1
|
Ford T, Talbot A, Hayward G, Tonkin-Crine S, Ziebland S, McNiven A. Managing recurrent vulvovaginal thrush from patient and healthcare professional perspectives: A systematic review and thematic synthesis. PATIENT EDUCATION AND COUNSELING 2024; 118:108004. [PMID: 37826917 DOI: 10.1016/j.pec.2023.108004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/28/2023] [Accepted: 10/05/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE This systematic review aims to identify what is known about patient and healthcare professional experiences of managing recurrent vulvovaginal thrush by synthesising published findings. METHODS Five databases were searched for studies on patient and healthcare professional experiences managing recurrent thrush. Two reviewers independently screened and quality assessed qualitative, quantitative, and mixed-methods studies. Findings from eligible studies were thematically synthesised. RESULTS 720 papers were identified, and 29 were included. Four descriptive themes were developed to depict the repeated management of recurrent thrush. These themes were: (re)experiencing impacts, (re)identifying recurrent thrush, (re)considering consultations, and (re)trying treatments. An analytic high-order frame of 'interwoven and reoccurring uncertainties' was used to understand these themes. CONCLUSIONS Patients and healthcare providers face uncertainties when managing recurrent thrush. The inconsistencies raised across papers suggests an unaddressed gap in knowledge about patient experiences and their informational and support needs; this includes insights about this condition's diagnosis, management, treatment, impacts, and meaning. PRACTICE IMPLICATIONS This review has implications for patient education, health promotion, and communication between patients and providers. Our interpretations suggest the need for more research and resources to help support patients and clinicians in managing this condition to promote more understanding, communication, and collaborative care.
Collapse
Affiliation(s)
- Tori Ford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Amelia Talbot
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Gail Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sarah Tonkin-Crine
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Abigail McNiven
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
2
|
Roselletti E, Pericolini E, Nore A, Takacs P, Kozma B, Sala A, De Seta F, Comar M, Usher J, Brown GD, Wilson D. Zinc prevents vaginal candidiasis by inhibiting expression of an inflammatory fungal protein. Sci Transl Med 2023; 15:eadi3363. [PMID: 38055800 PMCID: PMC7616067 DOI: 10.1126/scitranslmed.adi3363] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 11/15/2023] [Indexed: 12/08/2023]
Abstract
Candida causes an estimated half-billion cases of vulvovaginal candidiasis (VVC) every year. VVC is most commonly caused by Candida albicans, which, in this setting, triggers nonprotective neutrophil infiltration, aggressive local inflammation, and symptomatic disease. Despite its prevalence, little is known about the molecular mechanisms underpinning the immunopathology of this fungal infection. In this study, we describe the molecular determinant of VVC immunopathology and a potentially straightforward way to prevent disease. In response to zinc limitation, C. albicans releases a trace mineral binding molecule called Pra1 (pH-regulated antigen). Here, we show that the PRA1 gene is strongly up-regulated during vaginal infections and that its expression positively correlated with proinflammatory cytokine concentrations in women. Genetic deletion of PRA1 prevented vaginal inflammation in mice, and application of a zinc solution down-regulated expression of the gene and also blocked immunopathology. We also show that treatment of women suffering from recurrent VVC with a zinc gel prevented reinfections. We have therefore identified a key mediator of symptomatic VVC, giving us an opportunity to develop a range of preventative measures for combatting this disease.
Collapse
Affiliation(s)
- Elena Roselletti
- Medical Research Council Centre for Medical Mycology at The University of Exeter, University of Exeter, Geoffrey Pope Building Stocker Road, Exeter, UK, EX4 4QD
| | - Eva Pericolini
- Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy, 41125
| | - Alexandre Nore
- Medical Research Council Centre for Medical Mycology at The University of Exeter, University of Exeter, Geoffrey Pope Building Stocker Road, Exeter, UK, EX4 4QD
| | - Peter Takacs
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary, 4032
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA, 23507
| | - Bence Kozma
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary, 4032
| | - Arianna Sala
- Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy, 41125
| | - Francesco De Seta
- Department of Medical Sciences, University of Trieste, Institute for Maternal and Child Health-IRCCS, Burlo Garofolo, Trieste, Italy, 34137
| | - Manola Comar
- Unit of Advanced Microbiology Diagnosis and Translational Research, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, University of Trieste, Trieste, Italy, 34137
| | - Jane Usher
- Medical Research Council Centre for Medical Mycology at The University of Exeter, University of Exeter, Geoffrey Pope Building Stocker Road, Exeter, UK, EX4 4QD
| | - Gordon D Brown
- Medical Research Council Centre for Medical Mycology at The University of Exeter, University of Exeter, Geoffrey Pope Building Stocker Road, Exeter, UK, EX4 4QD
| | - Duncan Wilson
- Medical Research Council Centre for Medical Mycology at The University of Exeter, University of Exeter, Geoffrey Pope Building Stocker Road, Exeter, UK, EX4 4QD
| |
Collapse
|
3
|
Dong Y, Chen M, Wu Y. Effects of social norms and message framing on reducing the stigma of gynecological diseases: A cognitive-affective-behavioral model. Appl Psychol Health Well Being 2023; 15:1221-1236. [PMID: 36539383 DOI: 10.1111/aphw.12433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
This paper presents an experiment exploring message strategies to reduce the stigma of gynecological diseases and promote women's sexual and reproductive health. Drawing on the cognitive-affective-behavioral model of stigma, we propose that social norms and message framing as two message strategies, respectively, address the cognitive and affective components of the stigma of gynecological diseases, which lead to desired changes in the help-seeking intention as the behavioral component. We conducted a 3 (no norm vs. descriptive norm vs. descriptive plus injunctive norms) by 2 (gain-framed vs. loss-framed) between-subject experiment (N = 202). The results reveal that messages with the combination of descriptive and injunctive norms reduce the greatest cognitive components of stigma. Gain-framed messages induced fewer affective components than loss-framed ones. The results suggest that changes in the cognitive and affective components of stigma may sequentially lead to favorable changes in the behavioral component. This study contributes to public understanding of the stigma of gynecological diseases by disentangling the various components and identifying the specific message strategies for stigma reduction.
