Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5442_Библиотеки_им_академика_М_И_Перельмана.pdf
infections (e.g., syphilis) whereby the patient is asymptomatic for years and symptoms
appear in the late stages of the disease (
Centers for Disease Control and Prevention, 2017).
If STDs are not treated they may manifest as pelvic inflammatory disease (PID), infertility,
pregnancy complications, birth defects, and neurological damage. Prolonged exposure to
STDs has been reported to increase the chances of HIV/AIDS (
Cates & Wasserheit, 1991;
Maier & Katsufrakis, 2015
).
Venereal diseases have been attributed to several pathogens including bacteria, viruses,
and fungi (
Table 5.1). In South Africa, N. gonorrhoeae, C. trachomatis, and T. pallidum are the
top bacterial causal agents of STDs (
Johnson, Coetzee, & Dorrington, 2005; Kharsany et al.,
2020
). Candida albicans is the most common fungus causing vaginal yeast infections.
Candida albicans is part of the normal human microbiota, however, if the immune system is
suppressed the fungus may be pathogenic (
Anwar, Malik, & Subhan, 2012; Chin, Lee,
Rusliza, & Chong, 2016
). Haemophilus ducreyi is another relatively common bacterial patho-
gen that causes chancroid, whilst Gardnerella vaginalis that causes bacterial vaginosis is
most prevalent in females than in males (
Johnson et al., 2005).
TABLE 5.1 Microorganisms associated with sexually transmitted diseases.
Disease
Type of
organism Microorganism References
Vaginal yeast infections Fungi Candida albicans
Cavalcanti Filho et al. (2017), Mayer, Wilson, and
Hube (2013)
Chlamydia Bacteria Chlamydia trachomatis Achakazai et al. (2017), Geisler and Stamm (2007)
Lymphogranuloma
venereum (LGV)
Bacteria Chlamydia trachomatis
serovars (13)
Geisler and Stamm (2007), Johnson et al. (2005)
Bacterial vaginosis Bacteria Gardnerella vaginalis Machado, Castro, Palmeira-de-Oliveira, Martinez-
de-Oliveira, and Cerca (2016)
Chancroid Bacteria Haemophilus ducreyi Belcher and Dawson (2017), Johnson et al. (2005)
Herpes Virus Herpes simplex virus
(HSV)
Talwar et al. (2000)
Human
immunodeficiency virus
(HIV)
Virus Human
immunodeficiency
virus
Simon, Ho, and Karim (2006)
Human papillomavirus
(HPV)
Virus Human
papillomavirus
Boxman, Hogewoning, Mulder, Bouwes Bavinck,
and Ter Schegget (1999)
Granuloma inguinale Bacteria Klebsiella granulomatis Kibbi, Bahhady, and El-Shareef (2012)
Gonorrhea Bacteria Neisseria gonorrhoeae Tshikalange, Mamba, and Adebayo (2016), Van
Vuuren and Holl (2017)
Shigellosis Bacteria Shigella sonnei, Shigella
flexneri
Centers for Disease Control and Prevention (2017)
Syphilis Bacteria Treponema pallidum Achakazai et al. (2017)
Trichomoniasis Parasite Trichomonas vaginalis Centers for Disease Control and Prevention (2017)
184 5. The use of South African medicinal plants in the pursuit to treat gonorrhea and other sexually transmitted diseases
Medicinal Plants as Anti-infectives
The high prevalence of STDs has heightened the burden on the available market thera-
pies as there is a rampant increase in drug-resistant STD pathogens. Therefore this has
brought medicinal plants in the limelight as candidates for new alternative therapeutics
for STDs (
Palmeira-de-Oliveira et al., 2013). This review will focus primarily on one of the
prevalent STDs in South Africa, namely, gonorrhea.
