Is uncertain vulvovaginal candidiasis a marker of vulvodynia? A study in a Dutch general practice research database
Background: A recent Dutch study in general practice showed a clear relationship between the diagnosis of vulvovaginal candidiasis (VVC) and symptoms suggestive of provoked vulvodynia (PVD). PVD accounts for the largest group of vulvar pains, but is often not recognised by GPs. Aim: To investigate w...
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| Format: | Article |
| Language: | English |
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Royal College of General Practitioners
2017-05-01
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| Series: | BJGP Open |
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| Online Access: | https://bjgpopen.org/content/1/2/bjgpopen17X100905 |
| _version_ | 1818953284373708800 |
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| author | Peter Leusink Daphne van Moorsel Hans Bor Gé A Donker Peter Lucassen Doreth Teunissen Ellen Laan Antoine Lagro-Janssen |
| author_facet | Peter Leusink Daphne van Moorsel Hans Bor Gé A Donker Peter Lucassen Doreth Teunissen Ellen Laan Antoine Lagro-Janssen |
| author_sort | Peter Leusink |
| collection | DOAJ |
| description | Background: A recent Dutch study in general practice showed a clear relationship between the diagnosis of vulvovaginal candidiasis (VVC) and symptoms suggestive of provoked vulvodynia (PVD). PVD accounts for the largest group of vulvar pains, but is often not recognised by GPs. Aim: To investigate whether diagnostic uncertainty about VVC in general practice could also point to the diagnosis of PVD, and whether and how this diagnostic uncertainty affects management. Design & setting: An observational study in 2014 in Dutch general practices of the NIVEL Primary Care Database. Method: Women with an uncertain diagnosis of VVC were distinguished from those with certain VVC based on the occurrence of recurrent episodes and persisting complaints, despite treatment. Factors known to be associated with PVD were hypothesised to be more prevalent in women with uncertain VVC. Data on symptom management by GPs were collected. Results: In total 7066 women with VVC or uncertain VVC were included. Uncertain VVC was found to account for 28% of these patients. Compared to VVC, the group uncertain VVC included significantly more women with female genital symptoms, tiredness, irritable bowel syndrome (all P<0.001), feeling anxious, reduced sexual desire, depressive disorder, relationship problems, and micturition symptoms (all P<0.05). Compared to VVC, the group uncertain VVC included significantly higher mean numbers of telephone consultations (P<0.001), more referrals to gynaecology (P = 0.009), and higher mean numbers of prescriptions per patient (P<0.001). Conclusion: This study's findings indicate that uncertain VVC could be a marker of PVD. GPs might reconsider their diagnostics and management when women present recurrent and persistent vulvovaginal complaints, especially if accompanied by dyspareunia, functional syndromes, micturition symptoms, and psychological conditions. |
| first_indexed | 2024-12-20T10:03:50Z |
| format | Article |
| id | doaj.art-6235f07ef606436baa865ef175a3accf |
| institution | Directory Open Access Journal |
| issn | 2398-3795 |
| language | English |
| last_indexed | 2024-12-20T10:03:50Z |
| publishDate | 2017-05-01 |
| publisher | Royal College of General Practitioners |
| record_format | Article |
| series | BJGP Open |
| spelling | doaj.art-6235f07ef606436baa865ef175a3accf2022-12-21T19:44:17ZengRoyal College of General PractitionersBJGP Open2398-37952017-05-011210.3399/bjgpopen17X100905Is uncertain vulvovaginal candidiasis a marker of vulvodynia? A study in a Dutch general practice research databasePeter Leusink0Daphne van Moorsel1Hans Bor2Gé A Donker3Peter Lucassen4Doreth Teunissen5Ellen Laan6Antoine Lagro-Janssen7Department of Primary and Community Care, Unit Gender & Women’s Health, Radboud University Medical Centre, Nijmegen, The NetherlandsDepartment of Primary and Community Care, Unit Gender & Women’s Health, Radboud University Medical Center, Nijmegen, The