Collapse
Affiliation(s)
- Yujie Dong
- School of Media and Communication, Shanghai Jiao Tong University, Shanghai, China
| | - Meng Chen
- School of Media and Communication, Shanghai Jiao Tong University, Shanghai, China
| | - Yuheng Wu
- School of Media and Communication, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
4
|
Lietz A, Eckel F, Kiss H, Noe-Letschnig M, Farr A. Quality of life in women with chronic recurrent vulvovaginal candidosis: A sub-analysis of the prospective multicentre phase IIb/III Prof-001 study. Mycoses 2023. [PMID: 37147720 DOI: 10.1111/myc.13602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/27/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Chronic recurrent vulvovaginal candidosis (RVVC), defined as three or more episodes of vulvovaginal candidosis per year, significantly impairs quality of life (QoL) and sexual health. OBJECTIVES The primary objective of this study was to assess health-related QoL in women with RVVC using validated questionnaires before and after treatment. The secondary objective was to analyse the effect of RVVC on women's sexual health. PATIENTS/METHODS This was a sub-analysis of a randomised, controlled, double-blinded study titled 'A phase IIb/III, parallel-arm, randomized, active-controlled, double-blind, double-dummy, multicenter, non-inferiority study in patients with recurrent vulvovaginal candidosis to compare the clinical efficacy, safety and tolerability of topically administered ProF-001 (Candiplus®) to oral fluconazole, which was conducted at 35 study sites in Austria, Poland and Slovakia. QoL was assessed using the European Quality of Life (EQ) five-dimension five-level scale (EQ-5D-5L) and visual analogue scale (EQ-VAS) questionnaires, followed by specific questions regarding sexuality. RESULTS From 2019 to 2021, 360 of 432 (83.3%) women with RVVC had accomplished a 6-months maintenance treatment and were enrolled in this sub-analysis. The EQ-5D-5L and EQ-VAS scores demonstrated improved QoL in 137 (65.2%) and 159 (75.4%) women after 6 months of maintenance treatment. Each individual aspect of sexual health significantly improved (all p < .05). A reduction in pain frequency during or after sexual intercourse in the 6-month period occurred in 124 (66.3%) women. CONCLUSIONS Women with RVVC had high QoL and sexual health impairment; however, a 6-months maintenance treatment resulted in effective improvement in QoL and sexual health.
Collapse
Affiliation(s)
- Andrea Lietz
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University Vienna, Vienna, Austria
| | - Fanny Eckel
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Herbert Kiss
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Alex Farr
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
5
|
Brusselmans J, De Sutter A, Devleesschauwer B, Verstraelen H, Cools P. Scoping review of the association between bacterial vaginosis and emotional, sexual and social health. BMC Womens Health 2023; 23:168. [PMID: 37029382 PMCID: PMC10080849 DOI: 10.1186/s12905-023-02260-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/06/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Bacterial vaginosis (BV) is a condition that, if symptomatic, is characterized by discharge and odor, with high recurrence rates even when treated. This study aims to review what literature exists on the association between BV and the emotional, sexual, and social health of women. METHODS MEDLINE, Embase and Web of Science databases were searched from inception until November 2020. Studies reporting an association between women's emotional, sexual and/or social health and symptomatic BV in a qualitative and/or quantitative manner were included. Selected studies were divided in three categories, i.e. reporting on the emotional, sexual and/or social association. All studies were critically evaluated and discussed. RESULTS Sixteen studies were included. Concerning emotional health, we found eight studies that calculated the association between stress and BV, in four this was statistically significant. Four qualitative studies on emotional health showed that the severity of the symptoms influenced the impact on women's lives. All studies on sexual health reported that many women experienced an impact on their relationship and sexual intimacy. Results for social life ranged from no association found to most of the study population showing avoidance behavior. CONCLUSION This review shows that symptomatic BV can be associated with diminished emotional, sexual, and social health, but there is too little evidence to state the extent of this association.
Collapse
Affiliation(s)
- Judith Brusselmans
- Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, Ghent, 9000, Belgium.
| | - An De Sutter
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, Ghent, 9000, Belgium
| | - Brecht Devleesschauwer
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Hans Verstraelen
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Piet Cools
- Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, Ghent, 9000, Belgium
| |
Collapse
|
6
|
Dong Y. "Premature" Girls with "Illegitimate" Diseases: A Qualitative Exploration of the Stigma of Gynecological Diseases for Unmarried Young Women in China. JOURNAL OF HEALTH COMMUNICATION 2023; 28:111-120. [PMID: 36855814 DOI: 10.1080/10810730.2023.2185322] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Stigma has been a prominent barrier in women's pursuit of better sexual and reproductive health (SRH). Specifically, evidence supports the stigmatization of gynecological diseases (GDs) for unmarried young women. Drawing upon the model of social identity threats, this study explored the GD stigma and social identity threats faced by unmarried young women in China with 26 in-depth interview data. The interpersonal, socio-cultural, and intrapersonal layers of GD stigma were identified. First, participants' disclosure and concealment of GDs concerning different significant others were contrasted as an interpersonal layer and voluntary response to social identity threats. In participants' GD experiences, peers stood out for providing emotional, tangible, and informational support, while parents were most often avoided for anticipated stigma. Second, collective representations of GDs and the cultural rationale in the socio-cultural layer were probed. The traditional and modernized sexual norms centering on the legitimacy of premarital sex and SRH knowledge were unveiled. At last, the interpersonal layer was identified. Unmarried young patients suffered social identity threats regarding their independence, sexual agency, and bodily awareness. This is one of the first studies that investigated the underappreciated GD stigma in China. Theoretical and practical implications are discussed.
Collapse
Affiliation(s)
- Yujie Dong
- School of Media and Communication, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
7
|
Thomas-White K, Navarro P, Wever F, King L, Dillard LR, Krapf J. Psychosocial impact of recurrent urogenital infections: a review. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231216537. [PMID: 38099456 PMCID: PMC10725120 DOI: 10.1177/17455057231216537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 07/12/2023] [Accepted: 08/18/2023] [Indexed: 12/18/2023]
Abstract
Recurrent urogenital infections such as bacterial vaginosis, vulvovaginal candidiasis, and urinary tract infections have a high prevalence and pronounced psychosocial impact. However, no review has compared the psychosocial impacts across infection types. This narrative review discusses the impact of common recurrent urogenital infections on psychosocial aspects, including quality of life, stress, mental health, sexual health, work productivity, race and ethnicity, and satisfaction of medical care. Validated questionnaires show that women with recurrent vulvovaginal candidiasis and urinary tract infections have decreased scores on all aspects of quality of life. Those with recurrent vulvovaginal candidiasis and urinary tract infections show lower mental health scores compared to the general population, with increased risk of anxiety and depression. Recurrent urogenital infections affect sexual relationships and intimacy, including avoidance due to symptoms or as a method of prevention. Recurrent infections also increase medical cost and negatively affect work productivity, leading to a combined estimated cost of over US$13 billion per year. There are clear effects of racial inequality involving minority populations that affect diagnosis, treatment, prevalence, and reporting of recurrent urogenital infections. Satisfactory medical treatment improves quality of life and mental health in those suffering from these conditions. Research evaluating psychosocial aspects of recurrent urogenital infections is variable and is not comparable across vulvovaginal conditions. Even so, psychosocial factors are important in understanding contribution and consequence of urogenital infections. Education, awareness, normalization, community support, and access to care can help to alleviate the negative implications of recurrent urogenital infections.
