Current patient perspectives of vulvovaginal candidiasis: incidence, symptoms, management and post-treatment outcomes

Abstract

Background: Vulvovaginal candidiasis (VVC) is a common infection affecting women worldwide. Reports of patterns/risk factors/trends for episodic/recurrent VVC (RVVC) are largely outdated. The purpose of this study was to obtain current patient perspectives of several aspects of VVC/RVVC.

Methods: Business cards containing on-line survey information were distributed to healthy volunteers and patients seeking standard, elective, or referral gynecologic care in university-affiliated Obstetrics/Gynecology clinics. The internet-based questionnaire was completed by 284 non-pregnant women (78% Caucasian, 14% African American, 8% Asian).

Results: The majority of the participants (78%) indicated a history of VVC with 34% defined as having RVVC. The most common signs/symptoms experienced were itching, burning and redness with similar ranking of symptoms among VVC and RVVC patients. Among risk factors, antibiotic use ranked highest followed by intercourse, humid weather and use of feminine hygiene products. A high number of respondents noted 'no known cause' (idiopathic episodes) that was surprisingly similar among women with a history of either VVC or RVVC. VVC/RVVC episodes reported were primarily physician-diagnosed (73%) with the remainder mostly reporting self-diagnosis and treating with over-the-counter (OTC) medications. Most physician-diagnosed attacks utilized a combination of pelvic examination and laboratory tests followed by prescribed antifungals. Physician-treated cases achieved a higher level of symptom relief (84%) compared to those who self-medicated (57%). The majority of women with RVVC (71%) required continual or long-term antifungal medication as maintenance therapy to control symptoms.

Conclusions: Current patient perspectives closely reflect historically documented estimates of VVC/RVVC prevalence and trends regarding symptomatology, disease management and post-treatment outcomes.

Keywords: Candida albicans; Disease management; Epidemiology; Incidence rates; RVVC; Risk factors; Symptomatology; VVC; Vaginitis; Vulvovaginal candidiasis.

Fig. 1

Prevalence of VVC/RVVC and distribution of lifetime/annual frequencies of infection. a Lifetime history of VVC in participating women (n = 284, pie chart) was assessed by a self-reported survey. Total VVC episodes in respondents with disease history were further stratified by lifetime frequencies (n = 204, bar chart). b Respondents with previous VVC episodes were classified by annual frequencies (n = 202, pie chart), and those with annual frequencies of > 3 VVC episodes were further stratified by age (n = 70, bar chart). The percentage in each section indicates the proportion of women among those who reported answers to each parameter. Data were analyzed by Fisher’s exact test for binomial proportions comparing two populations of women categorized by the dashed lines. NS, not significant

Fig. 2

Methods of disease diagnoses and management in women seeking treatment for vaginitis. a The process of diagnosing vaginitis conditions by participating women (n = 214, pie chart) was assessed by a self-reporting survey. Methods of physician-based diagnoses used in respondents seeking medical care were further classified (n = 152, bar chart). b The respondents who underwent antifungal treatment (n = 212) were categorized based on diagnostic and therapeutic approaches. The percentage in each section indicates the proportion of women among those who reported answers to each parameter. Data (A, pie chart) were analyzed by Fisher’s exact test for a binomial proportion comparing two populations of women opting for physician-based diagnosis and self-diagnosis/other (dashed lines). OCT, over-the-counter (non-prescription)