Background on gonorrhea
Gonorrhea is one of the most problematic STDs in the world. The global incidence rate
for 2016 was estimated to be at 20 and 26 new reported gonococcal infections per 1000
women and men, respectively (
Rowley et al., 2019). According to the WHO, sub-Saharan
Africa is the most affected region in the world (
WHO Regional Office for Africa, 2018;
World Health Organisation, 2019
). In South Africa, gonorrhea is the second most prevalent
bacterial STD affecting humans (
Kularatne, Niit, et al., 2018). In 2017, it was estimated that
of the 4.5 million South Africans that were infected with gonorrhea, 6.6% were females
and 3.5% were males (
Kularatne, Kufa-Chakezha, Maseko, & Gumede, 2018). Gonorrhea is
prevalent in sexually active individuals mostly below 30 years (
Shim, 2011). The high inci-
dence of gonorrhea has been due to several factors which include low socioeconomic sta-
tus, the onset of sexual activity, safe sex awareness, and risky sexual behaviors (
Barnes &
Holmes, 1984; Oller, Wood, & St Luke, 1970
).
Gonorrhea is a disease transmitted via sexual contact in individuals through lesions
and bodily fluids (
Belcher & Dawson, 2017). The symptoms of the disease include lower
abdominal pains, vaginal or penial discharge, pain when urinating, itching of genitalia,
venereal sores, and ulcerations (lesions on the skin and mucosal tissue) (
Achakazai et al.,
2017; Centers for Disease Control and Prevention, 2017
). In some cases, the disease may
cause urethritis and PID. If symptoms are seen they are usually mild and nonspecific
(
Curran et al., 1975; McCormack, Stumacher, Johnson, & Donner, 1977). Gonorrhea can also
be asymptomatic in both males and females and most cases are diagnosed in women (
Platt,
Rice, & McCormack, 1983; Wallin, 1974
). Untreated gonococcal infections could result in infer-
tility, birth defects, and life-threatening ectopic pregnancies (
Plattetal.,1983). In some cases,
the infection can spread to the blood resulting in disseminated gonococcal infection, which
can lead to death (
Centers for Disease Control and Prevention, 2017).
The causal agent: Neisseria gonorrhoeae
Gonorrhea is caused by N. gonorrhoeae, a pathogen affecting humans, belonging to the
proteobacteria group and the Neisseriaceae family. It is nonspore-forming diplococcus,
which means that when viewed under the light microscope the bacteria exist as two bacte-
rial cells joined together
(Shim, 2011; Westling-Haggstrom, Elmros, Normark, & Winblad,
1977)
(Fig. 5.1). Neisseria gonorrhoeae mostly infects genital mucosa but has been found to
affect rectal, pharyngeal, oral and conjunctiva mucosa (
Quillin & Seifert, 2018). The patho-
gen cannot survive outside of the host as it relies on the host to acquire nutrients.
185Background on gonorrhea
Medicinal Plants as Anti-infectives
N. gonorrhoeae is a Gram-negative obligate anaerobic bacterium (Knapp & Clark, 1984).
It, therefore, does not require oxygen to grow but rather carbon dioxide. The pathogen has
a lipooligosaccharide (LOS) as the major component of the outer membrane with a lipid A
inner core (
Arenas, 2012; Christodoulides, 2019). The LOS lacks the repetitive
O-polysaccharide antigen which is found in lipopolysaccharide of other Gram-negative
bacteria (
McSheffrey and Gray-Owen, 2015)(Fig. 5.2). The gonococcal LOS is an immunos-
timulatory molecule which results in inflammation consequently increasing pathogenicity
of the bacteria (
Zhou et al., 2014). Changes in the fatty acid chains of lipid A alters the
pathogenesis and antibiotic susceptibility of N. gonorrhoeae (
Lewis et al., 2009; Liu, John, &
Jarvis, 2010
).