Collapse
Affiliation(s)
| | | | | | | | - Lillian R Dillard
- Department of Biochemistry and Molecular Genetics, University of Virginia, Charlottesville, VA, USA
| | - Jill Krapf
- The Centers for Vulvovaginal Disorders, Washington, DC, USA
| |
Collapse
|
8
|
Bradfield Strydom M, Walpola RL, McMillan S, Khan S, Ware RS, Tiralongo E. Lived experience of medical management in recurrent vulvovaginal candidiasis: a qualitative study of an uncertain journey. BMC Womens Health 2022; 22:384. [PMID: 36123738 PMCID: PMC9487134 DOI: 10.1186/s12905-022-01973-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 09/09/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Recurrent vulvovaginal candidiasis (RVVC) is experienced by up to 10% of pre-menopausal women globally, yet there is limited research exploring the perspective of women living with this challenging condition.
Methods
Semi-structured interviews with Australian women experiencing RVVC were conducted between April–July 2021. Interviews were transcribed verbatim, and qualitative interpretative phenomenological analysis (IPA) was conducted.
Results
Ten RVVC patients were interviewed. IPA revealed an uncertain journey living with RVVC for all participants ranging from initial symptoms and difficulties in obtaining a diagnosis, the trial and error of symptom management, to the overall debilitating impact of living with a personal and intimate health condition. Four key themes were identified: Theme 1 outlined challenges and delays in diagnosis and clinically appropriate management. Theme 2 found that health care professional (HCP) knowledge limitations impacted RVVC management. Theme 3 illustrated the consequences of a lack of HCP support leading to self-referral and self-education. Theme 4 details the significant emotional and psycho-social repercussions of RVVC.
Conclusions
This debilitating, life-long disease has a prolonged effect on women both physically and psychologically. Living with RVVC seems an uncertain journey that, to a large degree, women feel they must navigate alone. While resilience and self-empowerment were noted, better support through evidence-based treatment options, educated and evidence-informed HCPs and a sympathetic social support network is needed to decrease the disease burden. Future clinical management guidelines and patient support need to consider the findings of this study.
Collapse
|
9
|
Cherenack EM, Sikkema KJ. Puberty- and Menstruation-Related Stressors Are Associated with Depression, Anxiety, and Reproductive Tract Infection Symptoms Among Adolescent Girls in Tanzania. Int J Behav Med 2022; 29:160-174. [PMID: 34195917 DOI: 10.1007/s12529-021-10005-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Puberty and menstruation are significant stressors for adolescent girls and young women in low-resource settings in sub-Saharan Africa. However, little is known about the impact of these stressors on girls' mental health and reproductive health. METHODS In 2018, a cross-sectional self-report survey was conducted with 581 adolescent girls and young women between 13 to 21 years old who had reached menarche and were attending secondary school in Moshi, Tanzania. Structural equation modeling was used to examine the relationships of puberty-related stressors and menstruation-related stressors (menstrual deficits, movement/activity difficulties, and menstrual symptoms) to depression, anxiety, and the likelihood of reporting reproductive tract infection (RTI) symptoms. RESULTS Puberty-specific stressors, menstrual symptoms, and menstrual deficits were associated with depression and anxiety. Movement/activity difficulties were associated with anxiety. Increases in menstrual symptoms, menstrual deficits, puberty stressors, and depression were associated with an increased likelihood of reporting a lifetime RTI. However, the relationship of puberty stressors and depression with RTIs was no longer significant in two of three models after correcting for Type I error. CONCLUSIONS Overall, puberty- and menstruation-related stressors were associated with mental health and symptoms of reproductive tract infections. This suggests there is an important relationship between stressors specific to adolescent girls and young women during puberty, mental health, and reproductive health. There is a need for adolescent-tailored interventions to reduce the negative impact of stressors among girls transitioning through puberty in sub-Saharan Africa.
Collapse
Affiliation(s)
- Emily M Cherenack
- Department of Psychology and Neuroscience, Duke Global Health Institute, Duke University, 417 Chapel Drive, Durham, NC, 27708, USA.
| | - Kathleen J Sikkema
- Department of Psychology and Neuroscience, Duke Global Health Institute, Duke University, 417 Chapel Drive, Durham, NC, 27708, USA
- Department of Sociomedical Sciences, Columbia University, 722 W 168th Street, New York, NY, 10032, USA
| |
Collapse
|
10
|
Denning DW, Kneale M, Sobel JD, Rautemaa-Richardson R. Global burden of recurrent vulvovaginal candidiasis: a systematic review. THE LANCET. INFECTIOUS DISEASES 2018; 18:e339-e347. [PMID: 30078662 DOI: 10.1016/s1473-3099(18)30103-8] [Citation(s) in RCA: 265] [Impact Index Per Article: 44.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 11/28/2017] [Accepted: 12/19/2017] [Indexed: 01/10/2023]
Abstract
Recurrent vulvovaginal candidiasis is a debilitating, long-term condition that can severely affect the quality of life of affected women. No estimates of the global prevalence or lifetime incidence of this disease have been reported. For this systematic review, we searched PubMed, Embase, and Web of Science databases for population-based studies published between 1985 and 2016 that reported on the prevalence of recurrent vulvovaginal candidiasis, defined as four or more episodes of the infection every year. We identified 489 unique articles, of which eight were included, consisting of 17 365 patients from 11 countries. We generated estimates of annual global prevalence, estimated lifetime incidence and economic loss due to recurrent vulvovaginal candidiasis, and predicted the number of women at risk to 2030. Worldwide, recurrent vulvovaginal candidiasis affects about 138 million women annually (range 103-172 million), with a global annual prevalence of 3871 per 100 000 women; 372 million women are affected by recurrent vulvovaginal candidiasis over their lifetime. The 25-34 year age group has the highest prevalence (9%). By 2030, the population of women with recurrent vulvovaginal candidiasis each year is estimated to increase to almost 158 million, resulting in 20 240 664 extra cases with current trends using base case estimates in parallel with an estimated growth in females from 3·34 billion to 4·181 billion. In high-income countries, the economic burden from lost productivity could be up to US$14·39 billion annually. The high prevalence, substantial morbidity, and economic losses of recurrent vulvovaginal candidiasis require better solutions and improved quality of care for affected women.
