Propolis – a nature alternative by vaginal disturbances?

Martin Imhof MD, PhDMartin Imhof MD, PhD

University Hospital for Gynecology ViennaUniversity Hospital for Gynecology Vienna

Dep. of Endocrinology and Treatment of Dep. of Endocrinology and Treatment of Fertility Fertility

Vaginal Infektion

InzidenceInzidence

70-75% of all women 1 x in live70-75% of all women 1 x in live

40-50% suffer from reoccuring Infection 40-50% suffer from reoccuring Infection (=> 4 Infections / year)(=> 4 Infections / year)

Vaginal Complaints

germ germ = Primary cause for = Primary cause for complainscomplains

cause cause = Failure of defense system = Failure of defense system

Therapy - Intention

… … to reestablish a physiologicalto reestablish a physiological

situation of the vagina situation of the vagina

Problem of AB Therapy

Selection of a pathological germ-groupSelection of a pathological germ-group

Good case

Physiological equilibrium

is reached again

Worst case

another pathogenic

germ renews the

Infection => Relapse

1-6 weeks after Therapy

Antibiotika und Antimykotika

Disadvantage Disadvantage

Adverse effects (for ins.: digestion)Adverse effects (for ins.: digestion)

Resistance of treated germsResistance of treated germs

barely prophylactic applicable!barely prophylactic applicable!

How does the optimal therapy look?

Reduces the sensible quantity of germs AND Reduces the sensible quantity of germs AND represses the subjective disturbancesrepresses the subjective disturbances

General antimicrobial (Bacteria, Fungal, Virus)General antimicrobial (Bacteria, Fungal, Virus)

Vaginal equilibrium is established and keep Vaginal equilibrium is established and keep alive itselfalive itself

ShouldnShouldn’’t cause Resistance and should be t cause Resistance and should be applicable as Prophylaxesapplicable as Prophylaxes

P R O P O L I S ?P R O P O L I S ?

Propolis

Makes the Bee-yard „aseptic“ Makes the Bee-yard „aseptic“

““Cement” and “Carpet of epidemic” Cement” and “Carpet of epidemic”

Antibacterial mechanism of action of Propolis

DNA dependant on RNA Polymerase DNA dependant on RNA Polymerase as follows: Bacteria are spited slowlyas follows: Bacteria are spited slowly

Penetrability of cell membrane increased Penetrability of cell membrane increased as follows: Bacteria get more sensitiv. as follows: Bacteria get more sensitiv.

The Hydroxy-cinnamon-acid inhibits The Hydroxy-cinnamon-acid inhibits reversible the Motility of Bacteria reversible the Motility of Bacteria as follows: slow dissermination as follows: slow dissermination

Anti-fungal effect of Propolis

Propolis in the Concentration of 0,25% to 2% is Propolis in the Concentration of 0,25% to 2% is effective against div. Dermal-phyteneffective against div. Dermal-phyten

Flavenoide legates Enzymes und Metal-ions Flavenoide legates Enzymes und Metal-ions which is important for the fungal-metabolism which is important for the fungal-metabolism

Antiviral Effect of Propolis

Is affected by different Virus (Influenza, Is affected by different Virus (Influenza, Herpes, Polio, Hepatitis as well as felines Herpes, Polio, Hepatitis as well as felines HIV)HIV)

viral DNA Production viral DNA Production in vitro is in vitro is inhibited to inhibited to factor 32. factor 32.

Inhibits the viral Adsorption at the cells Inhibits the viral Adsorption at the cells surface areasurface area

Effectively of Propolis against Protozoa

typical Parasite: typical Parasite: Trichomonas vaginalisTrichomonas vaginalis..

Propolis in the Concentration of 150 µg/ml Propolis in the Concentration of 150 µg/ml

shows a significant Inhibition of shows a significant Inhibition of trichomonal Proliferation.trichomonal Proliferation.

Antibacterial effectively of Propolis

010

2030

4050

6070

8090

100

0 200 400 600 800

concentration [µg/ml]

colo

ny fo

rmin

g un

it [%

of c

ontr

ol]

6 h B.s.

18 h B.s.

18 h E.coli

Antibacterial effects of Propolis on colony formation by Bacillus subtilis (Gram +) and Escherichia coli (Gram -) suspensions incubated on agar for 6 and 18 hours

In vitro Survival rate of Trichomonas vaginalis in different Concentration of

Propolis

0

10

20

30

40

50

60

70

80

90

100

0 50 100 150 200 250

t ime [h]

surv

ival

rat

e [%

]

control

150 µg/ml

50 µg/ml

5 µg/ml

0.5 µg/ml

0.05 µg/ml

The local anesthetic Propolis effect

„ „ ....... by subcutaneous application, the ....... by subcutaneous application, the Pinocembrin starts developing and the Café Pinocembrin starts developing and the Café acid-rest has almost the same anesthetic acid-rest has almost the same anesthetic effect than Lidocaineeffect than Lidocaine““

Paintz M, Metzner J.Paintz M, Metzner J.Pharmazie 1979 Dec;34(12):839-41 Pharmazie 1979 Dec;34(12):839-41

Propolis-therapy

Reduction of the total germ-exposureReduction of the total germ-exposure

RELATIVE physiologic gap by Lactobacillus RELATIVE physiologic gap by Lactobacillus acidophilusacidophilus

Reestablishment of physiologic situation Reestablishment of physiologic situation

