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Calendula officinalis cream for vaginal candidiasis.

Saffari E, Charandabi SMA, Adibpour M, Mirghafourvand M, Javadzadeh Y. 2016. Comparing the effects of Calendula officinalis and clotrimazole on vaginal Candidiasis: A randomized controlled trial. Women & Health. Available online. DOI: 10.1080/03630242.2016.1263272

Vulvovaginal candidiasis is a yeast infection involving the mucous lining of the genital area, and affects approximately 75% women across their lifetime. Candidiasis is commonly treated with fluconazole capsules and clotrimazole vaginal cream. Side effects and the potential for microbial resistance and infection relapse have been associated with these medications.

Calendula officinalis, commonly known as marigold, has been demonstrated to have anti-fungal properties; however, in-vivo studies in humans for its anti-fungal effects are limited. The current study was conducted to assess the effect of a C. officinalis vaginal cream with clotrimazole vaginal cream in the treatment of vaginal candidiasis. Secondary outcomes included the effect on clinical signs and symptoms on vaginal candidiasis as well as on sexual function.

The study was a triple-blind, randomised, controlled trial conducted in Iran involving 150 married, nonpregnant woman aged 18-45 years diagnosed with clinical and mycological vaginal candidiasis. Exclusion criteria included breastfeeding, history of herbal drug allergy, known chronic disease, concurrent vaginal infection, recurrent vulvovaginal candidiasis, abnormal uterine bleeding and a variety of medication exclusions amongst others. Participants were randomly allocated to receive either a C. offiinalis or clotrimazole (1%) vaginal cream and were to use a 5g application of cream for seven nights before bed. Women were advised to not use vaginal douche, other vaginal creams, herbal and systemic remedies, and to avoid tight pants during the study period. The C. officinalis cream consisted of a dried ethanol extract powder of flowers (extraction yield of 20%) mixed with a cream such that the final concentration of extract in the cream was 1%. Clinical and laboratory assessments were conducted at 10-15 days and 30-35 days after intervention. Female sexual function index (FSFI) was assessed at 30-35 days. Women with a positive laboratory result at the second follow-up were treated using routine medical treatment of clotrimazole vaginal cream.

Baseline characteristics and demographics of women in the Calendula and clotrimazole were comparable. Compared to the clotrimazole group, the proportion of women negative for candidiasis was significantly lower in the Calendula group at the 10-15 days post-intervention follow up, 49% vs 74%. At the second follow-up at 30-35 days however, compared to the clotrimazole group, the Calendula group had a significantly higher negative result of 77% vs 34%. From those with a negative result in the first follow-up, 15% in the Calendula group and 55% in the clotrimazole group had positive candidiasis results at the second follow-up. At baseline, signs and symptoms were comparable between groups, with the most frequent symptoms being vaginal discharge and vulvar pruritus. At the first follow-up, frequency of symptoms had reduced significantly and almost equally in both groups. At the second follow-up, the frequency of some but not all symptoms were significantly lower in the Calendula group than the clotrimazole group. A statistically significant increase in FSFI scores was observed for both groups from baseline, but this did not differ significantly between groups.

The results show that whilst the Calendula cream was less effective in producing negative candidiasis test results at the 10-15 day post intervention follow-up, in the longer term it was more effective at the 30-35 day follow up compared to clotrimazole. Furthermore, the improvement in symptoms was significant at 10-15 days for both groups and did not differ at this time point, despite a difference in observed negative test results. Authors concluded that vaginal Calendula cream appears to be effective in the treatment of vaginal candidiasis and to have a delayed but greater long-term effect compared to clotrimazole.

This study provides some interesting results, but was limited by the relatively short follow-up period and the lack of typing of Candida species. Whilst there may be a potential role of a topical Calendula cream for vaginal candidiasis, the long term effectiveness, it's effect on recurrent infection, and development of resistance all require further attention.
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Title Annotation:Reviews of articles on medicinal herbs
Author:Tester, Jodie
Publication:Australian Journal of Herbal Medicine
Article Type:Report
Date:Jun 1, 2017
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