Patient perspectives on vulvovaginal candidiasis

The 4 most frequently cited risk factors for VVC and RVVC were antibiotic use (37.8%); intercourse (21.6%); hormone-induced conditions like pregnancy, use of oral contraceptives and hormone replacement therapy (13.7%); and humid weather (11.3%).¹

In addition, 55.4% of respondents noted that their VVC episodes had no known cause. These idiopathic attacks were unexpectedly reported by similar proportions of women: 51.2% with a history of VVC and 62.9% with a history of RVVC.

Business cards containing online survey information were distributed to healthy volunteers and patients seeking standard, elective or referral gynecologic care at four university-affiliated ob-gyn clinics in Louisiana, Michigan, and Pennsylvania.

The questionnaire was completed between February 2016 and May 2018 by 284 nonpregnant women: 78% White, 14% Black, and 8% Asian.

Participants were roughly equally divided between those of reproductive age and those within perimenopausal or postmenopausal age.

Overall, 78% of participants indicated a history of VVC, with 34% defined as having RVVC.

Other common features of symptomatic VVC and RVVC episodes were vaginal discharge described as thick, white or cottage cheese-like (55.6%), pain during intercourse (40.5%), vaginal pain (38.1%), and vaginal dryness (29.3%).

The survey also found a moderate association of VVC and RVVC incidence to the use of feminine hygiene products (10.8%), a new sexual partner (8.3%), and receptive oral sex (6.9%). Less than 3% of cases were reported as diabetes related.

In total, 72.9% of VVC and RVVC episodes were physician-diagnosed, with 71.7% of physician-diagnosed attacks using a combination of pelvic examination and laboratory tests, followed by prescribed antifungals. But 28.3% of women reported that physician diagnosis was based upon a pelvic examination alone.

Following physician diagnosis, 66.5% of VVC cases were treated with oral or topical antifungal medications prescribed by the physician, while only 7.5% of cases were treated with over-the-counter (OTC) antifungal medications as instructed by the physician.

The remaining 27.1% of VVC and RVVC episodes were self-diagnosed without seeking medical care and treated with OTC medications.

Physician-treated cases achieved an 84% symptom-relief success rate compared to 57% who self-medicated.

Overall, 71% of women with RVVC required continual or long-term antifungal medication as maintenance therapy to control symptoms.

“Current patient perspectives closely reflect historically documented estimates of VVC/RVVC prevalence and trends regarding symptomatology, disease management and post-treatment outcomes,” wrote the authors.

They noted, however, that over the past 30-plus years there has not been any significant reduction in lifetime or annual prevalence rates of VVC, despite several new drugs and effective maintenance therapies for RVVC.

At least 1 review, published in The LANCET Infectious Diseases in 2018, predicted an upward trend in RVVC cases by 2030.2

This lack of progress is disheartening, according to the current authors, in part because of all the available data about the pathogenesis of disease and potential immunotherapeutic strategies.

“On the positive side, the fact that VVC and RVVC appear to manifest a similar, if not identical, clinical pathology suggests that any diagnostic or immunotherapeutic advances will benefit either condition,” they wrote.

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References

1. Yano J, Sobel JD, Nyirjesy P, et al. Current patient perspectives of vulvovaginal candidiasis: incidence, symptoms, management and post-treatment outcomes. BMC Womens Health. Published online March 29, 2019. doi:10.1186/s12905-019-0748-8.
2. Denning DW, Kneale M, Sobel JD, et al. Global burden of recurrent vulvovaginal candidiasis: a systematic review. Lancet Infect Dis. 2018;18(11):e339–ee47. doi:10.1016/S1473-3099(18)30103-8