Introduction
Female genital tract infections, including vulvovaginal candidiasis, are a significant public health concern due to their high prevalence and potential to cause complications, such as infertility, preterm birth, and pelvic inflammatory diseases.1,2 Genital infections are classified into two types according to the location of the causative organism: lower infections affecting the vulva, vagina, and cervix, and upper infections located in the fallopian tubes and ovaries.3 According to the World Health Organization, more than 375 million new cases of genital infections occur worldwide annually.4 This high global burden has also been emphasized in recent studies comparing World Health Organization sexually transmitted infection fact sheets with emerging health information tools.5 In Cameroon, epidemiological data are increasingly available through reports, master’s dissertations, and theses, but remain outdated, as is the case for many cities, including the Dschang district. Vulvovaginal infections are mainly caused by bacteria and yeasts (mainly Candida species). In fact, candidiasis is known to be the most common fungal infection in humans.6,7 Its prevalence in tropical Africa varies between 33% and 47% of opportunistic infections.8 Among these, vulvovaginal candidiasis is reported to affect the female genital tract,9 thus accounting for over one-third of cases of vaginitis.10 This disease is highly recurrent, affecting between 138 and 140 million women worldwide each year,11,12 with 70–75% of them suffering from at least one episode of vulvovaginal candidiasis per year during their lifetime.13 Its incidence has increased 2.5-fold over the past 20 years, in contrast to gonococcal and trichomonas vaginitis, which have declined over the same period.14Candida albicans, a commensal yeast of the vaginal mucosa, remains the most implicated pathogen among Candida species (77–95%), followed by non-albicans Candida (20–30%; Candida glabrata, Candida tropicalis, Candida krusei, and Candida parapsilosis).15,16 According to Kechia et al.,17 from 397 women examined at the University Hospital of the Faculty of Medicine and Biomedical Sciences (University of Yaoundé I, Cameroon), 35.52% of cases of vulvovaginal candidiasis were recorded. Due to the presence of different forms of vaginal candidiasis, various treatments have been developed; the most recent include oteseconazole, ibrexafungerp, and voriconazole, among others.18 However, studies have shown potential toxicity risks of most of these treatments in pediatric age groups and pregnant women.19 Other studies have also revealed that ibrexafungerp is expensive, especially for people living in developing countries.20 Although fluconazole is the first-line treatment for vulvovaginal candidiasis, thus improving the quality of life of over 96% of women, 63% have persistent infections after completing treatment. While voriconazole has antifungal activity against C. albicans, resistance has been demonstrated in other Candida species, notably C. glabrata and C. parapsilosis.21 Because of drug resistance, toxicity, and the high cost of currently available antifungal drugs, there is a pressing need to search for effective treatments against multi-resistant fungal strains.
For thousands of years, humans have used various plants found in their environment to treat all kinds of diseases.22 Many women rely on traditional medicine using herbal remedies to resolve their gynecological problems, due to perceived efficacy and reluctance to seek conventional medical care.23 These plants represent a huge reservoir of potential compounds, which have the advantage of being highly diverse in chemical structure and possessing a very wide range of biological activities.24 However, many of these medicinal plants are neither identified nor documented, and their traditional use has not yet received scientific validation. Thus, the present study aimed to identify and document medicinal plants that are used to treat vaginal infections in the Dschang district, and to evaluate the antifungal activity of extracts from the most utilized plants against selected Candida strains, including C. albicans, C. glabrata, C. tropicalis, C. krusei, and C. parapsilosis.
Materials and methods
Ethnobotanical study of plants used to treat vaginal infections in Dschang
The ethnobotanical survey was conducted among traditional healers and medicinal plant users in different localities of Dschang in the Menoua Division (West Cameroon). For this study, conventional equipment was used to gather information, and to collect and preserve the plant samples. Survey sheets, secateurs, newspapers, cardboard folders, wooden presses, and a digital camera were used. A semi-structured questionnaire (Supplementary File 1) was administered upon informed consent and availability of the traditional healers, herbalists, and traditional practitioners (e.g., herbal therapists). Once in the field, photographs of the plants were taken before collection. Grasses, trees, shrubs, and vines were the main plant materials. These materials were kept either inside clean paper or in presses for plant identification and authentication.
