Recurrent vulvovaginal candidiasis (RVVC) is a relapsing vaginal fungal infection caused by Candida species. In 57% of the cases, relapses occur within six months after fluconazole maintenance therapy, which is the current standard of care. The pathogenesis of RVVC is multifactorial, and recent studies have demonstrated that the vaginal microenvironment and activity of the immune system have a strong influence on the disease.
The high recurrence rate of complaints after fluconazole treatment may be attributed to the fact that fluconazole only interacts with the yeast, hyphae, and invasive Candida stages (Figure 2). In contrast, when an established biofilm is present, the ECM prevents the fluconazole from reaching the Candida cells, and therefore it will not have an effect on biofilms . Moreover, fluconazole does not affect the vaginal mucosal response . Since ancient times, honey has been used for wound treatment and care because of its antimicrobial and wound healing activities. Acquired azole resistance, the epidemiological shift from Candida albicans to NAC species, and the existence of biofilms demand better treatment options. Medical-grade honey (MGH) could be an accessible, effective, and affordable option . To assure the safety and efficacy of honey for clinical application, strict guidelines are followed to establish MGH . MGH is effective in acute and chronic wounds and provides rapid epithelization and wound contraction, has anti-inflammatory activity, stimulates debridement, decreases pain, resolves infections, decreases wound healing time, and is cost-effective . The use of honey for reducing biofilm formation on indwelling plastic devices such as urinary catheters are also considered, but more research is needed .
|(Increased raise in VVC caused by) NAC species||−||+|
|Microenvironment/vaginal mucosal response||−||+|
Detailed mechanisms of how MGH affects the indicated pathways are described in the original manuscript. Extensive pre-clinical and clinical literature is discussed that supports that MGH is a promising treatment for RVVC. In addition, a new randomized-controlled trial (clinicaltrials.gov NCT04626258) is presented that intents to investigate the mycological and clinical cure and the prophylactic efficacy of the MGH-formulation L-Mesitran Soft in relation to the standard of care (fluconazole). L-Mesitran Soft is CE- and FDA approved and contains 40% MGH and different supplements that consistently have demonstrated to enhance the antimicrobial and wound healing activities.