N. gonorrhoeae has a relatively small genome of B2 Mb compared to Escherichia coli with
a genome DNA of B4Mb(
Chung et al., 2008; McSheffrey & Gray-Owen, 2015). The gono-
cocci express pilin and Opa (Opacity-associated protein) genes. Subsequently, these genes
translate to surface proteins that allow adhesion between bacterial and human cells which
heightens the virulence of N. gonorrhoeae (
Ball & Criss, 2013; Griffiss, Lammel, Wang,
Dekker, & Brooks, 1999
). The Opa and pilin genes are subject to phase variation which is
the switching on and off of genes triggered by DNA polymerase slippage while replicating
tandem repeats. The slippage results in the addition or deletion of repeats which can cause
reading frame shifts affecting the resultant protein. Thus N. gonorrhoeae has antigenic vari-
ation that allows the bacteria to evade the host immune systems enabling bacterial persis-
tence and reinfection in a host (
Murphy, Connell, Barritt, Koomey, & Cannon, 1989;
Sadarangani, Pollard, & Gray-Owen, 2011; Yu et al., 2013
).
FIGURE 5.1 Causative agent diplococcus Neisseria gonorrhoeae viewed under the light microscope
(CDC/Renelle Woodall, 1969). Source: Woodall, R. (1969). Photomicrograph of a Gram-stained specimen, revealed
the presence of numerous Gram-negative, diplococcal bacteria that were identified as Neisseria gonorrhoeae.
ID#14855.
https://phil.cdc.gov/Details.aspx?pid 5 14855 (Accessed 2 February 2021).
186 5. The use of South African medicinal plants in the pursuit to treat gonorrhea and other sexually transmitted diseases
Medicinal Plants as Anti-infectives
Pathogenesis of Neisseria gonorrhoeae and evasion of host immune system
Gonococci infections result in prolonged inflammation allowing for persistence and
reinfection of the disease. The initial step in the infection of N. gonorrhoeae involves the
tethering of the bacteria to the genital epithelial cells via pathogen-associated molecular
patterns (PAMPs). The PAMPs involved include pili, LOS, and Opa proteins. The pili
attach to host CD46/complement receptor 3 whilst the LOS binds to asialoglycoprotein
receptor (
McSheffrey & Gray-Owen, 2015; Sadarangani et al., 2011). Additionally, Opa pro-
teins have an affinity for the carcinoembryonic antigen-related cell adhesion molecule
FIGURE 5.2 Virulence factor of Neisseria gonorrhoeae. Difference between lipooligosaccharide (LOS) and lipo-
polysaccharide (LPS) membrane structures in Gram-negative bacteria showing the polysaccharide core and lipid
A found in both molecules. Glu, glucose; GluN, N-glucosamine; kdo, 2-keto-3-deoxyoctinic acid; PEA, dipho-
sphoethanolamine; P, phosphate group.
187Background on gonorrhea
Medicinal Plants as Anti-infectives
family (CEACAM) (Lenz & Dillard, 2018; Sadarangani et al., 2011). The close interaction of
either of these PAMPs and the epithelial cell receptors trigger the endocytosis of the bacte-
rium, which elicits an immune response (
McSheffrey & Gray-Owen, 2015; Wang, Gray-
Owen, Knorre, Meyer, & Dehio, 1998
). N. gonorrhoeae triggers cytokine release which
results in the overzealous recruitment of neutrophils to the site of infection (Criss &
Seifert, 2012; Edwards & Butler, 2011
). Cytokines such as nuclear factor kappa B (NF-κB)
activate signal transduction pathways that induce IL-17 that drives the T
h
17 response,
which recruits neutrophils (
Feinen, Jerse, Gaffen, & Russell, 2010). The gonococci can
evade the host immune system as T
h
17 response that favors the production of IL-10; sup-
presses T cells in adaptive immunity which allows the infection to persist (
Liu, Liu, &
Russell, 2014
). The Opa proteins, within infected tissue, can bind to CEACAM 1 of den-
dritic cells which suppresses maturation of T
1
,T
2
, and B cells (Yu et al., 2013; Zhu et al.,
2012
). The T
1
helper cells are responsible for the killing and clearing of infected cells whilst
T
2
helper cells work in combination with B cells to produce memory cells and antibodies.
