Vulvovaginal candidiasis often misdiagnosed, overtreated

Diagnostic testing is rarely applied in patients with vulvovaginal candidiasis (VVC), leading to misdiagnoses and overprescribing of antifungal medications and unnecessary use of antibacterial agents, reports a recent study.

The current analysis included 149,934 women (median age 34 years) who had been diagnosed with VVC, of whom 3.4 percent (n=3,689) saw recurrent episodes of VVC (RVVC). Of note, more than 60 percent of VVC patients underwent diagnostic testing; in particular, only 37.1 percent of women received such tests.

Meanwhile, 43.8 percent of those with RVVC were subjected to diagnostic testing. Women who presented to an OB/GYN for their index visit were more likely to receive diagnostic testing, as compared with those who sought care from a family or internal medicine practitioner.

Of the diagnostic tests, microscopy was the most common, performed in 29.5 percent and 31.5 percent of VVC and RVVC patients, respectively. This was followed by antifungal susceptibility testing, which was reported in 5.2 percent and 4.9 percent of VVC and RVVC patients, respectively.

In terms of treatment, most patients (70 percent of VVC and 65.8 percent of RVVC) were given systemic fluconazole within 7 days after the index date. Topical antifungal medications were also common, prescribed to 19.4 percent of VVC and 27.3 percent of RVVC patients. Of note, 16.8 percent of VVC and 15.7 percent of RVVC patients also received systemic antibacterial agents.

“A sizeable proportion of patients with VVC received simultaneous prescriptions for systemic antibacterial medications, many of which were likely for bacterial vaginosis and urinary tract infections, further raising questions about excessive empiric therapy,” the researchers said.

“These findings support those from other studies suggesting a need for improved clinical care for VVC to improve antifungal stewardship and patient outcomes,” they added.