Collapse
Affiliation(s)
- David W Denning
- Global Action Fund for Fungal Infections, Geneva, Switzerland; University of Manchester and National Aspergillosis Centre, Wythenshawe Hospital, Manchester University Hospital Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
| | - Matthew Kneale
- University of Manchester and National Aspergillosis Centre, Wythenshawe Hospital, Manchester University Hospital Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Jack D Sobel
- School of Medicine, Wayne State University, Detroit, MI, USA
| | - Riina Rautemaa-Richardson
- University of Manchester and National Aspergillosis Centre, Wythenshawe Hospital, Manchester University Hospital Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Mycology Reference Centre Manchester, Wythenshawe Hospital, Manchester, UK
| |
Collapse
|
11
|
Blostein F, Levin-Sparenberg E, Wagner J, Foxman B. Recurrent vulvovaginal candidiasis. Ann Epidemiol 2017; 27:575-582.e3. [PMID: 28927765 DOI: 10.1016/j.annepidem.2017.08.010] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 08/03/2017] [Accepted: 08/04/2017] [Indexed: 01/13/2023]
Abstract
PURPOSE Recurrent vulvovaginal candidiasis (RVVC), multiple episodes of vulvovaginal candidiasis (VVC; vaginal yeast infection) within a 12-month period, adversely affects quality of life, mental health, and sexual activity. Diagnosis is not straightforward, as VVC is defined by the combination of often nonspecific vaginal symptoms and the presence of yeast-which is a common vaginal commensal. Estimating the incidence and prevalence is challenging: most VVC is diagnosed and treated empirically, the availability for purchase of effective therapies over the counter enables self-diagnosis and treatment, and the duration of the relatively benign VVC symptoms is short, introducing errors into any estimates relying on medical records or patient recall. METHODS We evaluate current estimates of VVC and RVVC and provide new prevalence estimates using data from a 2011 seven-country (n = 7345) internet panel survey on VVC conducted by Ipsos Health (https://www.ipsos.com/en). We also evaluate information on VVC-associated visits using the National Ambulatory Medical Care Survey. RESULTS The estimated probability of VVC by age 50 varied widely by country (from 23% to 49%, mean 39%), as did the estimated probability of RVVC after VVC (from 14% to 28%, mean 23%). CONCLUSIONS However estimated, the probability of RVVC was high suggesting RVVC is a common condition.
Collapse
Affiliation(s)
- Freida Blostein
- Center for Molecular and Clinical Epidemiology, University of Michigan, School of Public Health, Ann Arbor
| | - Elizabeth Levin-Sparenberg
- Center for Molecular and Clinical Epidemiology, University of Michigan, School of Public Health, Ann Arbor
| | | | - Betsy Foxman
- Center for Molecular and Clinical Epidemiology, University of Michigan, School of Public Health, Ann Arbor.
| |
Collapse
|
12
|
Bilardi JE, Walker SM, Temple-Smith MJ, McNair RP, Mooney-Somers J, Vodstrcil LA, Bellhouse CE, Fairley CK, Bradshaw CS. Women view key sexual behaviours as the trigger for the onset and recurrence of bacterial vaginosis. PLoS One 2017; 12:e0173637. [PMID: 28278277 PMCID: PMC5344463 DOI: 10.1371/journal.pone.0173637] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 02/23/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Bacterial vaginosis (BV) affects a third of women of reproductive age in the US and there is increasing evidence to suggest it may be sexually transmitted. This study aimed to extend and validate the findings of our earlier smaller qualitative study by exploring in detail women's views and experiences of the triggering factors associated with BV onset and recurrence. METHODS Women aged 20-49, who had experienced one or more symptomatic episode of BV within 6 months, were opportunistically recruited to complete a 38-item questionnaire on their experience of BV. RESULTS 103 women completed the questionnaire. Women were significantly more likely to report sexual than lifestyle factors triggered BV onset and recurrence (p<0.001). The top 3 factors women attributed to both BV onset and recurrence were identical-and all sexual. They included, in order: 1) unprotected sex; 2) sex with a new male partner; and 3) sex in general. The main lifestyle factors nominated included stress, diet, menstruation and the use of feminine hygiene products. While many women felt their BV had been transmitted through sexual contact (54%) and developed as a result of sexual activity (59%), few considered BV a sexually transmitted infection (STI) (10%). Despite this 57% felt partners should also be treated for BV. CONCLUSION These data concur with our earlier qualitative findings that women believe BV is triggered by sexual activity. While many women felt BV was sexually transmitted and supported partner treatment, they did not consider BV an STI. This contradiction is likely due to information conveyed to women based on current guidelines. In the absence of highly effective BV treatments, this study highlights the need for guidelines to indicate there is scientific uncertainty around the pathogenesis of BV and to contain clear health messages regarding the evidence for practices shown to be associated with a reduced risk of BV (i.e. consistent condom use.