The inactivation of this adaptive immunity results in prolonged inflammation, thus gono-
cocci infections are not cleared and the lack of antibodies permits reinfection in indivi-
duals (
Hedges, Mayo, Mestecky, Hook, & Russell, 1999; Hedges, Sibley, Mayo, Hook, &
Russell, 1998
). Opa proteins can also interact with neutrophils via CEACAM 3 resulting in
stimulation of oxidative burst of the bacteria. The fragments of the bacteria can elicit
immune responses in other noninfected cells within the tissue (
Sadarangani et al., 2011;
Sarantis & Gray-Owen, 2007
).
Evasion of host immune system via nutrition immunity
The small genome of N. gonorrhoeae limits the metabolic capacity of the gonococci. Thus
the bacteria rely on host mucosal membranes for nutrition (
Cornelissen, 2018; McSheffrey
& Gray-Owen, 2015
). Naturally, as a host defense mechanism, the body limits nutrients
available to microbes. The available iron in the body is bound to transferrin and lactoferrin
after which is transported and stored in the liver (
Parrow, Fleming, & Minnick, 2013). N.
gonorrhoeae has transferrin (Tbps) and lactoferrin (Lbps) receptors which interact with
transferrin and lactoferrin that have bound iron (
McSheffrey & Gray-Owen, 2015; Parrow
et al., 2013
). This mechanism allows the gonococcal bacteria to acquire iron for metabo-
lism. It has been shown that a defective gonococcal bacterium without both of these recep-
tors eliminates virulence (
Anderson, Hobbs, Biswas, & Sparling, 2003).
Coinfections of Neisseria gonorrhoeae
STDs are acquired via sexual contact and there is a possibility of contracting two infec-
tions simultaneously. Gonorrhea and chlamydia are the most common coinfections in indi-
viduals (
Guy et al., 2015; Leonard, Schoborg, Low, Unemo, & Borel, 2019; Seo, Choi, &
Lee, 2019
). Approximately 50% of gonococcal infections are coupled with chlamydia
(
Creighton, Tenant-Flowers, Taylor, Miller, & Low, 2003; McSheffrey & Gray-Owen, 2015).
Individuals are usually treated for both diseases even though they have contracted one of
the infections. The mechanistic interaction between the two is, however, unknown
(
Leonard et al., 2019).
N. gonorrhoeae can interact with HIV by suppressing the expression of HIV memory
response. The Opa
CEA
protein of N. gonorrhoeae suppresses the maturation of dendritic
188 5. The use of South African medicinal plants in the pursuit to treat gonorrhea and other sexually transmitted diseases
Medicinal Plants as Anti-infectives
cells, which are antigen-presenting cells (APCs) (Yu et al., 2013). These cells are responsi-
ble for activation of the humoral immune response which is activated by APCs, such as
dendritic lymphocytes, wh ich are recognized by T
2
(CD4
1
) helper cells. Consequently,
triggering B lym phocytes maturation into plasma cells that produce antibodies (
Martin-
Gayo & Yu, 2019; Steinman, 1991).
N. gonorrhoeae increases replication of HIV-1 in T cells by activation of 5
0
HIV long termi-
nal repeats. This is because N. gonorrhoeae causes genital epithelial cells to increase the pro-
duction of pro-inflammatory cytokines tumor necrosis factor α and interleukins (IL-6 & 8)
(
Ferreira et al., 2011). The gonococci pilin protein activates NF-κB, which is known to also
escalate HIV replication (
Acchioni et al., 2019; Dietrich et al., 2011). The occurrence of gono-
coccal infections increases the likelihood of individuals to seroconvert to HIV positive
(
Bernstein, Marcus, Nieri, Philip, & Klausner, 2010; McSheffrey & Gray-Owen, 2015; Mlisana
et al., 2012
).
Status of available treatments for gonorrhea
At present, for treatment of gonorrhea a combination of first-line antibiotics, azithromy-
cin, and ceftriaxone/cefixime is recommended (
Ryan, 2017; Wi et al., 2017). The treatment
is given as a single oral/intramuscular dose of ceftriaxone/ce fixime in combination with a
single oral dose of azithromycin (
World Health Organization, 2016b). The therapy is also
used in the treatment of other STDs such as chlamydia that normally exists as coinfections
with gonorrhea (
Belcher & Dawson, 2017).