Propolis-therapy

Rapid abatement of disorders through local-Rapid abatement of disorders through local-anesthetic effect (reinforcement)anesthetic effect (reinforcement)

No resistence due to biologic VariationNo resistence due to biologic Variation

Low side effects Low side effects

Propolis as a Therapy of vaginal disorders

M ImhofM Imhof

Universitätsklinik für Frauenheilkunde Universitätsklinik für Frauenheilkunde Wien Wien

melprotect®

Propolis (5%) camomile Lime-tree blossom pH 4.5

Study Propolis (melprotect®) -Irrigation

56 symptomatic Patients with reoccuring 56 symptomatic Patients with reoccuring Vaginal-Infection (>=4/year)Vaginal-Infection (>=4/year)

Anonymised questionnaires for Evaluation Anonymised questionnaires for Evaluation 2 weeks before and after the closing of 2 weeks before and after the closing of studies. studies.

After 6 months telephonic questionnaires After 6 months telephonic questionnaires

Using of MELPROTECT

1 x daily 30 ml per Applicator for one week1 x daily 30 ml per Applicator for one week

After acute therapy reduce melprotect slowlyAfter acute therapy reduce melprotect slowly

(every 2 day, every 3 day etc.)(every 2 day, every 3 day etc.)

Questionnaire 1. How strong have been/are the vaginal pains before/after the 1. How strong have been/are the vaginal pains before/after the

therapy?therapy? 2. How strong was/is the itching before/after the therapy?2. How strong was/is the itching before/after the therapy? 3. How strong was the cauterization before/after the therapy?3. How strong was the cauterization before/after the therapy? 4. How strong was/is the vaginal defluxion in the last month/after the 4. How strong was/is the vaginal defluxion in the last month/after the

therapy?therapy? 5. How hindering was/is the Vaginal-Infection before/after the therapy 5. How hindering was/is the Vaginal-Infection before/after the therapy

during the sexual intercourse?during the sexual intercourse? 6. How hindering was/is the eventual Vaginal-Infection before/after the 6. How hindering was/is the eventual Vaginal-Infection before/after the

therapy during normal sportive activities?therapy during normal sportive activities? 7. How hindering was/is the Vaginal-Infection in the last month / after 7. How hindering was/is the Vaginal-Infection in the last month / after

the therapy during the daily life activities the therapy during the daily life activities (shopping, going out,...) ?(shopping, going out,...) ?

8. How satisfied have you been/are you with the previous/actual 8. How satisfied have you been/are you with the previous/actual medicinal therapy for the Vaginal-Infection?medicinal therapy for the Vaginal-Infection?

Questionnaire - Analyse

0

1

2

3

4

5

6

7

8

Vorher 1,54 3,77 2,84 4,88 3,68 1,36 1,25 2,91

Nachher 0,13 1,09 0,93 2,09 0,79 0,11 0,38 7,36

Frage1 Frage2 Frage3 Frage4 Frage5 Frage6 Frage7 Frage8

Result 49 (87%) of patients described a reduction of disorders 49 (87%) of patients described a reduction of disorders

after the using of Propolis (melprotect)after the using of Propolis (melprotect)

7 (13%) of patients couldn’t notice a change of disorders 7 (13%) of patients couldn’t notice a change of disorders after the using of Propolis (melprotect)after the using of Propolis (melprotect)

0

5

10

15

20

25

Abstrichauswertung vor Therapie

Soorinfektion

E1

Mischinfektion

Gardnerella

Abstrich o.B.

0

10

20

30

40

50

Abstrichauswertung nach Therapie

Soorinfektion

E1

Mischinfektion

Gardnerella

Abstrich o.B.

Telephonic Questionnaireafter 6 Month

Following Question was asked:Following Question was asked:

1. Did you suffer on a new infection?1. Did you suffer on a new infection?

2. Did you get a therapy for the infected 2. Did you get a therapy for the infected disorders again?disorders again?

3. How do you judge the therapy-success?3. How do you judge the therapy-success?

Telephonic - Questionnaire Results

Patient, where an positive result was seen: Patient, where an positive result was seen:

31 (63%) of patients report no reinfection31 (63%) of patients report no reinfection

16 (33%) of patients report about the recurrence of 16 (33%) of patients report about the recurrence of SymptomsSymptoms

2 (4%) there was no questionnaire possible2 (4%) there was no questionnaire possible

* * ** * *Imhof M, Lipovac M, Kurz Ch, Barta J, Wiesenthal B, Huber J 5% propolis solution for the treatment of chronic vaginitis Int J Gynaecol Obstet. 2005 May;89(2):127-32.

Conclusion Antimicrobial effect against common germs Antimicrobial effect against common germs

No resistance similar to a Antibiotic therapyNo resistance similar to a Antibiotic therapy

Relative support of the physiological Vagina-floraRelative support of the physiological Vagina-flora

Local-anaesthetic effectLocal-anaesthetic effect

Allergic reaction very seldom Allergic reaction very seldom

The use for Gardnarella- und Chlamydien-The use for Gardnarella- und Chlamydien-infection is not assured infection is not assured

* * ** * *

Thank you very much Thank you very much for yourfor your

attention attention

Epicutaneous Test

30 patients30 patients melprotectmelprotect®® was applied in a test chamber was applied in a test chamber

on the skin for 48hrson the skin for 48hrs evaluation after 42hrs and 78hrsevaluation after 42hrs and 78hrs no allergenicity in any patientno allergenicity in any patient no irritation in any patientno irritation in any patient