Location and study site
The ethnobotanical study was conducted in Dschang in the Menoua Division, West Region of Cameroon. Located at an altitude of 1,400 meters on the southeastern slope of the Bamboutos Mountains, Dschang has a microclimate (average temperature of 16 °C, maximum of 31 °C during the hottest month of April), making it suitable for agricultural and ecological studies. Dschang city is 60 kilometers (a 45-min drive) from Bafoussam (capital of the West Region), 300 kilometers (a four-hour journey) from Douala (capital of the Littoral Region), and 400 kilometers (a five-hour journey) from Yaoundé (capital of the Central Region). The municipality covers 262 km2, with 20 communities in the urban area and 96 in the rural area. The five groups that make up the municipality are: Foto: 99 km2; Foréké-Dschang: 86 km2; Fongo-Ndeng: 31 km2; Fossong Wentcheng: 18 km2; Fotetsa: 11 km2; Urban center: 7 km2.25,26
Description of the study area
The study site is situated in Dschang in the Menoua Division (West Region of Cameroon), at latitude 5°26′36.348″ N and longitude 10°4′7.46″ E. This area falls within agro-ecological zone III of Cameroon, more specifically the Cameroon Western Highlands. The Dschang district has a mean altitude of 1,400 m above sea level.27 The climate of Dschang is a humid tropical monsoon type with two seasons: a dry season of four months (from mid-November to mid-March) and a long rainy season of eight months (mid-March to mid-November). The average annual rainfall ranges between 1,800 and 2,000 mm. The annual temperature of Dschang ranges from 13.02 °C to 31.00 °C, with an average of 20 °C and an average thermic amplitude of 14 °C. The relative humidity of air (maximum amount of water vapor) is about 60%.27 The study area also comprises the Menoua River watershed, which is located in Cameroon’s Western Highlands, a mountainous region with volcanic soil, and is drained by a fifth-order stream (Menoua) originating from the Bamboutos Mountains. The Santchou Hills are the source of numerous streams that contribute to the river system.28 The vegetation consists mostly of woody savannah shrubs and grassland, with some trees. In the Dschang district, the basement rocks consist of Neoproterozoic granite-gneiss, late Proterozoic granitoids intruded within the granite gneisses, and gabbroic dykes that crop out in two previous units. The composition of rocks here includes basalt, trachyte, phonolites, and granite. Agriculture is generally the main activity of inhabitants in the Western Highlands of Cameroon. In this area, the land is cultivated intensely, with little to no rest periods (fallow land), to maximize crop production on limited land. Most farmers practice mixed cropping, where maize and beans are intercropped with Arabica coffee, cassava, plantains, and bananas, among others. Hydromorphic and red ferrallitic soils are respectively found in marshy lowlands and on the midslopes.29
Survey approach
The survey began with an administrative approach, during which the Délégué Régional of Health of the West Region of Cameroon authorized (authorization number 1058/25/06/2025/CE/CRERSH-OU/VP) the research to be carried out among herbalists, traditional health practitioners, and people with knowledge of medicinal plants.
Meeting with the participants
Several actors of the traditional pharmacopoeia (herbalists, clairvoyants, traditional healers, holders of knowledge in traditional medicine) were met according to their willingness and availability, using a well-established survey form (semi-structured questionnaire). This included questions on the identity (age, gender, profession, level of education, etc.) of the participants, local and common names of the plant species, the organs or parts of plants used, their modes of preparation, the route of administration of the recipes, and the experience of the respondents in treating with medicinal plants, among others. Notably, clairvoyants are known for their ability to diagnose ailments through spiritual means and prescribe treatments using locally sourced herbs and traditional remedies. Participants aged <18 years, 18–30 years, 31–50 years, and >50 years were considered adolescents, young, middle-aged and senior adults, respectively.30–32 People surveyed provided information on the use of medicinal plants to treat vaginal infections.
Plant characterization
Botanical descriptions of the medicinal plants revealed by the respondents were retrieved from the literature. Plant identification websites, such as Prota 4U (https://www.prota4u.org/ , 2025),33 and The World Flora Online (https://www.worldfloraonline.org/ , 2025) were also used to identify the plants. Upon antifungal screening of selected plant extracts,34 the authentication of the bioactive plants was confirmed at the National Herbarium of Cameroon, where a specimen was deposited.
Antifungal activity
Plant material
Upon the botanical survey, the plants most indicated for the traditional treatment of vaginal infections were selected for antifungal screening. Different organs (leaves, stems, bark, fruit, etc.), collected at the study site, were brought to the laboratory, cut into pieces, dried at room temperature, and ground to obtain a fine powder.
Microbiological material
Antifungal activity of plant extracts was determined on five reference fungal strains, including C. albicans, C. glabrata, C. tropicalis, C. krusei, and C. parapsilosis, kindly donated by the Centre Pasteur of Cameroon (Yaoundé, Cameroon). These Candida species were stored in tubes containing Sabouraud Dextrose Agar by slant culture at 4 °C and maintained in continuous culture at the Laboratory for Phytobiochemistry and Medicinal Plant Studies, Department of Biochemistry, University of Yaoundé I.
Plant extraction
The extracts were prepared by maceration of different parts of selected plants using water or water–ethanol solution (3:7; v/v). Twenty grams of each plant powder was macerated in 120 mL of water or hydroethanolic solution for 24 h. The mixtures were stirred twice a day (morning and evening), and the macerates obtained were filtered using Whatman No. 1 filter paper, then ventilated at room temperature to obtain the crude extracts.35 These extracts were weighed, and the yields of extraction were calculated using the following formula:
Yield of extraction (%)=Weight of the extractWeight of the plant powder×100
The as-prepared extracts were further stored at 4 °C for evaluation of antifungal activity.
Preparation of solutions
Preparation of stock solutions of extracts
The stock solutions of the extracts were prepared at 100 mg/mL by dissolving 100 mg of each crude extract in 100% dimethyl sulfoxide. Amphotericin B was prepared under the same conditions by dissolving 1 mg of the drug in 1 mL of sterile distilled water.
Preparation of fungal inocula
The fungal inocula were prepared according to the 0.5 McFarland standard. A colony from 48-h cultures on Sabouraud Dextrose Agar was collected using a platinum loop and placed in a test tube containing 10 mL of 0.9% NaCl, and calibrated to 0.5 McFarland by comparison with the corresponding turbidity of 2.5 × 106 CFU/mL as evidenced by optical density measurement.36
Inhibitory effects of plant extracts
Preliminary screening
A preliminary screening of antifungal activity of extracts from selected plants was performed at a single concentration (5 mg/mL) against five Candida strains, including C. albicans, C. glabrata, C. tropicalis, C. auris, and C. parapsilosis. The inhibitory effects of the plant extracts were determined in liquid medium according to the protocol M27-A4, described in the Clinical and Laboratory Standards Institute guidelines.36 190 µL of Sabouraud Dextrose Broth (SDB) was added to each well of a 96-well microtiter plate, followed by 4 µL of stock solution of extracts (5 mg/mL). Then, 100 µL of a fungal suspension loaded at 2.5 × 106 CFU/mL was distributed into the test and negative control wells. The final concentration of the inoculum in each well was 5 × 103 cells/mL. The sterility control (blank) consisted of culture medium only, whereas the positive control comprised the culture medium, inoculum, and amphotericin B. The negative control comprised the culture medium and fungal inoculum. The microplates were sealed and incubated at 37 °C for 48 h. At the end of the incubation period, 20 µL of a freshly prepared resazurin solution (0.15 mg/mL) was added to all wells, followed by an additional incubation under the same conditions for 30 min. Wells in which no color change from blue (resazurin) to pink (resorufin) was observed corresponded to no growth of fungal cells.