Ceftriaxone and cefixime are antibiotics classified as third-generation extended-spectrum
cephalosporins (ESC) (
Fig. 5.3). These antibiotics inhibit N. gonorrhoeae by inhibiting the
penicillin-binding proteins (PBP) which are used to make peptidoglycan cross-links in the bac-
terial cell wall (
Unemo, Del Rio, & Shafer, 2016). Azithromycin is a macrolide antibiotic that
inhibits translation by binding to the 50S ribosomal subunit (
Douthwaite and Champney,
2001
).
Azithromycin was first introduced for the treatment of gonorrhea in the 1980s and the
third-generation cephalosporins in the 1990s (
Suay-Garcı
´
a&Pe
´
rez-Gracia, 2018; Unemo
et al., 2016
). These antibiotics were introduced as N. gonorrhoeae had gained resistance to
the then used tetracycline, penicillin, amoxicillin, and fluoroquinolones like ciprofloxacin
(
Ohnishi, Golparian, et al., 2011; Ohnishi, Saika, et al., 2011; Unemo & Nicholas, 2012). In
the 1980s ciprofloxacin and azithromycin were used as the first-line treatments, however,
N. gonorrhoeae gained resistance (
Lewis et al., 2008; Lynagh et al., 2015; Stevens et al., 2014;
Unemo et al., 2016
). The mode of action used by the ciprofloxacin-resistant strains is by
reducing the affinity of DNA gyrase whilst in azithromycin-resistant strains by altering
the 50S ribosomal subunit target (
Unemo & Shafer, 2011, 2014). The escalation in ciproflox-
acin resistance resulted in the abandonment of the regiment for gonorrhea treatment
(
Lewis et al., 2008; Unemo et al., 2016). As the years progressed azithromycin was discour-
aged as a monotherapy due to the resistance that was observed and it was therefore
recommended to be used in combination with cefixime/ceftriaxone (
Bignell et al., 2013).
Azithromycin-resistant strains have been detected in many countries including Australia,
Ireland, and Canada (
Kularatne, Kufa-Chakezha, et al., 2018; Lynagh et al., 2015; Martin
189Status of available treatments for gonorrhea
Medicinal Plants as Anti-infectives
et al., 2019; Stevens et al., 2014; World Health Organisation, 2019). Even though ceftriaxone
and cefixime are used as current regiments, antibiotic resistance has been reported in vari-
ous parts of the world (
Unemo et al., 2016; Wi et al., 2017). According to the National
Institute for Communicable Diseases (NICD) of South Africa, cefixime resistance isolates
have been detected in Cape Town, Gauteng, and the Eastern Cape province (
Kularatne,
Maseko, Gumede, Radebe, & Chakezha, 2017
). Resistance of ESCs in N. gonorrhoeae is by
mutations to the penicillin-binding proteins and also increasing efflux of the ESCs in the
bacterium (
Unemo & Shafer, 2014).Theriseofcephalosporinantibioticresistancehas
resulted in some countries opting to alternatively use spectinomycin or gentamicin in
combination with azithromycin (
Australasia Sexual Alliance, 2019; Bignell et al., 2013;
Public Health Canada, 2017; Suay-Garcı
´
a&Pe
´
rez-Gracia, 2018; World Health
Organisation, 2019
).
The upsurge of ESC resistance has been a concern as there is now an emergence of
multidrug resistant (MDR) and extensively drug-resistant (XDR) N. gonorrhoeae (
Alirol
et al., 2017; Mart in et al., 2019
). Bacterial isol ates tha t h ave res istance to at least two of
the currentl y recommended therapeu tics, as well as resistance to at least two of peni-
cillin, tetracycline, erythromycin, or ciprofloxacin, are categorized as XDR strains
(
Martin et al., 2019). On the other hand, MDR bacterial strains have resistance to at
least one current recommended therapy and resistance to at least two other antibiotics
(penicillin, tetracycline, erythromycin, or ciprofloxacin). Treatment failures of both
FIGURE 5.3 First-line drugs. Structure of (A) ceftriaxone; (B) cefixime; and (C) azithromycin.
