A4 Honey cream proves attractive for vaginal use: the vaginal smear as a test ³

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1 A4 Honey cream proves attractive for vaginal use: the vaginal smear as a test ³ Mathilde E. Boon Preface For centuries, honey products have been used for all kinds of ailments and problems both of man and animal.1,2 It is possible to use pure honey, but it is not very user friendly in that form. Already in Egyptian times it was mixed with grease and flour the convenience s sake.2 Various publications have already shown that honey strengthens the immune system, slows down infections, works as an antioxidant and kills bacteria and even some types of fungi Every housewife can draw this conclusion herself: She never sees bacteria-or fungus growth in her honey jar, but her home made jelly easily goes mouldy. Sugar also has a preventing effect on bacteria growth, but the research by Cooper et al. 12,13 clearly proves that sugar is five times less anti-bacterial than honey (Manuka and other honey). ³Submitted for publication to: Supplement, onafhankelijk vakblad over natuurlijke voeding en gezondheid. Reprinted with permission. Fig. A4.1. Hypha of candida, invasive growth in the epithelium Fig. A4.2. The functioning of L-Mesitran on colonial growth of bacteria and Candida. Honey concentrations of 10% are sufficient to suppress most of the bacteria. Most kinds of honey contain an enzyme, glucose-oxidase, which is involved in the production of hydrogen peroxide. It is a well known fact that hydrogen peroxide is very anti-bacterial. 1 mmol/l Hydrogen peroxide is found in honey, a concentration high enough to kill bacteria. A cream that contains a bit over 10% of the right kind of honey can deal with most of the micro-organisms. L-Mesitran is a honey cream used for wounds. The effect of L-Mesitran on bacteria and Candida is illustrated in Figure A4.1 (data provided by the producer of L-Mesitran ). The effect of L-Mesitran on the bacteria tested was substantial. Already after the first hour the number began to decrease and after 48 hrs. all the bacteria were dead. A remarkable result was seen for the Candida albicans. Contrary to the expectations the fungi started to grow even in the first hour and the amount of fungus increased by 100% (see Figure A4.1). After a couple of hours, the fungus growth declined, and they even started to deteriorate. Finally, after 48 hours, no Candida could be found. The functioning of L-Mesitran is possibly partly due to the adding of Lanoline.14 Already in ancient times, grease or oil was added to honey in order to increase its effect. The experiments described here are in vitro: In vivo, everything can of course be quite different. Up until now L-Mesitran was only used as a wound cream. On the basis of the information above, it seemed interesting to test the effect of L-

