercus infectoria G.Olivier) for treatment of vaginitis.
A clinical trial was designed to assess the efficacy of a novel herbal suppository, containing myrtle and oak gall (MOGS) in treatment of vaginitis.
In a parallel randomized clinical trial, 120 women with vaginitis were randomly assigned to MOGS, metronidazole, or placebo. Formulation was simulated from traditional Persian manuscripts and MGOS was prepared after pharmaceutical optimization processing as well as quantification of gallic acid by HPLC. The study was double-blind for MOGS and placebo and single-blind for metronidazole group.
MOGS effectively improved vaginal discharge (p = 0.024 for BV and 0.018 for trichomoniasis) and pH (compared to placebo (p = 0.013) and metronidazole (p = 0.001)). Both MOGS and metronidazole could reverse whiff test. Metronidazole was the best medication for making Nugent score negative (p = 0.005) as well as the best therapy according to laboratory findings to treat BV in comparison with placebo (p = 0.021). While for trichomoniasis, MOGS could improve the disease more successfully (p = 0.001). Both MOGS and metronidazole treated mixed vaginitis (p = 0.002).
MOGS would be a chance for developing new treatment for trichomoniasis.
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Adverse Drug Reaction
Body Mass Index
Complementary and Alternative Medicine
Myrtle and Oak Gall suppository
Traditional Persian Medicine
Mills BB. Vaginitis: beyond the basics. Obstet Gynecol Clin N Am. 2017;44:159–77. https://doi.org/10.1016/j.ogc.2017.02.010.
Paladine HL, Desai UA. Vaginitis: diagnosis and treatment. Am Fam Physician. 2018;97(5):321–9.
Bautista CT, Wurapa E, Sateren WB, Morris S, Hollingsworth B, Sanchez JL. Bacterial vaginosis: a synthesis of the literature on etiology, prevalence, risk factors, and relationship with chlamydia and gonorrhea infections. Mil Med Res. 2016;3. https://doi.org/10.1186/s40779-016-0074-5.
van Schalkwyk J, Yudin MH, Allen V, Bouchard C, Boucher M, Boucoiran I, et al. Vulvovaginitis: screening for and management of trichomoniasis, vulvovaginal candidiasis, and bacterial vaginosis. J Obstet Gynaecol Can. 2015;37:266–74. https://doi.org/10.1016/S1701-2163(15)30316-9.
Eschenbach DA, Hillier S, Critchlow C, Stevens C, DeRouen T, Holmes KK. Diagnosis and clinical manifestations of bacterial vaginosis. Am J Obstet Gynecol. 1988;158:819–28. https://doi.org/10.1016/0002-9378(88)90078-6.
Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recommendation and Reports. 2015;64(3):1–137.
Ifeanyi OE, Chinedum OK, Chijioke UO. Trichomonas vaginalis: complications and treatment. International Journal of Current Research in Medical Sciences. 2018; https://doi.org/10.22192/ijcrms.2018.04.05.012.
Wølner-Hanssen P, Krieger JN, Stevens CE, Kiviat NB, Koutsky L, Critchlow C, et al. Clinical manifestations of vaginal trichomoniasis. JAMA. 1989;261:571–6. https://doi.org/10.1001/jama.1989.03420040109029.
Singh J, Kalia N, Kaur M. Recurrent vulvovaginal infections: etiology, diagnosis, treatment and management. In: Singh P, editor. Infectious diseases and your health. Singapore: Springer; 2018. p. 257–89.
Schwebke JR, Burgess D. Trichomoniasis. Clin Microbiol Rev. 2004;17:794–803. https://doi.org/10.1128/CMR.17.4.794-803.2004.
Edwards T, Burke P, Smalley H, Hobbs G. Trichomonas vaginalis: clinical relevance, pathogenicity and diagnosis. Crit Rev Microbiol. 2016:1–12. https://doi.org/10.3109/1040841X.2014.958050.