190 5. The use of South African medicinal plants in the pursuit to treat gonorrhea and other sexually transmitted diseases
Medicinal Plants as Anti-infectives
azithromycin and ESCs toward XDR N. gonorrhoeae have been reported (Martin et al.,
2019
). The first of such cases were reported in Australia and the United Kingdom
(
Australian Government Department of Health, 2018; European Centre for Disease
Prevention and Control, 2018; Public Health England, 2018
). Recently some XDR iso-
lates have been detected in Canada as well (Martin et al., 2019). The heightened antibi-
otic resistance observed in N. gonorrhoeae globally has resulted in the WHO placing it
on the global priority list level 2 (
World Health Organization, 2017). The emergence of
XDR N. gonorrhoeae isolates thus puts a burden on the available antibiotics by reducing
their efficiency (
Crowther-Gibson et al., 2011). This, therefore, prompts the need for
TABLE 5.2 Selected South African medicinal plants used traditionally for the treatment of sexually
transmitted diseases.
Plant species Family Parts used References
Tabernaemontana
elegans*
Apocynaceae Leaves/roots
De Wet et al. (2012)
Catharanthus roseus* Apocynaceae Roots Mongalo and Makhafola (2018), Semenya, Potgieter,
Johannes, and Erasmus (2013)
Aloe ferox* Asphodelaceae Leaves Van Wyk, Van Oudtshoorn, and Gericke (2017)
Aloe marlothii Asphodelaceae Leaves De Wet et al. (2012)
Helichrysum
caespitatum*
Asteraceae Whole plant Semenya, Potgieter, and Erasmus (2013)
Senecio serratuloides* Asteraceae Whole plant De Wet et al. (2012), Semenya, Potgieter, and Erasmus
(2013)
, Semenya, Potgieter, Johannes et al. (2013)
Helichrysum
populifolium
Asteraceae Leaves De Wet et al. (2012)
Elaeodendron
transvaalense
Celastraceae Roots Mabogo (1990), Semenya, Potgieter, and Erasmus
(2013)
Terminalia sericea Combretaceae Roots/stem bark Mongalo and Makhafola (2018)
Combretum molle* Combretaceae Leaves/roots De Wet et al. (2012), Fyhrquist et al. (2002)
Dioscorea sylvatica* Dioscoreaceae Bulb Semenya, Potgieter, and Erasmus (2013), Semenya,
Potgieter, Johannes et al. (2013)
Diospyros lycioides* Ebenaceae Roots Semenya, Potgieter, Johannes et al. (2013)
Jatropha zeyheri* Euphorbiaceae Roots Mongalo and Makhafola (2018), Semenya, Potgieter,
Johannes et al. (2013)
Cassia abbreviata* Fabaceae Roots/stem bark Mongalo and Makhafola (2018)
Senna italica* Fabaceae Root Chauke, Shai, Mogale, Tshisikhawe, and Mokgotho
(2015)
Albizia adianthifolia* Fabaceae Leaves De Wet et al. (2012)
(Continued)
191Status of available treatments for gonorrhea
Medicinal Plants as Anti-infectives
drug discovery to produce new and alternative therapies for the treatment of
gonorrhea.
Selected South African plants used in traditional medicine for the treatment of
sexually transmitted diseases and their bioactivity
The antibiotic resistance burden has consequently brought plants into the limelight for
drug development for gonorrhea and other STDs (
Palmeira-de-Oliveira, Silva, Palmeira-
de-Oliveira, Martinez-de-Oliveira, & Salgueiro, 2013). Plants have been reported to have a
vast diversity in chemistry and they have been used throughout history in folk medicine
by traditional healers worldwide (
De Wet, Nzama, & Van Vuuren, 2012; Palmeira-de-
Oliveira, Silva, Palmeira-de-Oliveira, Martinez-de-Oliveira, & Salgueiro, 2013; Yang et al.,
2012
). Tab le 5.2 provides a summary of some of the South African medicinal plants used
in traditional medicine for the treatment of venereal diseases including gonorrhoea. In the
section below selected plants are discussed further in detail with emphasis on their bioac-
tivity and in vitro studies that have been conducted. In general, for antimicrobial studies,
a plant extract is considered to have noteworthy activity if the minimum inhibitory con-
centration (MIC) is below 1 mg/ml (
Ndhlala et al., 2013; van Vuuren, 2008).
