Treating recurrent vulvovaginal candidiasis with honey

Because the mechanism of action of medical-grade honey (MGH) is based on enhancing wound healing and exerting strong broad-spectrum antimicrobial activity, MGH may also help to treat recurrent vulvovaginal candidiasis (RVVC), according to a review in the Journal of Fungi.

“We are confident that MGH is an attractive alternative treatment to the antifungal agent fluconazole,” said senior author Niels Cremers, PhD, head of research for Triticum Exploitatie BV, a manufacturer of wound care products based on MGH, in Maastricht, the Netherlands. “Fluconazole is often prescribed for 6 months as maintenance therapy for RVVC. However, a long-term cure is hard to achieve and 6 months after therapy, 57% of patients have relapses. These numbers clearly show there is a high unmet need and demand for novel therapies.”1

In contrast to fluconazole, MGH is expected to have multiple beneficial mechanisms. “In addition to the antifungal activity on Candida albicans, MGH has proven to be effective against non-albicans Candida species, playing a more dominant role over the last several years and which by nature are more resistant toward fluconazole,” Cremers told Contemporary OB/GYN®.

MGH might also be potent for treating RVVC by eradicating biofilms, “which is likely another important reason why it is so hard to get rid of persistent and recurrent Candida infections,” Cremers said. “Furthermore, MGH has immunomodulatory, anti-inflammatory, and anti-oxidative activities that positively influence the vaginal microenvironment, which likely will attribute to a long-term cure, MGH could directly limit symptoms as well, such as itching and pain.”

Both in vitro and clinical studies demonstrate honey as a promising alternative therapy for RVVC.

The review authors were surprised by the high number of patients with VVC: 75% of all women develop the fungal infection at least once in their life. “The infection causes soreness, irritations, vaginal discharge, itchiness, and discomfort,” Cremers said.

And recurrence, at least 3 episodes per year, affects roughly 138 million women per year worldwide, with a prevalence of 9% reported among women aged 25 to 34 years.

Cremers noted that honey has been used for wound care for several millennia. “MGH formulations like L-Mesitran (mesitran.com) follow strict criteria to ensure their safety, quality, and efficacy,” he said. “The antimicrobial activity of MGH relies on multiple mechanisms, including its osmotic activity, its low pH, releasing small amounts of hydrogen peroxide, and containing antimicrobial molecules.”

Recently, the antifungal activity of honey against multiple Candida species was investigated, not only those causing VVC, but also against Candida auris, of which some strains are multi- or pan-resistant.

Candida auris is a superbug that can cause nosocomial outbreaks and has even caused mortality rates of up to 60%,” Cremers said. “So, the fact that honey is able to kill these hard-to-kill fungal pathogens is very promising.”

Supplements added to MGH formulations, such as is done for L-Mesitran, strongly enhance the antimicrobial activity of honey, according to Cremers.

A few small pilot studies of honey and vaginitis reported that honey is safe and without serious side effects. Besides 6% noncompliance, 17% of patients experienced soiling of underclothes, and 1.2% had local irritation.

“However, it is not advised to use honey-based products on patients with known allergies to honey, and future research should further investigate potential side effects,” Cremers said.

The review authors are starting a randomized controlled trial at 2 hospitals in the Netherlands, for which they will further investigate the efficacy of MGH, including its clinical, mycological, and prophylactic efficacy.

“If the theory matches the clinical findings, we do not expect any barriers to adopting MGH as therapy for treating VVC or RVVC,” Cremers said.

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Cremers reports no relevant financial disclosures.

Reference

  1. van Riel, SJJM, Lardenoije CMJG, Oudhuis GJ, et al. Treating (recurrent) vulvovaginal candidiasis with medical-grade honey: concepts and practical considerations. J Fungi (Basel). 2021 Aug 16;7(8):664. doi:10.3390/jof7080664