Determination of minimum inhibitory concentrations (MICs) and minimum fungicidal concentrations (MFCs)
Determination of MICs: To determine the MICs, 190 µL of SDB was added to the first twelve wells in column A of a 96-well microtiter plate, whereas 100 µL was introduced into the remaining wells of the plate. Then, 4 µL of a sterile solution of each extract at 100 mg/mL was added to the first 12 wells, whereas 10 µL of amphotericin B (100 mg/mL) was introduced into the last three corresponding wells. This was followed by a series of five two-fold dilutions, from column A to column F. Then, 100 µL of a fungal suspension loaded at 2.5 × 106 CFU/mL was distributed into the test and negative control wells. The final inoculum concentration in each well was 5 × 103 cells/mL. The sterility control (blank) consisted of culture medium only, the positive control encompassed the culture medium, inoculum, and amphotericin B, and the negative control comprised culture medium and fungal inoculum. The microplates were covered and incubated at 37 °C for 48 h. At the end of incubation, 20 µL of freshly prepared resazurin solution (0.15 mg/mL) was added to all wells, followed by an additional incubation for 30 min under the same conditions. The lowest concentrations at which no color change from blue to pink was observed corresponded to no fungal growth and were considered the MICs, which were used to determine MFCs.
Determination of MFCs: The MFCs of plant extracts were determined in liquid medium using preparations derived from the MIC microplates. From the plates used to determine MICs, 25 µL aliquots from wells that showed no growth and were without resazurin treatment were aseptically removed and transferred to corresponding wells in another sterile microplate containing 175 µL of SDB. The contents of the wells were then diluted eight times to remove the inhibitory effect of the extracts. The sterility control consisted of culture medium only, whereas the negative control comprised the fungal inoculum and culture medium. The microplates were covered and incubated at 37 °C for 48 h. At the end of the incubation period, the plates were treated as described in subsection b.1. Tests were performed in triplicate in sterile 96-well microplates. The fungicidal or fungistatic effect of the extracts was estimated by calculation of the MFC/MIC ratio. According to Traoré et al.,37 when the MFC/MIC ratio of an antimicrobial substance is ≤ 4, it is classified as fungicidal; if the ratio is > 4, the substance is classified as fungistatic.
Statistical analysis
Data obtained from the ethnobotanical survey were analyzed using Microsoft Excel version 2016, which was also used to plot graphs (histograms). Variables were presented as frequencies (counts of observations in each defined category). Quantitative data analysis was performed using one-way analysis of variance with GraphPad Prism 8.0.1 software.38 Values were represented as mean ± standard deviation. Differences between means were compared by Dunnett’s test. Samples with a P-value ≤ 0.05 were considered statistically significant. Antifungal tests were performed in triplicate for each sample (plant extract).
Results
Ethnobotanical survey
Sociodemographic profile of the participants
Source of information
The survey was conducted in the Dschang district among 65 people, including 32 traditional healers, 8 clairvoyants, 12 naturopaths, and 13 other participants (9 farmers, 1 student, 1 trader, 1 housewife, and 1 winemaker) (Supplementary Fig. 1).
Distribution of participants by gender
During this ethnobotanical survey, there was a marked interest in the use of medicinal plants among males and females. Out of 65 people surveyed, 34 participants were men and 31 respondents were women (Supplementary Fig. 2). The majority of traditional healers (81.25%) were men, while naturopaths (66.7%) and clairvoyants (100%) were predominantly women. Among the other respondents, 30.76% were men (02 farmers, 01 winemaker, and 01 trader), versus 69.23% women (07 farmers, 01 student, and 01 housewife) (Supplementary Fig. 2).
Distribution of the respondents by age
Sixty-five informants, aged between 18 and 95, were interviewed. The respondents were divided into four age groups: <18 years, [18–30] years, [31–50] years, and >50 years. The majority of traditional practitioners (53.1%) and naturopaths (41.7%) were over 50 years old. Among the clairvoyants, there was a prevalence of people aged between 18 and 30 years (37.5%) or between 31 and 50 years (37.5%) (Fig. 1).
Distribution of participants according to their level of education
This study revealed a diversity of education levels among the interviewees (Supplementary Fig. 3). The majority of informants attended up to primary school, representing 78.2%, followed by university level (12.85%) and secondary level (8.95%). The majority of traditional practitioners and clairvoyants attended school up to the primary level (Supplementary Fig. 3), which might be due to the fact that traditional healers start treating people with medicinal plants from a very early age (childhood).
Information on the use of medicinal plants to treat vaginal infections
Frequency of use of various plant organs by the respondents
Figure 2 illustrates the different organs of plants used in the treatment of vaginal infections by the informants. Most clairvoyants (58.31%) use bark in their plant preparations, compared to traditional practitioners (47.3%) and naturopaths (40%), who mostly use leaves to treat vaginal diseases. Overall, the plant parts used by different groups of participants include bark, leaves, seeds, stems, roots, and fruits (Fig. 2).