NetherlandsDepartment of Primary and Community Care, Unit Gender & Women’s Health, Radboud University Medical Center, Nijmegen, The NetherlandsPrimary Care Database, NIVEL, Utrecht, The NetherlandsDepartment of Primary and Community Care, Unit Gender & Women’s Health, Radboud University Medical Center, Nijmegen, The NetherlandsDepartment of Primary and Community Care, Unit Gender & Women’s Health, Radboud University Medical Center, Nijmegen, The NetherlandsDepartment of Sexology and Psychosomatic Obstetrics and Gynaecology, Academic Medical Center, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Primary and Community Care, Unit Gender & Women’s Health, Radboud University Medical Center, Nijmegen, The NetherlandsBackground: A recent Dutch study in general practice showed a clear relationship between the diagnosis of vulvovaginal candidiasis (VVC) and symptoms suggestive of provoked vulvodynia (PVD). PVD accounts for the largest group of vulvar pains, but is often not recognised by GPs. Aim: To investigate whether diagnostic uncertainty about VVC in general practice could also point to the diagnosis of PVD, and whether and how this diagnostic uncertainty affects management. Design & setting: An observational study in 2014 in Dutch general practices of the NIVEL Primary Care Database. Method: Women with an uncertain diagnosis of VVC were distinguished from those with certain VVC based on the occurrence of recurrent episodes and persisting complaints, despite treatment. Factors known to be associated with PVD were hypothesised to be more prevalent in women with uncertain VVC. Data on symptom management by GPs were collected. Results: In total 7066 women with VVC or uncertain VVC were included. Uncertain VVC was found to account for 28% of these patients. Compared to VVC, the group uncertain VVC included significantly more women with female genital symptoms, tiredness, irritable bowel syndrome (all P<0.001), feeling anxious, reduced sexual desire, depressive disorder, relationship problems, and micturition symptoms (all P<0.05). Compared to VVC, the group uncertain VVC included significantly higher mean numbers of telephone consultations (P<0.001), more referrals to gynaecology (P = 0.009), and higher mean numbers of prescriptions per patient (P<0.001). Conclusion: This study's findings indicate that uncertain VVC could be a marker of PVD. GPs might reconsider their diagnostics and management when women present recurrent and persistent vulvovaginal complaints, especially if accompanied by dyspareunia, functional syndromes, micturition symptoms, and psychological conditions.https://bjgpopen.org/content/1/2/bjgpopen17X100905general practicevulvodyniavulvovaginal candidiasisclinical decision-makingdifferential diagnosisuncertainity |
| spellingShingle | Peter Leusink Daphne van Moorsel Hans Bor Gé A Donker Peter Lucassen Doreth Teunissen Ellen Laan Antoine Lagro-Janssen Is uncertain vulvovaginal candidiasis a marker of vulvodynia? A study in a Dutch general practice research database BJGP Open general practice vulvodynia vulvovaginal candidiasis clinical decision-making differential diagnosis uncertainity |
| title | Is uncertain vulvovaginal candidiasis a marker of vulvodynia? A study in a Dutch general practice research database |
| title_full | Is uncertain vulvovaginal candidiasis a marker of vulvodynia? A study in a Dutch general practice research database |
| title_fullStr | Is uncertain vulvovaginal candidiasis a marker of vulvodynia? A study in a Dutch general practice research database |
| title_full_unstemmed | Is uncertain vulvovaginal candidiasis a marker of vulvodynia? A study in a Dutch general practice research database |
| title_short | Is uncertain vulvovaginal candidiasis a marker of vulvodynia? A study in a Dutch general practice research database |
| title_sort | is uncertain vulvovaginal candidiasis a marker of vulvodynia a study in a dutch general practice research database |
| topic | general practice vulvodynia vulvovaginal candidiasis clinical decision-making differential diagnosis uncertainity |
| url | https://bjgpopen.org/content/1/2/bjgpopen17X100905 |
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