Muzny CA, Schwebke JR. The clinical spectrum of Trichomonas vaginalis infection and challenges to management. Sex Transm Infect. 2013;89:423–5. https://doi.org/10.1136/sextrans-2012-050893.
Homayouni A, Bastani P, Ziyadi S, Mohammad-Alizadeh-Charandabi S, Ghalibaf M, Mortazavian AM, et al. Effects of probiotics on the recurrence of bacterial vaginosis: a review. Journal of Lower Genital Tract Diseas. 2014; https://doi.org/10.1097/LGT.0b013e31829156ec.
Bradshaw CS, Morton AN, Hocking J, Garland SM, Morris MB, Moss LM, et al. High recurrence rates of bacterial vaginosis over the course of 12 months after oral metronidazole therapy and factors associated with recurrence. J Infect Dis. 2006;193:1478–86. https://doi.org/10.1086/503780.
Obiero J, Rulisa S, Ogongo P, Wiysonge CS. Nifuratel-Nystatin combination for the treatment of mixed infections of bacterial vaginosis, vulvovaginal candidiasis, and trichomonal vaginitis. The Cochrane Database of Systematic Reviews. 2018. https://doi.org/10.1002/14651858.CD013012.
Mahboubi M. Systematic review: the potency of Zataria multiflora Boiss. in treatment of vaginal infections. Infectio. 2018; https://doi.org/10.22354/in.v22i2.712.
Nyirjesy P, Robinson J, Mathew L, Lev-Sagie A, Reyes I, Culhane JF. Alternative therapies in women with chronic vaginitis. Obstet Gynecol. 2011;117:856–61. https://doi.org/10.1097/AOG.0b013e31820b07d5.
Felix TC, de Brito Röder DVD, dos Santos Pedroso R. Alternative and complementary therapies for vulvovaginal candidiasis. Folia Microbiol (Praha). 2018;64:133–41. https://doi.org/10.1007/s12223-018-0652-x.
Askari SF, Mohagheghzadeh A, Azadi A, Namavar Jahromi B, Tansaz M, Badr P. A brief review on vaginal drug delivery in traditional Persian medicine. Traditional and Integrative Medicine. 2018;3(4):224–30.
Askari SF, Azadi A, Namavar Jahromi B, Tansaz M, MirzapourNasiri A, Mohagheghzadeh A, et al. A comprehensive review about Quercus infectoria G. Olivier Gall Research Journal of Pharmacognosy. 2019;7(1):69–77.
Ghaeni Heravi SM. Qarabadin-e salehi. Badr P, Mohagheghzadeh a, shams Ardekani MR, editors. Chogan pub: Tehran; 2013.
Aghili Shirazi MH. Qarabadin-e kabir. Research Institute for Islamic and Complementary Medicine: Tehran; 2007.
Azam KM. Qarabadin-e azam. Almai: Tehran; 2014.
Avicenna H. The canon of medicine. Sharafkandi a, translator. Tehran: Soroush Press; 1997.
Tonkaboni MM. Tohfat almomenin. Rahimi R, shams Ardekani MR, Farjadmand F, editors. Tehran: Shahid Beheshti University of Medical Sciences; 2007.
Aghili MH. Makhzan aladvia. Shams Ardakani MR, Rahimi R, Farjadmand F, editors. Tehran: Tehran University of Medical Sciences pub; 2009.
Mansouri SM. Kefaye Mansouri. Research Institute for Islamic and Complementary Medicine: Tehran; 2003.
Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts E, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30:239–45. https://doi.org/10.1038/clpt.1981.154.
Ardestani MM, Aliahmadi A, Toliat T, Dalimi A, Momeni Z, Rahimi R. Antimicrobial activity of Quercus infectoria gall and its active constituent, gallic acid, against vaginal pathogens. Traditional and Integrative Medicine. 2019;4(1):12–21.
Bhalerao S, Mohite S, Kulkarni S, Deo V, Shrikhande B. Effect of Lucronil® tablets in the patients with leucorrhea: an open clinical trial. International Journal of Science and Research. 2016;5(10):1338–42.