Modes of preparation of medicinal plants by the respondents
According to the survey, the majority of traditional practitioners (40.6%) use maceration as the mode of plant preparation, while among clairvoyants (37.5%), the predominant mode of preparation is decoction. Among naturopaths, ovule formulation (25%) was predominant, followed by maceration and decoction (Fig. 3).
Distribution of participants according to their experience in using plants to treat vaginal infections
The number of years of experience of participants in using medicinal plants to treat vaginal infections was also recorded (Supplementary Fig. 4). The majority of traditional healers (87.5%), naturopaths (75%), and clairvoyants (91.66%) have more than five years of experience in using medicinal plants to treat vaginal infections.
Adverse effects indicated by the respondents following the administration of different herbal preparations
Figure 4 shows the various adverse effects observed following the administration of herbal preparations by the participants. The majority of plants used by all groups of participants did not present any adverse effects upon oral administration. However, some respondents reported dizziness (traditional practitioners and clairvoyants), diarrhea (traditional practitioners and naturopaths), pollakiuria (7.7% of other groups), itching (12.5% of clairvoyants), risk of abortion (12.5% of clairvoyants), and asthenia (6.25% of traditional practitioners) as notable adverse effects for certain plants (Fig. 4).
Information on medicinal plants used to treat vaginal infections in Dschang
A total of 48 plant species (Table 1) belonging to 33 different families [Asteraceae (6), Amaranthaceae (3), Fabaceae (3), Anacardiaceae (2), Burseraceae (2), Rutaceae (2), Myrtaceae (1), Piperaceae (2), Amaryllidaceae (1), Lamiaceae (1), Poaceae (2), Solanaceae (1), Liliaceae (1), Asphodelaceae (1), Araliaceae (1), Annonaceae (1), Apocynaceae (1), Caricaceae (1), Combretaceae (1), Bignoniaceae (1), Campanulaceae (1), Meliaceae (1), Malvaceae (2), Crassulaceae (1), Moraceae (1), Euphorbiaceae (1), Lauraceae (1), Cucurbitaceae (1), Hypericaceae (1), Commelinaceae (1), Urticaceae (1), Zingiberaceae (1)] were recorded by respondents as medicinal plants used to treat vaginal infections. Images of these plant species are also shown in Table 1.39-76
Table 1List of medicinal plants used to treat vaginal infections in the Dschang district, West Cameroon
| Scientific name of the plant | Family’s name | Local name | Common name | Plant organs | Modes of preparation | Route of administration | Reference/Source |
|---|
| Canarium schweinfurthii | Burseraceae | Mbeuih | Black fruit | Bark | Decoction | Oral | 39 |
| Syzygium aromaticum L. | Myrtaceae | «Clove nail» | Clove nail | Seeds | Infusion, maceration | Oral, genital | 39 |
| Piper nigrum | Piperaceae | Sap (black pepper) | Black pepper | Fruits | Infusion | Oral | 40 |
| Amaranthus tricolor L. | Amaranthaceae | Panzem | Two sides | Leaves | Expression | Rectal | 41 |
| Ocimum gratissimum | Limiaceae | Village’s Macep | Wild basil | Leaves | Infusion, maceration | Oral | 42 |
| Beta vulgaris | Amaranthaceae | Beet root | Beet root | Fruits | Expression | Oral | 39 |
| Cymbopogon citratus | Poaceae | Lemongrass | Lemongrass | Leaves | Infusion | Oral | 43 |
| Solanum torvum | Solanaceae | Wild eggplant | Wild eggplant | Fruits | Expression | Rectal | 10742 SRF/Cam, «National Herbarium of Cameroon» |
| Allium sativum L. | Liliaceae | Garlic | Garlic | Pods | Ovule | Vaginal | 44 |
| Aloe vera barbadensis | Asphodelaceae | Aloe vera | Aloe vera | Leaves | Ovule | Vaginal | 45 |
| Crinum distichum Herb | Amaryllidaceae | Melan | Crinole | Leaves | Expression | Rectal | 46 |
| Panax ginseng | Araliaceae | Ginseng | Ginseng | Roots | Poudre | Oral | 47 |
| Carica papaya L. | Caricaceae | Papaya’s leaves | Papaya | Leaves | Infusion | Oral | 48 |
| Mangifera indica L. | Anacardiaceae | Leaves of Mango tree | Mango tree | Bark | Decoction | Oral | 49 |
| Combretum micranthum | Combretaceae | Kinkéliba | Kinkéliba | Bark | Maceration | Oral | 50 |