2 Mesitran outside the field of wound care to see if honey cream is interesting for vaginal use. For this purpose, the vaginal smear was used to test the efficiency of L-Mesitran in vivo. L-Mesitran was applied by us, on women with vaginitis complaints. It is a fact that vaginal infections can mean a great deal of misery for the woman concerned and that even marriages can fail because of it.15 The common treatment for vaginitis is either an antibiotics cure or an anti fungus remedy. Table A4.1. Complaints*, primary to the use of honey cream excessive or crumbly secretion 30 Painful sex 14 Burning sensation 15 Itching 3 *One woman can have several complaints Table A4.2. The deviating vaginal flora, primary to the use of honey cream. Candida 11 Trichomonas 1 Bacterial vaginosis 12 Lactobacillosis 4 Honey cream for vaginal use Of thirty women that visited their GP because of suspected vaginitis, the complaints were first sorted out (see Table A4.1.). They all had either excessive or crumbly secretion. In addition, they had complaints such as painful sex, itching or a burning sensation. The women were informed that their complaints could be remedied by using honey cream vaginally. If they were prepared to test the honey cream, they were asked to take note what clinical effects the honey cream precisely produced and to report this to the GP. They were advised to insert a small daub of cream in their vagina every evening and this for at least a week. Of each of these women, their GP took a vaginal smear before the honey-cure was started. The smears were colored, and it was determined microscopically whether or not the vaginal flora was deviant (see Table A4.2). At the same time the inflammatory infiltration in the smears was examined. The most common microscopic diagnoses were Bacterial Vaginosis (BV) and Candida, in 12 and 11 cases respectively. Only two women had a completely normal flora. Inflammatory infiltration was found in eight smears. A check-up smear, administered after the honey cream treatment, was available with 19 of the 30 women. Comparing the original smear with the check-up smear allowed us to chart the effect of the honey cream on the vaginal flora and on the inflammatory infiltration. From one woman suffering from Candida vaginitis, we had several smears from the month before the honey cream treatment. We also had smears that she had taken during the monthly cycle in which the honey cream was used. In this series of smears we could determine very precisely what the effect of honey cream was on the fungal growth. Clinical effect Three women noticed that the cream stung a bit after they inserted it, but that this stinging sensation stopped after a couple of minutes. There was only one woman whose complaints did not diminish, all the others reported that already after a couple of days of use of the honey cream, their complaints diminished. The majority (27) found the effect to be noticeable. Two were helped a little bit. Less painful sex was mentioned in particular. Microscopic effect In all of the smears we could conclude that L-Mesitran had a microscopically perceptible effect (Table A4.3). We saw that the inflammatory infiltration greatly declined or even disappeared. Especially the effect on fungus was impressive: in only one case we found a couple of fungal spores in the check-up smear. The effect on BV was not as pronounced but there was nevertheless some effect in most cases. In the series of smears from the only woman with Candida, we were able to chart very well the course of the fungal growth. First, we examined what we could see in the smear when the fungus was left untouched, i.e. without antimycoticym and without honey. On the seventh day of the cycle we did not see any fungus, but on the fourteenth day the first signs of fungus appeared. On that day, we mainly saw spores. We perceived short fungal threads growing out of some (viable) spores. This is commonly known as the taugé-stage. On day 21 we perceived a large number of long fungal threads. The Candida-hypae had further developed and we also perceived branches (Figure A4.3). Finally, on day 28 the fungi had developed into

3 thick knots (figure A4.4). Then, we looked at what could be found in the smears taken during the honey cream treatment. On day 14, after a long search, we found a solitary spore, but not a single taugé. These spores did not develop on their own and even disappeared completely after a couple of days. Finally we could not find a single spore of the fungal infection during the honey treatment on day 21 and day 28, whereas without honey, thick knots of fungus were found in the woman s smears at the end of her cycle! Table A4.3. Microscopic changes, after using honey cream for 7 days. Inflammatory infiltration disappeared 1* Inflammatory infiltration decreased 7* Candida disappeared 5** Candida decreased 1** Bacterial vaginosis disappeared 2** Bacterial vaginosis decreased 2** Fig A4.3. The taugé stage of Candida. (Two) short hypae sprout from the viable spores. *inflammatory infiltration was seen in eight smears ** see Table A4.2. Fig. A4.4. The Candida-hypae are further developed. We can also see branches. In the case of this woman, we could demonstrate in the vaginal smears, how the honey cream strongly influenced her fungal growth. Honey cream with recidivating candiditis There are a lot of inquiries about the honey cream from these General Practitioners who participated in the pilot study: at the request of the GP we send out a tube of L-Mesitran so that they can gain additional experience using it. We are also contacted by women that we used to counsel during their recidivating Candida-infections in the days when we did not yet have