Collapse
Affiliation(s)
- Jade E. Bilardi
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Victoria, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sandra M. Walker
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | | | - Ruth P. McNair
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Julie Mooney-Somers
- Centre for Values, Ethics and the Law in Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Lenka A. Vodstrcil
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Clare E. Bellhouse
- Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christopher K. Fairley
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Catriona S. Bradshaw
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
13
|
Nguyen Y, Lee A, Fischer G. Quality of life in patients with chronic vulvovaginal candidiasis: A before and after study on the impact of oral fluconazole therapy. Australas J Dermatol 2016; 58:e176-e181. [DOI: 10.1111/ajd.12487] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 03/17/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Yvonne Nguyen
- Department of Dermatology; Kolling Institute; Northern Sydney Local Health District; St Leonards New South Wales Australia
- Department of Dermatology; Royal North Shore Hospital; St Leonards New South Wales Australia
| | - Andrew Lee
- Department of Dermatology; Kolling Institute; Northern Sydney Local Health District; St Leonards New South Wales Australia
- Department of Dermatology; Royal North Shore Hospital; St Leonards New South Wales Australia
- Sydney Medical School Northern; University of Sydney; St Leonards New South Wales Australia
| | - Gayle Fischer
- Department of Dermatology; Kolling Institute; Northern Sydney Local Health District; St Leonards New South Wales Australia
- Department of Dermatology; Royal North Shore Hospital; St Leonards New South Wales Australia
- Sydney Medical School Northern; University of Sydney; St Leonards New South Wales Australia
| |
Collapse
|
14
|
Zhu YX, Li T, Fan SR, Liu XP, Liang YH, Liu P. Health-related quality of life as measured with the Short-Form 36 (SF-36) questionnaire in patients with recurrent vulvovaginal candidiasis. Health Qual Life Outcomes 2016; 14:65. [PMID: 27129474 PMCID: PMC4850632 DOI: 10.1186/s12955-016-0470-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 04/21/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Recurrent vulvovaginal candidiasis (RVVC) has a poor therapeutic outcome and a severe impact on women and their partners, both physically and psychologically. Health-related quality of life (HRQOL) is significantly affected in patients with RVVC; however, little is known about HRQOL in patients with this disease. In this study, we aim to identify the clinical and mycological characteristics of women with RVVC and the effects of RVVC on women's HRQOL. METHODS We designed this study as a comparative cross-sectional study. The Short-Form Health Survey (SF-36) was used to measure HRQOL in 102 patients with RVVC and 101 women seeking general health care (controls). RVVC was defined as four or more episodes of proven VVC in the previous 12-month period. VVC was defined as vulvar itching, burning, erythema, vaginal discharge, pseudohyphae or blastoconidia on a wet 10 % potassium hydroxide (KOH)-treated vaginal slide and a positive Candida culture. Group comparisons were conducted with independent samples t test. Correlation analysis was performed on the variables. RESULTS The mean age at first diagnosis of the patients with RVVC was 30.96 years (SD 5.38), and the mean age of the controls was 29.75 years (SD 5.83; p > 0.05). The duration of the patients' complaints varied from 6 months to 10 years, with a mean duration of 22.28 (±21.75) months. The most common complaints were increased vaginal discharge (102 cases, 100 %), itching (97 cases, 95.1 %), dyspareunia (65 cases, 63.7 %), burning (79 cases, 77.5 %) and erythema (25 cases, 24.5 %). C. albicans was the predominant Candida species (86 strains, 84.3 %) in the patients, followed by C. glabrata (12 strains, 11.8 %). C. parapsilosis (1 strain, 0.9 %), C. tropicalis (1 strain, 0.9 %), C. krusei (1 strain, 0.9 %) and C. lusitaniae (1 strain, 0.9 %). The mean SF-36 dimension scores for physical function, role physical, bodily pain, general health, vitality, social functioning, role emotional, and mental health were significantly lower in the patients with RVVC than in the controls (85.20, 61.39, 77.79, 54.95, 53.17, 67.89, 52.48 and 59.17 vs. 90.20, 80.87, 87.08, 67.38, 59.69, 79.86, 68.01 and 65.38). The physical composite and mental composite scores of the patients with RVVC were 63.06 and 64.87, respectively, which were lower than those of the controls (75.01 and 74.87; p < 0.05). CONCLUSIONS Nearly all of the patients with RVVC had clinical symptoms. In our sample, RVVC was mainly caused by C. albicans. RVVC has negative effects on women's HRQOL, as indicated by lower physical and mental composite scores among the RVVC group compared with controls.
Collapse
Affiliation(s)
- Yu-Xia Zhu
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, 518036, China
| | - Ting Li
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, 518036, China
- Shantou University Medical College, Shantou, Guangdong, 515041, China
| | - Shang-Rong Fan
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, 518036, China.
- Shenzhen Key Laboratory of Gynecological Diagnostic Technology Research, Shenzhen, 518036, PR China.
| | - Xiao-Ping Liu
- Department of Laboratory Science, Peking University Shenzhen Hospital, Shenzhen, PR China
| | - Yi-Heng Liang
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, 518036, China
| | - Ping Liu
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, 518036, China
| |
Collapse
|
15
|
Bilardi J, Walker S, McNair R, Mooney-Somers J, Temple-Smith M, Bellhouse C, Fairley C, Chen M, Bradshaw C. Women's Management of Recurrent Bacterial Vaginosis and Experiences of Clinical Care: A Qualitative Study. PLoS One 2016; 11:e0151794. [PMID: 27010725 PMCID: PMC4807032 DOI: 10.1371/journal.pone.0151794] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 02/17/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Few data are available on how women manage recurring bacterial vaginosis (BV) and their experiences of the clinical care of this condition. This study aimed to explore women's recurrent BV management approaches and clinical care experiences, with a view to informing and improving the clinical management of BV. METHODS A descriptive, social constructionist approach was chosen as the framework for the study. Thirty-five women of varying sexual orientation who had experienced recurrent BV in the past 5 years took part in semi-structured interviews. RESULTS The majority of women reported frustration and dissatisfaction with current treatment regimens and low levels of satisfaction with the clinical management of BV. Overall, women disliked taking antibiotics regularly, commonly experienced adverse side effects from treatment and felt frustrated at having symptoms recur quite quickly after treatment. Issues in clinical care included inconsistency in advice, misdiagnosis and inappropriate diagnostic approaches and insensitive or dismissive attitudes. Women were more inclined to report positive clinical experiences with sexual health physicians than primary care providers. Women's frustrations led most to try their own self-help remedies and lifestyle modifications in an attempt to treat symptoms and prevent recurrences, including well-known risk practices such as douching. CONCLUSION In the face of considerable uncertainty about the cause of BV, high rates of recurrence, unacceptable treatment options and often insensitive and inconsistent clinical management, women are trying their own self-help remedies and lifestyle modifications to prevent recurrences, often with little effect. Clinical management of BV could be improved through the use of standardised diagnostic approaches, increased sensitivity and understanding of the impact of BV, and the provision of evidence based advice about known BV related risk factors.