| Tetrapleura tetraptera | Asteraceae | Four sides | Four sides | Fruits | Infusion, poudre | Oral, Rectal | 51 |
| ND | ND | Coup asock | Bark soop | Bark | Decoction | Oral | ND |
| Erigeron canadensis | Asteraceae | Mveng nguim | Canada’s fleabane | Leaves | Infusion | Oral | 52 |
| Citrus limon L. | Rutaceae | Lemon | Lemon | Fruits | Decoction, expression | Oral | 53 |
| Citrus limon L. Burm.f. | Rutaceae | Citron | Citron | Fruits | Expression | Oral | 54 |
| Dacryodes edulis | Burseraceae | Leaves of the plum’s tree | Plum tree | Leaves and bark | Decoction | Oral | 31913/HNC, «National Herbarium of Cameroon» |
| Annona muricata | Annonaceae | Leaves of soursop tree | Soursop tree | Leaves | Decoction | Oral | 42 |
| Guibourtia demeisei | Fabaceae | Essinga | Essinga | Bark | Decoction | Oral | 55 |
| Amaranthus spp. | Amaranthaceae | Felon rouge | Felon rouge | Leaves | Expression | Rectal | 56 |
| Spathodea campanulata | Bignoniaceae | Mefou | African Tulip tree | Bark | Decoction | Oral | 22791 SRF/Cam, «National Herbarium of Cameroon» |
| Lobelia giberroa Hemsl. | Campanulaceae | Kepan | Mountain lobelia | Leaves | Decoction | Oral | 57 |
| Taraxacum officinale | Asteraceae | Atananana | Picenlie | Roots | Decoction | Oral | 58 |
| Toona sinensis | Meliaceae | Ngum | Chinese cedar | Bark | Decoction | Oral | 59 |
| Hibiscus cannabinus | Malvaceae | Cargo | «Le Kenaf» | Leaves | Decoction | Oral | 60 |
| Echeveria can can | Crassulaceae | Mkaah | Can can | Leaves | Infusion | Oral | ND |
| Acacia nilotica | Fabaceae | Nep nep | Nep nep | Fruits | Maceration | Oral | 61 |
| Piper longum L. | Piperaceae | Long pepper | Long pepper | Fruits | Maceration | Oral | 62 |
| Ageratum conyzoides | Asteraceae | King of Grass | King of Grass | Leaves | Expression | Oral | 63 |
| Ficus exasperata Vahl | Moraceae | Atoueh | «Dede» | Bark | Decoction | Oral | 64 |
| Euphorbia hirta | Euphorbiaceae | Mabeumoh | ND | Leaves | Infusion | Oral | 65 |
| Allium tricoccum | Amaryllidaceae | Wild onion | Wild onion | Roots | Expression | Rectal | 66 |
| Cinnamomum verum | Lauraceae | Cinnamon | Cinnamon | Bark | Powder | Oral | 67 |
| Cucumeropsis mannii Naudin | Cucurbitaceae | Nkacli | Pistachio | Fruits | Expression | Oral | 68 |
| Hibiscus cannabinus L. | Malvaceae | Acargo | ND | Leaves | Decoction | Oral | 60 |
| Lannea spp. | Anacardiaceae | Keukeuh | ND | Bark | Decoction | Oral | ND |
| Harungana madagascariensis | Hypericaceae | «Coup metie» | Blood’s bark | Bark | Decoction | Oral | 69 |
| Guibourtia tessmannii | Fabaceae | Bubinga | Bubinga | Bark | Decoction | Oral | 70 |
| Spilanthes filicaulis | Asteraceae | Pantchou | Red’s head | Leaves | Infusion | Oral | 71 |
| Commelina benghalensis L. | Commelinaceae | Liwouwou | Pigweed | Leaves | Decoction | Oral | 72 |
| Tithonia diversifolia | Asteraceae | Jealousy flower | Jealousy flower | Roots | Decoction | Rectal | 18591SRF/Cam, «National Herbarium of Cameroon» |
| Pennisetum purpureum | Poaceae | Sissongo | Sissongo | Leaves | Infusion | Oral | 73 |
| Tabernaemontana elegans | Apocynaceae | Mbeumoh | Toad tree | Bark | Decoction | Oral | 74 |
| Urtica dioica L. | Urticaceae | Mbeubap | Stinging nettle | Leaves | Infusion | Oral | 75 |
| Zingiber officinale | Zingiberaceae | Ginger | Ginger | Roots | Infusion | Oral | 76 |
Antifungal activity
Yield of extraction
Following the ethnobotanical survey, a total of 17 mostly cited plant species were selected for anti-Candida screening: Spathodea campanulata, Tetrapleura tetraptera, M. indica, Lannea spp., Syzygium aromaticum, Solanum torvum, Toona sinensis, C. schweinfurthii, Panax ginseng, Ficus exasperata Vahl, Tabernaemontana elegans, Spilanthes filicaulis, Hibiscus cannabinus L., Ocimum gratissimum, Lobelia giberroa Hemsl., Leucaena glauca, and Allium sativum L., which were selected for antifungal testing against five strains of Candida (C. albicans, C. glabrata, C. tropicalis, C. auris, and C. parapsilosis). These plants were extracted by maceration using either water or a mixture of water and ethanol (3:7; v/v). The yields of extraction of different plant organs are shown in Table 2.