Aloe ferox
Aloe ferox Mill. (bitter aloe) belongs to the Asphodelaceae family of plants (Semenya, Potgieter,
& Erasmus, 2013; Semenya, Potgieter, Johannes, et al., 2013; Van Wyk et al., 2017)(Fig. 5.4). It is
TABLE 5.2 (Continued)
Plant species Family Parts used References
Elephantorrhiza
elephantina
Fabaceae Roots
Mongalo and Makhafola (2018), Semenya, Potgieter,
Johannes et al. (2013)
Burkea africana Fabaceae Roots Semenya, Potgieter, Johannes et al. (2013)
Pelargonium spp. Geraniaceae Roots Semenya, Potgieter, and Erasmus (2013), Semenya,
Potgieter, Johannes et al. (2013)
Hypoxis
hemerocallidea*
Hypoxidaceae Bulb Mongalo and Makhafola (2018), Semenya, Potgieter,
and Erasmus (2013)
Hypoxis obtusa* Hypoxidaceae Roots Semenya, Potgieter, and Erasmus (2013)
Ximenia caffra* Olacaceae Roots Chauke et al. (2015), De Wet et al. (2012), Mongalo and
Makhafola (2018)
Peltophorum
africanum*
Rhamnaceae Roots/stem bark Mongalo and Makhafola (2018), Semenya, Potgieter,
and Erasmus (2013)
Ziziphus mucronata* Rhamnaceae Roots Semenya, Potgieter, and Erasmus (2013), Semenya,
Potgieter, Johannes et al. (2013)
Note: *Plants used to treat gonorrhea and have been reported to have antigonococcal activity.
192 5. The use of South African medicinal plants in the pursuit to treat gonorrhea and other sexually transmitted diseases
Medicinal Plants as Anti-infectives
used in South African traditional medicine for the treatment of arthritis, conjunctivitis, eczema,
hypertension, STDs, stress, and venereal sores. Related species Aloe marlothii,A.Berger,andAloe
vera (L.) Burm.f. are also used in phytomedicine for treatment of STDs including HIV (
Semenya
et al., 2013
). The fleshy leaves are made into a decoction for the treatment of STDs such as gonor-
rhoea and syphilis (
Van Wyk et al., 2017).
FIGURE 5.4 Four South African plants used to treat gonorrhea: (A) Aloe ferox,(B)Cassia abbreviata,(C)Combretum
molle,(D)Hypoxis hemerocallidea. Source: From BotBin. (2005). Habitus, leaves and inflorescence. Species: Hypoxis
hemerocallidea Fisch. & C.A. Mey. Genus: Hypoxis. Family: Hypoxidaceae. Location: Berlin Botanical Gardens
Berlin-Dahlem.
https://commons.wikimedia.org/wiki/File:Hypoxis_hemerocallidea_BotGardBln1105InflorescenceHabitus.
JPG
. Gregory, D. (2007). Aloe ferox on R61 route between Cofimvaba and Ngcobo. https://commons.wikimedia.org/
wiki/File:Aloe_Ferox_between_Cofimvaba_and_Ngcobo.jpg
. Jeppetown. (2010). Sjambok Pod (Cassia abbreviata). https://com-
mons.wikimedia.org/wiki/File:Cassia_abbreviata_1.jpg
. Rotational. (2007). Combretum molle R. Br. ex G. Don. Fruit and
foliage of a Velvet bushwillow, at Hamerkop Kloof, Magaliesberg, South Africa. https://commons.wikimedia.org/wiki/
File:Combretum_molle00.jpg.
193Selected South African plants used in traditional medicine for the treatment of sexually
Medicinal Plants as Anti-infectives