Collapse
Affiliation(s)
- Jade Bilardi
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Victoria, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sandra Walker
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Ruth McNair
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Julie Mooney-Somers
- Centre for Values, Ethics and the Law in Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Meredith Temple-Smith
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Clare Bellhouse
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Christopher Fairley
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Marcus Chen
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Catriona Bradshaw
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
16
|
Liu HL, Lee HM, Chung YC. Dyspareunia and its comorbidities among Taiwanese women: analysis of the 2004-2010 Nationwide Health Insurance Database. J Sex Med 2015; 12:1012-8. [PMID: 25572330 DOI: 10.1111/jsm.12820] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Most of the existing studies on dyspareunia only focus on qualitative observations. These measurement tools may not reflect the actual situation of dyspareunia in Taiwan. AIM This study aimed to estimate the incidence of dyspareunia in Taiwan and investigate dyspareunia-associated comorbidities using the National Health Insurance Research Database (NHIRD). METHODS This study is a population-based retrospective cohort investigation. MAIN OUTCOME MEASURES We analyzed the 2004-2010 claims data on dyspareunia from the NHIRD. Dyspareunia was identified by outpatient visits using International Classification of Diseases, Ninth Revision, Clinical Modification (diagnosis code 6250). Patients who visited as outpatients with dyspareunia after the index date were considered to have comorbidities associated with dyspareunia medical conditions. The index events included vaginal disorders, vulvar disorders, uterine and ovarian factors, female genital organ and menstrual cycle disorders, menopause, and relative abdominopelvic organ disorders. The incidence of dyspareunia among different age groups was determined. The location and areas significantly related to the physical gynecology or relative pelvic organ causing the disease were also analyzed. RESULTS A total of 978 females of different ages had experienced dyspareunia. The incidence of dyspareunia was higher among individuals aged 30-34 years. The findings of this study indicated that dyspareunia was comorbid with menopause, pelvic floor dysfunction, and most gynecological infections. In particular, the more common physical causes of dyspareunia were introitus and vaginal infections (19.95%), menopause (16.80%), female genital organ and menstrual cycle disorders (15.22%), and female pelvic organ infections (13.65%). CONCLUSIONS This study posits that women of all ages (20-70 years) experience painful sexual intercourse. This large-scale nationwide claims-based study showed that menopause and pelvic infection disorder were dyspareunia-related comorbidities. Moreover, gynecological infections and pelvic floor dysfunctions were associated with dyspareunia.
Collapse
Affiliation(s)
- Hsin-Li Liu
- Department of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | | | | |
Collapse
|
17
|
|
18
|
Bilardi JE, Walker S, Temple-Smith M, McNair R, Mooney-Somers J, Bellhouse C, Fairley CK, Chen MY, Bradshaw C. The burden of bacterial vaginosis: women's experience of the physical, emotional, sexual and social impact of living with recurrent bacterial vaginosis. PLoS One 2013; 8:e74378. [PMID: 24040236 PMCID: PMC3770676 DOI: 10.1371/journal.pone.0074378] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 07/31/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Bacterial vaginosis is a common vaginal infection, causing an abnormal vaginal discharge and/or odour in up to 50% of sufferers. Recurrence is common following recommended treatment. There are limited data on women's experience of bacterial vaginosis, and the impact on their self-esteem, sexual relationships and quality of life. The aim of this study was to explore the experiences and impact of recurrent bacterial vaginosis on women. METHODS A social constructionist approach was chosen as the framework for the study. Thirty five women with male and/or female partners participated in semi-structured interviews face-to-face or by telephone about their experience of recurrent bacterial vaginosis. RESULTS Recurrent bacterial vaginosis impacted on women to varying degrees, with some women reporting it had little impact on their lives but most reporting it had a moderate to severe impact. The degree to which it impacted on women physically, emotionally, sexually and socially often depended on the frequency of episodes and severity of symptoms. Women commonly reported that symptoms of bacterial vaginosis made them feel embarrassed, ashamed, 'dirty' and very concerned others may detect their malodour and abnormal discharge. The biggest impact of recurrent bacterial vaginosis was on women's self-esteem and sex lives, with women regularly avoiding sexual activity, in particular oral sex, as they were too embarrassed and self-conscious of their symptoms to engage in these activities. Women often felt confused about why they were experiencing recurrent bacterial vaginosis and frustrated at their lack of control over recurrence. CONCLUSION Women's experience of recurrent bacterial vaginosis varied broadly and significantly in this study. Some women reported little impact on their lives but most reported a moderate to severe impact, mainly on their self-esteem and sex life. Further support and acknowledgement of these impacts are required when managing women with recurrent bacterial vaginosis.
Collapse
Affiliation(s)
- Jade E. Bilardi
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- * E-mail:
| | - Sandra Walker
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Meredith Temple-Smith
- General Practice and Primary Health Care Academic Centre, The University of Melbourne, Melbourne, Australia
| | - Ruth McNair
- General Practice and Primary Health Care Academic Centre, The University of Melbourne, Melbourne, Australia
| | - Julie Mooney-Somers
- Centre for Values, Ethics and the Law in Medicine and Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Clare Bellhouse
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Christopher K. Fairley
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Marcus Y. Chen
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Catriona Bradshaw
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| |
Collapse
|
19
|
Ekpenyong CE, Inyang-etoh EC, Ettebong EO, Akpan UP, Ibu JO, Daniel NE. Recurrent vulvovaginal candidosis among young women in south eastern Nigeria: the role of lifestyle and health-care practices. Int J STD AIDS 2013; 23:704-9. [PMID: 23104744 DOI: 10.1258/ijsa.2012.011382] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This work was carried out to study the association between lifestyle, health-care practices and incidence of recurrent vulvovaginal candidosis (RVVC) among young women in south eastern Nigeria. It was a multicentre case-control study of 176 women aged between 20 and 35 years recruited from the designated health facilities. Lifestyle and health-care practice structured questionnaires were used to survey the participants. Clinical examination was performed and vaginal swabs were taken from participants for microscopy, culture and sensitivity. The germ tube test was performed for identification of Candida albicans. The results of this study showed that frequent douching with water or other fluids (odds ratio [OR](adjusted) = 2.41, 95% confidence interval [CI] = 1.25-4.66, P = 0.000), wearing tight nylon/synthetic underwear (OR(adjusted) = 4.76, 95% CI = 2.28-9.95, P = 0.000), alternative medical treatment for repeated or recalcitrant cases (OR(adjusted) = 4.84, 95% CI = 2.94-15.91, P = 0.000), were significantly associated with higher odds for RVVC and self-diagnosis and use of over-the-counter antifungal medications (OR(adjusted) = 4.61, 95% CI = 2.29-9.32, P = 0.000) were associated with RVVC. Results of the fungal cultures showed that C. albicans and non-C. albicans were isolated from 83.7% and 16.3% of participants, respectively. Our results supported the association between some of the hypothesized risk factors and the occurrence of RVVC.
