Original research
Over-the-counter antifungal drug misuse associated with patient-diagnosed vulvovaginal candidiasis1 ☆,

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Abstract

OBJECTIVE:

To estimate what proportion of symptomatic women purchasing over-the-counter antifungal products for immediate treatment of presumed vulvovaginal candidiasis have vulvovaginal candidiasis or other genitourinary conditions.

METHODS:

A time-location sample of 95 symptomatic women who purchased and presented with an over-the-counter antifungal product for immediate and personal treatment of presumed vulvovaginal candidiasis were evaluated by clinical examination and pertinent laboratory tests. The percentage of women diagnosed having vulvovaginal candidiasis or other conditions, proportions of women with vulvovaginal candidiasis compared between groups with and without a prior diagnosis of vulvovaginal candidiasis, and groups that read or did not read the over-the-counter package label were assessed.

RESULTS:

The actual diagnoses for women who self-diagnosed vulvovaginal candidiasis were: vulvovaginal candidiasis 33.7%, bacterial vaginosis 18.9%, mixed vaginitis 21.1%, normal 13.7%, other diagnoses 10.5%, and trichomonas vaginitis 2.1%. Women with a previous clinically based diagnosis of vulvovaginal candidiasis were not more accurate in diagnosing vulvovaginal candidiasis than women without a prior clinical diagnosis (χ2 = 0.27, P = .6). Women who read the package label were no more likely to have vulvovaginal candidiasis than were women who did not read the label (Fisher exact test, P = .39).

CONCLUSION:

Many women who self-diagnose and use an over-the-counter product for treatment of presumed vulvovaginal candidiasis do not have vulvovaginal candidiasis. A history of a previous clinically based diagnosis of vulvovaginal candidiasis and reading the package label do not help women self-diagnose vulvovaginal candidiasis properly. Ready access to these products is associated with wasted financial expenditures, unfulfilled expectations, and a delay in correct diagnosis for a substantial number of women.

Section snippets

Materials and methods

Women 18 years of age and older who purchased an over-the-counter product for treatment of self-diagnosed vulvovaginal candidiasis at pharmacies and grocery stores in the metropolitan areas of Augusta, Georgia, Philadelphia, Pennsylvania, Detroit Michigan, Charleston, South Carolina, and Omaha, Nebraska, were referred for enrollment in the study between September 1997 and December 1999. Subjects were included if they: 1) had symptoms which prompted them to purchase an over-the-counter

Results

Of 104 women enrolled in the study, complete data were available for 95 who presented with a self-diagnosis of vulvovaginal candidiasis and intended to use the product immediately for themselves. The mean age of subjects was 36.6 years, and the range was 18–67 years. The majority (53.7%) of subjects was black, 40.0% were white, and 6.3% were Hispanic or Asian. With respect to marital status, 39.0% of women were married, 36.8% single, 17.9% divorced, and 6.3% separated or widowed. The majority

Discussion

We determined that approximately one-third of women who self-diagnosed a vulvovaginal candidiasis infection and purchased an over-the-counter product to treat their condition actually had vulvovaginal candidiasis confirmed by a nearly immediate clinical and laboratory examination. An additional 20% of women had vulvovaginal candidiasis, but also with another type of vaginitis. Self-treatment with an over-the-counter antifungal product will generally cure vulvovaginal candidiasis in women with

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    ☆

    This study was supported by an unrestricted grant from Pfizer, Inc., New York, New York. 3M Pharmaceuticals, St. Paul, Minnesota, supplied free samples of Metrogel-Vaginal.

    1

    Special thanks to Betsy Foxman, PhD, for trial design guidance and manuscript review. Saundra Turner, FNP, PhD, and Lisa Woodward, RN, provided clinical trial support.

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    Copyright © 2002 The American College of Obstetricians and Gynecologists. Published by Elsevier Inc. All rights reserved.