Long-term symptomatic group B streptococcal vulvovaginitis: eight cases resolved with freshly cut garlic. - GreenMedInfo Summary

We found that neither an accepted diagnostic definition nor a treatment has been established for GBS

vulvovaginitis. A review of the literature revealed 5 previous articles describing a combined total of 26 cases

of GBS vaginitis in the absence of other pathogens (1-5). GBS vulvovaginitis presents with complaints of

vulvar burning and clear or white vaginal discharge. The labia appear fiery-red, sometimes with fissures. It

has been reported in both celibate and non-celibate women. Cultures contain GBS at a high multiplicity:

>100,000,000 colony forming units (CFU)/g of vaginal fluid) or +4 growth and decreased lactobacillus. GBS

vaginitis is sometimes identified as aerobic vulvovaginitis. High colonization with GBS appears to provoke

the release of cytokines causing inflammation and a severe decrease in lactobacillus. Current first line of

treatment is oral penicillin or clindamycin. It was first noticed in 1976 in an original article in the American J

of OBGYN entitled: Antibiotic Treatment of Parturient Women Colonized with GBS, that oral antibiotics were

ineffective at permanently decreasing asymptomatic GBS vaginal colonization. Women will culture negative

for GBS immediately after 10-14 day regimens of antibiotics, but several days later the vagina is usually

recolonized. An optimal treatment scheme for eliminating either asymptomatic or symptomatic vaginal

GBS and simultaneously normalizing the vaginal ecosystem has not been established. Seven to 14 day

regimen of oral antibiotics may or may not permanently eliminate the symptoms of symptomatic infections

successfully. Adjunctive local therapies that have been used are estrogen crème, povidine gel, chlorhexidine

gel, and fresh garlic cloves cut in half. Fresh garlic releases allicin when cut. Allicin inhibits the growth of

GBS in all GBS strains tested (6), most likely by interfering with the metabolism of cysteine and the function

of the microtubules.

Eight patients with confirmed symptomatic vaginal GBS of 6 months to 4 years duration, not resolved by

course(s) of oral antibiotics, presented to our practice over 4 year period. All presented with red labia,

erythema and erosion of the vaginal walls. In addition, they all had one or more of the following: periodic

burning sensation in the vagina, pain following intercourse, dyspareunia, periodic pain on urination, fissures,

thick white odourless discharge, thick white putrid discharge, thick clear discharge, and nausea. (Table 1)

Ten to fourteen day courses of Clindamycin or Penicillin had temporarily relieved but did not permanently

resolve their symptoms. Several local antibiotics known to be effective against GBS were discussed with

these clients: Fresh garlic, chlorhexidine gel and/or povidine-iodine.

The women all successfully resolved the symptoms by using half a freshly cut clove of garlic inserted

vaginally at night and removed in the morning, for 3 to 6 weeks followed by maintenance doses of once

every 2-4 days. The women were unable to obtain chlorhexidine gel at pharmacies and found povidine to be