Collapse
Affiliation(s)
- C E Ekpenyong
- Department of Physiology, College of Health Sciences, University of Uyo, Akwa Ibom State, Nigeria.
| | | | | | | | | | | |
Collapse
|
20
|
Hirekatur RS. Recurrent Yeast Infections. Integr Med (Encinitas) 2012. [DOI: 10.1016/b978-1-4377-1793-8.00021-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
21
|
Beikert FC, Le MT, Koeninger A, Technau K, Clad A. Recurrent vulvovaginal candidosis: focus on the vulva. Mycoses 2011; 54:e807-10. [DOI: 10.1111/j.1439-0507.2011.02030.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
22
|
Effects of psychological stress and fluoxetine on development of oral candidiasis in rats. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2010; 17:668-73. [PMID: 20130126 DOI: 10.1128/cvi.00380-09] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Psychological stress has been found to suppress cell-mediated immune responses that are important for limiting the proliferation of Candida albicans. Fluoxetine has been observed to reduce negative consequences of stress on the immune system in experimental and clinical models, but there are no data on its effects on oral candidiasis. We designed experiments to evaluate the effects of fluoxetine on the development of oral candidiasis in Sprague-Dawley rats exposed to a chronic auditory stressor. Animals were submitted to surgical hyposalivation in order to facilitate the establishment and persistence of C. albicans infection. Stress application and treatment with drugs (placebo or fluoxetine) were initiated 7 days before C. albicans inoculation and lasted until the end of the experiments, on day 15 postinoculation. Establishment of C. albicans infection was evaluated on days 2 and 15 after inoculation. Tissue injury was determined by the quantification of the number and type (normal or abnormal) of papillae on the dorsal tongue per microscopic field. A semiquantitative scale was devised to assess the degree of colonization of the epithelium by fungal hyphae. Our results showed that stress exacerbates C. albicans infection in the tongues of rats. Significant increases in Candida counts, the percentage of the tongue's surface covered with clinical lesions, the percentage of abnormal papillae, and the colonization of the epithelium by hyphae were found in stressed rats compared to the nonstressed ones. Treatment with fluoxetine significantly reversed these adverse effects of stress. Besides the psychopharmacological properties of fluoxetine against stress, it has consequences for Candida infection.
Collapse
|
23
|
|
24
|
Donders GGG, Babula O, Bellen G, Linhares IM, Witkin SS. Mannose-binding lectin gene polymorphism and resistance to therapy in women with recurrent vulvovaginal candidiasis. BJOG 2008; 115:1225-31. [DOI: 10.1111/j.1471-0528.2008.01830.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
25
|
Gautham M, Singh R, Weiss H, Brugha R, Patel V, Desai NG, Nandan D, Kielmann K, Grosskurth H. Socio-cultural, psychosexual and biomedical factors associated with genital symptoms experienced by men in rural India. Trop Med Int Health 2008; 13:384-95. [DOI: 10.1111/j.1365-3156.2008.02013.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
26
|
Ehrström S, Kornfeld D, Rylander E. Perceived stress in women with recurrent vulvovaginal candidiasis. J Psychosom Obstet Gynaecol 2007; 28:169-76. [PMID: 17577760 DOI: 10.1080/01674820601168176] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Recurrent vulvovaginal candidiasis (RVVC) has become very common. The aim of this study was to evaluate if women with RVVC perceive more signs of chronic stress than healthy control subjects. STUDY DESIGN Thirty-three women with RVVC and 28 healthy control subjects completed a questionnaire about perceived stress at work and in private life, and a health questionnaire. A comparison of the results was performed with the one-way ANOVA test. RESULTS More women with RVVC than control subjects reported signs of burnout (p < 0.001), emotional symptoms of stress (p < 0.005), impaired balance between work and leisure time (p = 0.01), bodily symptoms of stress (p < 0.05), worrying factors at work (p < 0.05), and presented type D-personality (p < 0.05). CONCLUSIONS The results of this pilot study showed higher degree of perceived stress in women with RVVC compared with healthy controls. These results are in line with our earlier findings of blunted morning rise cortisol and lower mean levels of cortisol in women with RVVC compared with healthy controls.
Collapse
Affiliation(s)
- Sophia Ehrström
- Division of Obstetrics and Gynecology, Danderyd Hospital, Karolinska Institutet, 182 88 Stockholm, Sweden.
| | | | | |
Collapse
|
27
|
Hirekatur R. Recurrent Yeast Infections. Integr Med (Encinitas) 2007. [DOI: 10.1016/b978-1-4160-2954-0.50029-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
28
|
Ehrström SM, Kornfeld D, Thuresson J, Rylander E. Signs of chronic stress in women with recurrent candida vulvovaginitis. Am J Obstet Gynecol 2005; 193:1376-81. [PMID: 16202729 DOI: 10.1016/j.ajog.2005.03.068] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2004] [Revised: 02/20/2005] [Accepted: 03/30/2005] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to determine whether there is an association between recurrent vulvovaginal candida and chronic stress. Chronic stress affects the hypothalamus-pituitary-adrenal axis, which influences the immune function. Recurrent candida vulvovaginitis is increasing. STUDY DESIGN Women with recurrent vulvovaginal candida (n = 35) and age-matched healthy control subjects (n = 35) collected saliva for the analysis of cortisol. Hormone analyses of blood samples and vulvovaginal examinations were performed. A questionnaire was completed. RESULTS Morning rise cortisol level was significantly blunted among patients compared with control subjects (P < .002). Mean levels of salivary cortisol were lower the first 45 minutes after awakening in women with recurrent vulvovaginal candida, compared with control subjects. More patients than control subjects reported a history of condyloma, bacterial vaginosis, and herpes genitalis. No differences were seen between patients and control subjects regarding sexual hormone binding globulin, dihydroepiandrosterone, testosterone or Hemoglobin A1c. CONCLUSION Morning rise salivary cortisol level is blunted in women with recurrent vulvovaginal candida, which indicates signs of chronic stress. The higher incidence of vulvovaginal infections in these women compared with control subjects may reflect impaired immunity, which may be due to chronic stress.