Table 2Plant extraction yields according to organs and solvents
| Scientific name of the plant | Plant organs | Solvents | Yield of extraction (%) |
|---|
| Spathodea campanulata | Bark | Water | 9.00 |
| | Water +Ethanol (70%) | 11.80 |
| Tetrapleura tetraptera | Fruits | Water | 15.00 |
| | Water +Ethanol (70%) | 23.90 |
| Mangifera indica L. | Bark | Water | 4.30 |
| | Water +Ethanol (70%) | 9.80 |
| Lannea spp. | Bark | Water | 1.75 |
| | Water +Ethanol (70%) | 5.35 |
| Syzygium aromaticum L. | Fruits | Water | 1.20 |
| | Water +Ethanol (70%) | 25.50 |
| Solanum torvum | Bark | Water | 7.30 |
| | Water +Ethanol (70%) | 7.65 |
| Toona sinensis | Bark | Water | 3.40 |
| | Water +Ethanol (70%) | 7.90 |
| Canarium schweinfurthii | Bark | Water | 7.60 |
| | Water +Ethanol (70%) | 15.20 |
| Panax ginseng | Roots | Water | 13.60 |
| | Water +Ethanol (70%) | 11.60 |
| Ficus exasperata Vahl | Bark | Water | 3.35 |
| | Water +Ethanol (70%) | 1.05 |
| Tabernaemontana elegans | Bark | Water | 1.00 |
| | Water +Ethanol (70%) | 11.80 |
| Spilanthes filicaulis | Leaves | Water | 10.20 |
| | Water +Ethanol (70%) | 3.60 |
| Hibiscus cannabinus L | Leaves | Water | 17.50 |
| | Water +Ethanol (70%) | 12.50 |
| Ocimum gratissimum | Leaves | Water | 15.00 |
| | Water +Ethanol (70%) | 59.50 |
| Lobelia giberroa Hemsl. | Leaves | Water | 15.30 |
| | Water +Ethanol (70%) | 9.30 |
| Leucaena glauca | Bark | Water | 4.60 |
| | Water +Ethanol (70%) | 15.10 |
| Allium sativum L. | Pods | Water | 70.30 |
| | Water +Ethanol (70%) | 43.00 |
The yield of extraction of aqueous extracts from the 17 selected plants ranged from 1.00% (T. elegans bark extract) to 70.30% (A. sativum bulb extract) (Table 2). Moreover, maceration with the hydroethanolic solution afforded extraction yields ranging from 1.05% (F. exasperata bark extract) to 59.50% (O. gratissimum leaf extract) (Table 2).
Inhibitory effects of plant extracts on the Candida species
Preliminary screening of antifungal activity
Table 3 presents the detailed results obtained following preliminary screening of selected plant extracts at a single concentration (5 mg/mL).
Table 3Antifungal activity of extracts from selected plants used to treat vaginal infections at the concentration of 5 mg/mL
| Extracts/Fungal strains | SCEH20 | SCEHAlc | TTFrH20 | TTFrHAlc | MIEH20 | MIEHAlc | LSPEH20 | LSPEHAlc | SAFrH20 | SAFHAlc | STEH20 | STEHAlc | TSEH20 | TSEHAlc | CSEH20 | CSEHAlc | PGRH20 | PGRHAlc | FEEH20 | FEEHAlc | TEEH20 | TEEHAlc |
|---|
| C. auris | − | + | − | − | − | + | − | − | + | − | − | − | − | − | − | + | − | − | − | − | − | − |
| C. albicans (CPC strain) | − | − | − | − | + | + | − | − | + | − | − | − | − | − | − | + | − | − | − | − | + | − |
| C. parapsilosis | − | − | − | − | − | + | + | + | − | − | − | − | − | − | − | + | − | − | − | − | − | − |
| C. tropicalis | − | − | − | − | − | + | + | − | + | − | − | − | − | − | − | + | − | − | − | − | − | − |
| C. albicans | − | − | − | − | + | − | − | + | − | − | − | − | − | − | − | − | − | − | − | + | − | − |
| Extraits/Souches | SFFH20 | SFFHAlc | HCFH20 | HCFHAlc | OGFH20 | OGFHAlc | LGFH20 | LGFHAlc | ESEH20 | ESEHAlc | ASGsH20 | ASGsHAlc | Amphotericin B |
|---|
| C. auris | − | − | − | − | − | − | − | − | − | − | − | − | + |
| C. albicans (CPC strain) | − | − | − | − | − | − | − | − | − | − | − | − | + |
| C. parapsilosis | − | − | − | − | − | − | − | − | − | − | − | − | + |
| C. tropicalis | − | − | − | − | − | + | − | − | − | + | − | − | + |
| C. albicans | − | − | − | − | − | − | − | − | − | − | − | − | + |
Following the preliminary screening of thirty-four (34) extracts (17 aqueous extracts and 17 water-ethanol extracts) from the seventeen (17) selected plants (S. campanulata, T. tetraptera, M. indica, Lannea spp., S. aromaticum, S. torvum, T. sinensis, C. schweinfurthii, P. ginseng, F. exasperata, T. elegans, S. filicaulis, H. cannabinus, O. gratissimum, L. giberroa, L. glauca, and A. sativum) against the five Candida species (C. albicans, C. glabrata, C. tropicalis, C. auris, and C. parapsilosis), nine extracts (SCEHAlc, MIEH20, MIEHAlc, LSPEH20, LSPEHAlc, SAFrH20, CSEHAlc, FEEHAlc, and TEEH20) inhibited the growth of at least one Candida strain at a concentration of 5,000 µg/mL. Among these extracts, two (MIEHAlc and CSEHAlc: hydroethanolic extracts from M. indica and C. schweinfurthii, respectively) inhibited almost all the Candida species tested and were selected for the determination of MICs and MFCs. Amphotericin B (positive control) inhibited the growth of all the Candida species tested (Table 4).
Table 4Minimum inhibitory and minimum fungicidal concentrations (mg/mL) of active extracts
| Extracts | Parameters | C. auris | C. albicans (CPC strain) | C. parapsilosis | C. tropicalis | C. albicans |
|---|
| MIEHAlc | MIC | 2.5 ± 0.0*** | 0.625 ± 0.0**** | 0.315 ± 0.0**** | 0.315 ± 0.0**** | – |
| MFC | – | – | 0.315 ± 0.0 | 0.625 ± 0.0 | – |
| r | – | – | 1.0 | 2.0 | – |
| CSEHAlc | MIC | 2.5 ± 0.0*** | 2.5 ± 0.0*** | 2.5 ± 0.0*** | 2.5 ± 0.0*** | – |
| MFC | – | – | – | 5.0 ± 0.0 | – |
| r | – | – | – | 2.0 | – |
| Amphotericin B (µg/mL) | | 12.5 ± 0.0 | 12.5 ± 0.0 | 12.5 ± 0.0 | 12.5 ± 0.0 | 12.5 ± 0.0 |
MICs and MFCs
Table 4 summarizes the minimum inhibitory and MFCs of extracts that showed inhibition on the majority of yeasts tested at a concentration of 5 mg/mL.