4 honey cream at our disposal. Thus, we re-established contact with 32-yearold Mrs. X. We got to know her 5 years ago: she then came to us because she had a recidivating Candida-infection and got completely stuck in the medical circuit. Fig. A4.5. This shows the onset of knot formation of the Candida. Thick knots are hard to capture on film, but were nevertheless present in large amounts in this smear, taken on day 28 of the cycle. In the past during different Candida-cycles, we received smears that she had taken on day 7, 14, 21 and 28 of the menstrual cycle, according to our instructions. So we knew the pattern of her candida-infections very well. In 2002 she wrote the following to us: Lately, I ve been sexually active again. Ten days ago, I received an antibiotics-cure (Amoxilline) because of a sinus infection that did not react to milder medication. When I got to the last two capsules, on day 18 of my cycle, I noticed that something was wrong with the fungus again: I felt itching and a burning sensation. I took a smear on day 20, 21 and 22. We colored the smears and saw that she had passed the taugé-stage already on day 20: A lot of fungal threads had already developed. On day 21, the number of fungi was even greater and the fungal threads had increased in length and on day 22 we could see thick packs of branching hypae. The woman wrote to us to say that her complaints were (temporarily?) relieved after a Trisporal-cure. It would have been much better if she had rubbed honey cream on her vagina during the Amoxilline cure. If she had, the fungus would not have gotten as far as it had now. We proceeded to send her a tube of honey cream so that she could take precautionary measures. She was very motivated to try and take matters in her own hands and control the fungal growth with the honey cream, in which she has succeeded very well up until now, thanks to the tube of honey cream in the cupboard. This she wrote to us in Since then, we have sent tubes of honey cream to numerous women with recidivating candidiasis. We were able to conclude that, in some cases, the honey cream alone was not adequate to eliminate the fungal growth completely. But there are a lot of women we have made very happy with honey cream, because it enabled them to put a complete stop to an onset of candidiasis and thereby considerably cut back a on the number of antimycotic treatments. Conclusion L-Mesitran honey cream provides interesting perspectives for women with candidiasis. Pregnant and nursing women are an interesting target group for this feather light treatment. We also see possibilities to control recidivating candidiasis (with women susceptible to it). From our research we can conclude that vaginal cytology is ideal to visualize the effect of honey cream: the smears showed obvious effects after use. Acknowledgements We are grateful to Dr. Theo Postmes, the Godfather of L-Mesitran, for the inspiring conversations we were allowed to have with him. We also thank the women who were willing to test L-Mesitran for vaginal use, which has allowed us to chart the potential of honey cream to stop fungal growth. References 1. Molan PC. Why honey is effective as a medicine 2. The scientific explanation of its effects, Honey and Healing. Munn P, Jones R (eds), International Bee Research Association, April 2001, pp Manjo G. The healing hand. Man and wound in the ancient world. Harvard University Press; Cambridge, Massachusetts, USA, Zumla A, Lulat A. Honey - a remedy rediscovered. Journal of the Royal Society of Medicine 1989; 82:

5 4. Al Somai N, Coley KE, Molan PC, Hancock BM. Susceptibility of Heliobacter pylorito the activity of manuka honey. Journal of the Royal Society of Medicine 1994; 87: Ali ATMM, Chowdhury MNH, Al Humayyd MS. Inhibitory effect of natural honey on Heliobacter pylori, Tropical Gastroenterology. 1991; 12: Molan PC. The antibacterial activity honey.1. The nature of the antibacterial activity. Bee World 1992; 1: Boon ME. Schimmelverhalen. In: Weg van de Groenesteeg; jaarverslag 2001 van het Leids Cytologisch en Pathologisch Laboratorium. Boon ME, Beck S, Coevorden RS van, Melkert P (eds). Leiden: Coulomb Press Leyden, 2002, pp Allen KL, Molan PC. The sensitivity of mastitis-causing bacteria to the antibacterial activity of honey. New Zealand Journal of Agricultural Research 1997, 40: Brady NF, Molan PC, Harfoot CG. The sensitivity of dermatophytes to the antimicrobial activity of manuka honey and other honey. Pharmaceutical Sciences 2: Cooper RA, Molan PC. The use of honey as an anti-septic in managing Pseudomonas infection. Journal of Wound Care 1999; 8: Efem SEE, Udoh KT, Iwara CI. The antimicrobial spectrum of honey and its clinical significance. Infection 1992; 20: Obi CL, Ugoji EO, Edun SA, Lawal SF, Anyiwo CE. The antibacterial effect of honey on diarrhoea causing bacterial agents isolated in Lagos, Nigeria. African Journal of Medical Sciences 1994; 23: Wahdan HAL. Causes of the antibacterial activity in honey. Infection 1998; 36: Cooper RA, Wigley P, Burton NF. Susceptibility of multiresistant strains of Burkholderia cepacia to honey. Letters in Applied Microbiology 2000; 31: Cooper RA, Molan PC, Harding KG. The sensitivity to honey of Grampositive cocci of clinical significance isolated from wounds. Journal of Applied Microbiology 2002; 93: 857.