Collapse
Affiliation(s)
- Sophia M Ehrström
- Department of Obstetrics and Gynecology, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
| | | | | | | |
Collapse
|
29
|
Mårdh PA, Wågström J, Landgren M, Holmén J. Usage of antifungal drugs for therapy of genital Candida infections, purchased as over-the-counter products or by prescription: 2. Factors that may have influenced the marked changes in sales volumes during the 1990s. Infect Dis Obstet Gynecol 2005; 12:99-108. [PMID: 15739824 PMCID: PMC1784592 DOI: 10.1080/10647440400003972] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND: The epidemiology of vulvovaginal candidiasis (VVC) and such recurrent infections (RVVC) has been difficult to study as the majority of episodes of these conditions are self-treated by the women affected. In Sweden, all pharmacies are owned by the state and all prescriptions and over-the-counter (OTC) products, such as antifungals, are registered in a database, which offers unique possibilities to study the epidemiology of VVC/RVVC. OBJECTIVES: To analyze all prescriptions and OTC products purchased for therapy of VVC/RVVC and to establish reasons for any observed variation in the sales figures. METHODS: Sales figures in the Swedish county of Skåne of antifungal drugs for therapy of VVC/RVVC were analyzed by the aid of the 'ACS' database of the National Corporation of Swedish Pharmacies for the years 1990--1999. The size of the female population in the county is approximately half a million. RESULTS: The study showed that 93% of all antifungal drugs for VVC/RVVC were sold as OTC products. An increase in sales of the drugs occurred until mid- 1993/94, followed by a decrease until end of the study period in 1999. Demographic factors (e.g. the number of female inhabitants in the county, pharmacies and health-care units), the pregnancy rate and pharmacy-dependent factors (such as the introduction of shelves for self-selection of antifungal products) did not explain the observed variations in sales. Distinct short-term variations in the number of prescriptions of fluconazole and itraconazole could be explained by drugs company sales campaigns and logistics factors in drug distribution. The sales volumes in the 33 municipalities in the county correlated with the density of the population, which was not the case for the total number of prescriptions made in the county during the 1990s. The variation in antifungal drug sales was similar to that of hormonal intrauterine devices, but this was not the case for oral contraceptives. The total Swedish usage of antibiotics showed a similar variation to that of the antifungal drugs analyzed. CONCLUSION: The study stresses the limited impact on the treatment of VVC/RVVC by the medical community. Behavior-related factors in the female population are the most likely explanation for the marked variations found in the usage of drugs for the two conditions.
Collapse
Affiliation(s)
- Per-Anders Mårdh
- Department of Obstetrics and Gynaecology, University Hospital, Lund, Sweden.
| | | | | | | |
Collapse
|
30
|
Affiliation(s)
- Helen Mitchell
- Mortimer Market Centre, Camden Primary Care Trust, London.
| |
Collapse
|
31
|
Danielsson I, Sjöberg I, Stenlund H, Wikman M. Prevalence and incidence of prolonged and severe dyspareunia in women: results from a population study. Scand J Public Health 2003; 31:113-8. [PMID: 12745761 DOI: 10.1080/14034940210134040] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
AIMS The principle aim of this study was to investigate the prevalence and incidence of prolonged (>/= 6 months) and severe dyspareunia in a non-patient population of women, and to explore the rate of recovery as well as the inclination to seek medical care. Another aim was to compare the use of oral contraceptives among women who had ever had dyspareunia and those who had not. METHODS A total of 3,017 women aged 20-60 participating in a screening program for cervical cancer answered a questionnaire about possible painful coitus. RESULTS The prevalence was 9.3% for the whole group and 13% for women aged 20-29 and 6.5% for the women aged 50-60, with a risk ratio of 2.0 (95% CI 1.4-2.8) for the youngest age group compared with the oldest. The incidence risk ratio was 9.3 (95% CI 2.8-30.9) for the youngest age group compared with the oldest. Using age-specific incidence rates, a rising incidence of dyspareunia in young women was demonstrated. Of the women who had ever had prolonged and severe dyspareunia 28% had consulted a physician for their symptoms; 20% recovered after treatment, while 31% recovered spontaneously. No differences were found in the use of oral contraceptives between the women who had had dyspareunia and those who had not. CONCLUSIONS Prolonged and severe dyspareunia is a great health problem among all women and especially young women, for whom a rising incidence of dyspareunia is suggested and discussed. Surprisingly few women have consulted a physician, raising the question of why this is the case and what can be done about it.
Collapse
Affiliation(s)
- Ingela Danielsson
- Department of Obstetrics and Gynaecology, Sundsvall Hospital, S-851 86 Sundsvall, Sweden.
| | | | | | | |
Collapse
|
32
|
Corcoran C, Gallitano A, Leitman D, Malaspina D. The neurobiology of the stress cascade and its potential relevance for schizophrenia. J Psychiatr Pract 2001; 7:3-14. [PMID: 15990497 DOI: 10.1097/00131746-200101000-00002] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This review explores the neurobiology of stress and its possible role in the etiology of schizophrenia. Major life events may play a role in onset and relapse in schizophrenia. Other data suggest that early stress exposure increases schizophrenia risk, especially in individuals with latent vulnerability. Animal research has led to an elucidation of the mechanisms by which stress and cortisol are toxic to the hippocampus and impair cognition. Associations among these factors have been found in a variety of human conditions, including psychiatric illness and normal aging. These mechanisms are plausible in schizophrenia, which is characterized by a degree of cortisol dysregulation, hippocampal abnormality, and cognitive impairment. Characterization of the role of the stress cascade in schizophrenia has implications for novel pharmacologic and other treatment, especially for cognitive symptoms, which are debilitating and largely refractory to treatment.
Collapse
Affiliation(s)
- C Corcoran
- New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, Department of Psychiatry, USA
| | | | | | | |
Collapse
|
33
|
Chapple A, Hassell K, Nicolson M, Cantrill J. 'You don't really feel you can function normally': Women's perceptions and personal management of vaginal thrush. J Reprod Infant Psychol 2000. [DOI: 10.1080/713683045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
34
|
Abstract
LEARNING OBJECTIVES The reader of this review will learn about the different clinical forms of allergic vulvovaginitis. This specific and important chapter has not been previously summarized and described in the medical literature. Vaginal mucosa is also able to show an allergic response similarly to the nose, eyes, lungs, and skin. Physicians should be familiarized with this kind of manifestation in order to make the proper diagnosis and evaluation of this entity. DATA SOURCES MEDLINE searches were undertaken since 1966 for citations of any kind of allergic vulvovaginitis. Relevant reviews and articles identified in this process were surveyed for additional and earlier citations. Textbooks of medicine, gynecology, dermatology, and infectious diseases have also been consulted. Old medical textbooks and journals of allergy and internal medicine were recovered from the Division of History of the Medicine of the Faculdade de Medicina da Universidade Federal de Minas Gerais (Federal Medical College), Belo Horizonte, Brazil. CONCLUSIONS A great variety of allergens are able to provoke allergic reactions in the female genital tract. The immunology of the vagina, the influence of hormones, menstrual cycle, and psychologic factors are also highlighted in this review. A possibility of vaginal hyperreactivity is proposed in this text. Adequate management provides important relief of symptoms in the majority of cases.
Collapse
Affiliation(s)
- P S Moraes
- Division of Allergy and Clinical Immunology of the Hospital Mater Dei-Belo Horizonte, MG, Brazil
| | | |
Collapse
|