The incubation of extracts from Mangifera indica and C. schweinfurthii (MIEHAlc and CSEHAlc) with the five Candida species yielded MIC values ranging from 0.315 to 2.5 mg/mL (Table 4). The MIEHAlc extract (hydroethanolic extract of M. indica bark) was the most active, with an MIC value of 0.315 mg/mL on C. parapsilosis and C. tropicalis and 0.625 mg/mL on C. albicans (CPC strain). The hydroethanolic extract of C. schweinfurthii (CSEHAlc) revealed an MIC of 2.5 mg/mL on four yeasts out of the five tested. Overall, C. parapsilosis and C. tropicalis were the most sensitive Candida strains to the hydroethanolic extract of M. indica bark. According to the criteria reported by Tamokou et al.,77 an extract is considered highly active if MIC < 100 µg/mL; significantly active if 100 ≤ MIC ≤ 512 µg/mL; moderately active if 512 ≤ MIC ≤ 2,048 µg/mL; weakly active if MIC > 2,048 µg/mL; and inactive if MIC > 10 mg/mL. Therefore, the hydroethanolic extract of M. indica bark (MIEHAlc) is significantly active against C. parapsilosis and C. tropicalis, whereas the hydroethanolic extract of C. schweinfurthii (CSEHAlc) is weakly active against all yeasts tested (Table 4). Furthermore, the fungicidal or fungistatic effect of the extracts was estimated by the MFC/MIC ratio according to Traoré et al.’s criteria.37 Thus, CSEHAlc and MIEHAlc extracts presented MFC/MIC ratios less than or equal to four (≤4). According to Traoré et al.,37 when the MFC/MIC ratio of an antimicrobial substance is ≤4, it is classified as fungicidal; if the ratio is >4, it is classified as fungistatic. Accordingly, CSEHAlc and MIEHAlc extracts showed fungicidal activity on C. tropicalis (Table 4).
Discussion
Female genital tract infections are a global public health problem due to their high prevalence, serious consequences for women’s reproductive welfare (infertility, pregnancy complications), and transmission to infants. Vaginal diseases caused by Candida species are fungal threats with high prevalence among all vaginal infections. The treatment of vaginal Candida infections is primarily based on the use of antifungal drugs, such as fluconazole, clotrimazole, and miconazole, etc.78 However, fungal resistance is one of the main limitations that makes these treatments less effective, in addition to the development of a number of adverse effects.79 Thus, there is a pressing need to search for effective treatments against vaginal infections. Medicinal plants are a well-recognized and often low-cost source of active ingredients for treating vaginal infections, with a growing body of evidence supporting their efficacy against various pathogens.80,81 Many women rely on the traditional system of medicine using herbal remedies to resolve their gynecological problems due to cost, cultural beliefs, accessibility, perceived efficacy, and the feeling of embarrassment in presenting medical conditions to conventional doctors.23 However, information on the use of medicinal plants in treating vaginal infections is not well documented. Moreover, there is a significant lack of scientific evidence to support the traditional use of numerous medicinal plants. Thus, this study aimed to identify and document medicinal plants used to treat vaginal infections in the Dschang district and to validate the traditional use of the most cited plants through in vitro antifungal tests.
Upon an ethnobotanical survey, a total of 65 people were interviewed, including 32 traditional practitioners, 8 clairvoyants, 12 naturopaths, and 13 other participants. The interviewees were dominated by men (34) compared to women (31). This observation may be due to women’s reluctance in providing information on the use of medicinal plants or their hesitation to take part in the study.82 The most represented participants were aged above 50 years. The predominance of older respondents indicates a lack of interest in traditional
medicine among young people, possibly because traditional practices are rooted in ancestral culture and are less relevant to younger generations.83 Moreover, the most commonly used plant organs included leaves and bark, whereas the modes of plant preparation were dominated by decoction and ovule formulation.
Notably, a total of forty-eight (48) plant species belonging to 33 families (Table 1) were identified as being used to treat vaginal infections in the Dschang district. Among these plants, seventeen species were most cited by the respondents (S. campanulata, T. tetraptera, M. indica, Lannea spp., S. aromaticum, S. torvum, T. sinensis, C. schweinfurthii, P. ginseng, F. exasperata, T. elegans, S. filicaulis, H. cannabinus, O. gratissimum, L. giberroa, L. glauca, and A. sativum) and were selected for evaluation of antifungal activity against five Candida species (C. albicans, C. glabrata, C. tropicalis, C. auris, and C. parapsilosis) responsible for vaginal infections. Plant extracts were obtained by maceration using water or hydroethanolic solution (3:7, v/v) and then subjected to antifungal screening at a concentration of 5 mg/mL. From these extracts, two (CSEHAlc and MIEHAlc: hydroethanolic extracts of C. schweinfurthii and M. indica, respectively) inhibited the growth of the majority of the Candida species and were subjected to MIC and MFC determinations.
