Iran Journal of Nursing

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Dodangeh N, Kheirkhah M, Abolghasemi J, Mojab F, Farshad F. Comparison of the Effects of Glycyrrhiza Glabra Vaginal Cream and Clotrimazole on the Symptoms of Fungal Vulvovaginitis. IJN 2019; 32 (117) :23-32
URL: http://ijn.iums.ac.ir/article-1-2881-en.html

Background & Aims: Vaginitis is a common cause of women's referrals to gynecology and obstetrics clinics as 75% of women have experienced the infection at least once, while approximately 45% have been affected twice or more. Candida albicans is responsible for 85-90% of fungal vaginal infections. Some of the predisposing factors in this regard are recent antibiotic use, pregnancy, diabetes, and use of contraceptives. The increased use of antibiotics has led to the higher prevalence of candida, and candida fungal vaginal infections are more prevalent and harder to eradicate during pregnancy. The growing interest of physicians and researchers in discovering new drugs has led to the increasing use of herbal products for the treatment of fungal infections with fewer side-effects in a more cost-effective manner compared to chemical drugs. Licorice belongs to the Fabaceae family and grows in southeastern Europe and southwestern Asia, including in Iran. The plant has anti-inflammatory and detoxifying properties and is used in the treatment of asthma, bronchitis, cough, peptic ulcer, and arthritis. The antiviral effects of herpes simplex type I have been confirmed in-vitro, as well as its synergistic effect with fluconazole on the treatment of fungal infections. Nevertheless, few clinical studies have been conducted in this regard, and further investigations have been recommended. The present study aimed to determine the effects of licorice on the treatment of fungal vaginal infections to suggest a drug with minimal side-effects and costs in the treatment of this common infection among women.
Materials & Methods: This double-blind, three-blind, two-group randomized clinical trial was conducted on all the married women with fungal vulvovaginitis referring to Kamali Clinic affiliated to Alborz University of Medical Sciences, Iran. Eligible subjects were enrolled in the study in the case of positive fungal vaginal smear and stratified to two groups of intervention and control in a computerized manner. The inclusion criteria were women of the reproductive age (15-49 years), married women, no pregnancy, lactation or menopause, presenting with two symptoms of candida vaginitis (itching, burning and irritation, cheese-like discharge, burning urine, painful intercourse), absence of known chronic diseases (e.g., immunodeficiency, hypertension, diabetes), no therapies or use of herbal and chemical drugs for the treatment of genital infections within the past two weeks, absence of other vaginal infections (e.g., trichomoniasis, bacterial and mixed vaginitis), no use of creams and vaginal suppository 48 hours prior to the study, no participation in another research at the same time, no history of licorice allergies, no use of antibiotics and corticosteroids for the past two weeks for other medical reasons, and positive Sabouraud agar fungal test. The exclusion criteria were pregnancy during the treatment, allergies to licorice during the treatment, compulsive use of antibiotics for the treatment of systemic non-vaginitis infections during the treatment, and non-observance of the correct treatment method (forgetting to use the drug for more than one night). The sample size was determined by the McNemar test at 0.95 confidence level and 0.8 test power considering 10% attrition, and 30 subjects were assigned to each group. Based on the sample size, the random allocation table with four blocks was prepared. After explaining the research objectives and obtaining informed consent from the subjects, they were stratified to the intervention and control groups using the table. Data were collected using an information registration form for the age, education level, occupation status, education level of the spouse, occupation status of the spouse, family income per month, housing status, history of menstruation and pregnancy, number of pregnancies, deliveries, menstrual patterns, methods of contraception, and disease and drug use history, history of drug allergies, and history of antibiotic use within the past two weeks. The patient's complaints were recorded in the symptom and clinical observation forms during the three visits. The evaluation checklist consisted of two sections for the recording of clinical observations and laboratory results. Clinical observations included vulvovaginal redness, cheese-like discharge, pustular papular lesions, vulvovaginal redness, and abnormal cervix, which were examined in the lithotomy position. With a sterile cotton swab that had been placed in an autoclave at the temperature of 120°C for 15 minutes before the examination, a sample was prepared from the secretions of the upper and lateral walls of the vagina, drawn on a slide, and sent to the laboratory. The laboratory results were recorded in a form based on the laboratory results. Licorice vaginal cream was prepared and packaged in the botanical laboratory of Shahid Beheshti University of Tehran (health code: 101301012003), and 1% clotrimazole vaginal cream made by Pars Pharmaceutical Company was used as the basic treatment. In total, 60 completely identical vaginal creams with similar color, size, and shape coded A and B were provided to the researcher to be applied to the subjects based on the allocation table by an applicator inside the vagina for seven nights. The subjects were asked to refer to the center one week after the intervention with a coded card and a form for the recording of the signs and symptoms of the disease, which was completed daily by the samples. In addition, the patients were reminded of the time of the visits via phone, and the effects of the drugs on the signs and symptoms of the disease were examined to be recorded in the observation checklist. For the final confirmation of the presence or absence of the fungi, the sample smears were sent to the laboratory again. After data collection, data analysis was performed in SPSS version 16 using descriptive statistics (frequency, mean, and standard deviation) and inferential deviation (McNemar test and GEE).
Results: After the treatment, improvements were observed in the vaginal discharge, pruritus, irritation and burning, burning urine, painful intercourse, vulvovaginal redness, and cheese-like discharge. Furthermore, the McNemar test indicated a significant difference before and after the treatment in each group, while the GEE test showed no significant difference between the groups. Also, no significant differences were observed between the results of the laboratory examinations.
Conclusion: According to the results, licorice had therapeutic effects on the symptoms of fungal vaginal infection. Therefore, the use of licorice is suggested as an herbal medicine in the treatment of fungal vulvovaginitis.