Zare A, Moshfeghy Z, Zarshenas MM, Namavar Jahromi B, Akbarzadeh M, Sayadi M. Quercus brantii Lindl. Vaginal cream versus placebo on Bacterial Vaginosis: A randomized clinical trial. Quercus brantii Lindl Vaginal cream versus placebo on bacterial vaginosis: a randomized clinical trial Journal of Herbal Medicine. 2019;16:100247. https://doi.org/10.1016/j.hermed.2018.11.003.
Masoudi M, Miraj S, Rafieian-Kopaei M. Comparison of the effects of Myrtus communis L, Berberis vulgaris and metronidazole vaginal gel alone for the treatment of bacterial vaginosis. J Clin Diagn Res. 2016. https://doi.org/10.7860/JCDR/2016/17211.7392.
Viana AFSC, da Silva FV, Fernandes HDB, Oliveira IS, Braga MA, Nunes PIG, et al. Gastroprotective effect of (−)-myrtenol against ethanol-induced acute gastric lesions: possible mechanisms. J Pharm Pharmacol. 2016;68:1085–92. https://doi.org/10.1111/jphp.12583.
Kaur G, Hamid H, Ali A, Alam MS, Athar M. Antiinflammatory evaluation of alcoholic extract of galls of Quercus infectoria. J Ethnopharmacol. 2004;90:285–92. https://doi.org/10.1016/j.jep.2003.10.009.
Darogha SN. Antibacterial activity of Quercus infectoria extracts against bacterial isolated from wound infection. Journal of Kirkuk University Scientific Studies. 2009;4(1):20–30.
Basri D, Ha F, Jantan I. Antibacterial activity of the galls of Quercus infectoria. Malaysian Journal of Science. 2005;24(1):257–62.
Alem G, Mekonnen Y, Tiruneh M, Mulu A. In vitro antibacterial activity of crude preparation of myrtle (Myrtus communis) on common human pathogens. Ethiop Med J. 2008;46(1):63–9.
Mansouri S, Foroumadi A, Ghaneie T, Najar AG. Antibacterial activity of the crude extracts and fractionated constituents of Myrtus communis. Pharm Biol. 2001;39:399–401. https://doi.org/10.1076/phbi.39.5.399.5889.
Schwebke JR, Hillier SL, Sobel JD, McGregor JA, Sweet RL. Validity of the vaginal gram stain for the diagnosis of bacterial vaginosis. Obstet Gynecol. 1996;88:573–6. https://doi.org/10.1016/0029-7844(96)00233-5.
Modak T, Arora P, Agnes C, Ray R, Goswami S, Ghosh P, et al. Diagnosis of bacterial vaginosis in cases of abnormal vaginal discharge: comparison of clinical and microbiological criteria. The Journal of Infection in Developing Countries. 2011;5(5):353–60.
Mahmoudvand H, Badparva E, Baharvand Z, Salehi LH. Anti-trichomonas vaginalis activities and apoptotic effects of some Iranian medicinal plants. Trop Biomed. 2018;35(2):347–53.
Khalilzadeh S, Eftekhar T, Rahimi R, Mehriardestani M, Tabarrai M. An evidence-based review of medicinal plants used for the treatment of vaginitis by Avicenna in “the Canon of Medicine”. Galen Medical Journal. 2019; https://doi.org/10.31661/gmj.v8i0.1270.
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Festschrift in honor of late Professor Dr. Seyed Hadi Samsam-Shariat, Isfahan School of Pharmacy
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Askari, S.F., Jahromi, B.N., Dehghanian, A. et al. Effect of a novel herbal vaginal suppository containing myrtle and oak gall in the treatment of vaginitis: a randomized clinical trial. DARU J Pharm Sci (2020). https://doi.org/10.1007/s40199-020-00365-6
- Oak gall
- Traditional Persian medicine