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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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Autores principales: Leusink, Peter, van Moorsel, Daphne, Bor, Hans, Donker, Gé A, Lucassen, Peter, Teunissen, Doreth, Laan, Ellen, Lagro-Janssen, Antoine
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Royal College of General Practitioners 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6169963/
https://www.ncbi.nlm.nih.gov/pubmed/30564664
http://dx.doi.org/10.3399/bjgpopen17X100905
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author Leusink, Peter
van Moorsel, Daphne
Bor, Hans
Donker, Gé A
Lucassen, Peter
Teunissen, Doreth
Laan, Ellen
Lagro-Janssen, Antoine
author_facet Leusink, Peter
van Moorsel, Daphne
Bor, Hans
Donker, Gé A
Lucassen, Peter
Teunissen, Doreth
Laan, Ellen
Lagro-Janssen, Antoine
author_sort Leusink, Peter
collection PubMed
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.
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spelling pubmed-61699632018-12-18 Is uncertain vulvovaginal candidiasis a marker of vulvodynia? A study in a Dutch general practice research database Leusink, Peter van Moorsel, Daphne Bor, Hans Donker, Gé A Lucassen, Peter Teunissen, Doreth Laan, Ellen Lagro-Janssen, Antoine BJGP Open Research 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. Royal College of General Practitioners 2017-05-31 /pmc/articles/PMC6169963/ /pubmed/30564664 http://dx.doi.org/10.3399/bjgpopen17X100905 Text en Copyright © The Authors https://creativecommons.org/licenses/by/4.0/ This article is Open Access: CC BY license (https://creativecommons.org/licenses/by/4.0/)
spellingShingle Research
Leusink, Peter
van Moorsel, Daphne
Bor, Hans
Donker, Gé A
Lucassen, Peter
Teunissen, Doreth
Laan, Ellen
Lagro-Janssen, Antoine
Is uncertain vulvovaginal candidiasis a marker of vulvodynia? A study in a Dutch general practice research database
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 Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6169963/
https://www.ncbi.nlm.nih.gov/pubmed/30564664
http://dx.doi.org/10.3399/bjgpopen17X100905
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