The MIEHAlc extract was the most active, with a common MIC value of 0.315 mg/mL on C. parapsilosis and C. tropicalis. The hydroethanolic extract of C. schweinfurthii (CSEHAlc) showed an MIC value of 2.5 mg/mL when tested against all the Candida species. CSEHAlc and MIEHAlc revealed a fungicidal effect on C. parapsilosis and C. tropicalis, as their MFC/MIC ratios were less than or equal to four (≤4). Mangifera indica is reported to contain secondary metabolites, such as phenols and polyphenols,84 whereas C. schweinfurthii is very rich in flavonoids, terpenoids, phenols, and alkaloids, among others.85 Thus, it is reasonable to speculate that the antifungal activity observed in M. indica and C. schweinfurthii might be due to the presence of these secondary metabolites. Notably, previous studies have shown that flavonoids, alkaloids, and phenolic compounds exert antifungal action by inhibiting DNA synthesis, biofilm formation, and cell wall development.86,87 The antifungal activity observed in this study might be attributed to at least one of these mechanisms. These results suggest that extracts from M. indica and C. schweinfurthii possess antifungal activity and could serve as a potential source of active ingredients for the discovery of drugs against vaginal Candida infections.
Limitations and perspectives
The present study aimed to identify medicinal plants used to treat vaginal infections in the Dschang district and to evaluate the antifungal activity of the most promising plants on five Candida species. Forty-eight (48) plant species belonging to 33 families were identified as plants used by respondents (traditional practitioners, naturopaths, etc.) to treat vaginal infections in Dschang. In vitro antifungal screening of selected plants indicated M. indica and C. schweinfurthii as the anti-Candida plants that could be further exploited for antifungal drug discovery. However, more research is needed to authenticate the majority of the plants identified and evaluate the antifungal activity of the other documented plants. Since it is essential that anti-Candida plant extracts be thoroughly investigated chemically to identify their active ingredients, further studies on isolation and characterization of the active principles are of outstanding importance. Toxicity and pharmacokinetic studies of the most promising plant extracts (M. indica and C. schweinfurthii), as well as their antifungal modes of action (inhibition of fungal cell walls and efflux pumps), should be investigated to ensure the successful utilization of these plants for antifungal drug discovery.
Conclusions
In this study, the medicinal plants used traditionally to treat vaginal infections in the Dschang district were identified and documented through an ethnobotanical survey. Decoction and ovule formulation were the most commonly used modes of plant preparation, with leaves and bark being the most commonly used plant organs. Among the water and hydroethanol extracts obtained from the most cited plants (17 plants), two extracts (CSEHAlc and MIEHAlc) from M. indica and C. schweinfurthii showed promising antifungal activity against selected Candida species, with low MIC values. Determination of the MFCs confirmed the fungicidal effect of these extracts. This novel contribution demonstrates the ethnobotanical use of plants in treating vaginal infections and validates their traditional use through in vitro antifungal assays. Nonetheless, more research is needed to authenticate the majority of the recorded plants at the National Herbarium of Cameroon and to evaluate the antifungal activity of the other documented plants. In vitro toxicity studies of M. indica and C. schweinfurthii extracts, as well as investigation of their antifungal modes of action, are warranted for the successful utilization of these plants in antifungal drug discovery.
Supporting information
Supplementary material for this article is available at https://doi.org/10.14218/JERP.2025.00047 .
Supplementary File 1
Questionnaire.
(DOCX)
Supplementary Fig. 1
Frequency distribution of the participants by profession. Following an ethnobotanical survey on medicinal plants used to treat vaginal infections at the Dschang district, West-Cameroon, participants mainly included traditional healers, naturopaths, and clairvoyants. Other participants incompassed 09 farmers, 01 student, 01 trader, 01 housewife and 01 winemaker.
(TIF)
Supplementary Fig. 2
Frequency distribution of participants by gender. Men and women participated to the ethnobotanical survey. Other participants included 09 farmers, 01 student, 01 trader, 01 housewife and 01 winemaker.
(TIF)
Supplementary Fig. 3
Frequency distribution of the participants by education level. A frequency distribution of participants by education level shows the percentage of individuals at each educational stage. Other participants included 09 farmers, 01 student, 01 trader, 01 housewife and 01 winemaker.
(TIF)
Supplementary Fig. 4
Frequency distribution of participants by experience in using medicinal plants. A frequency distribution of participants by experience in using medicinal plants organizes data into categories of experience levels.
(TIF)
Declarations
Acknowledgement
The authors are thankful to the Cameroon National Herbarium (Yaoundé, Cameroon) for plant identification and to the Centre Pasteur of Cameroon for providing the Candida strains.
Ethical statement
This research involving human participants was carried out in adherence to the principles of the World Medical Association Declaration of Helsinki (as revised in 2024). Prior to the commencement of the study, the research protocol was reviewed and approved by the Western Regional Ethics Committee for Human Health Research in Cameroon (CRERSH-West) (ID No. 1058/25/06/2025/CE/CRERSH-OU/VP). Participation in the ethnobotanical survey was voluntary, and informed consent was obtained from every participant. The health, dignity, and rights of research participants take precedence over the interests of science and society.
Data sharing statement
Data are available from the corresponding author upon reasonable request.
Funding
This research received no external funding.
Conflict of interest
The authors declare no conflicts of interest.
Authors’ contributions
Study concept and design (BPK, FFB), acquisition of data (ASML, YNN, JAK, SPT, AMM, CADN, AJN), analysis and interpretation of data (ASML, YNN, JAK, SPT, AMM, CADN, AJN), critical revision of the manuscript for important intellectual content (BPK, FFB), administrative, technical, or material support (ASML, YNN, JAK, SPT, AMM, CADN, AJN), and study supervision (BPK). All authors have read and agreed to the published version of the manuscript.