Abstract

Objectives: To determine: 1) The accuracy in patient self-diagnosis and medical diagnosis of vulvovaginal candidiasis (VVC) in Western Australia; 2) The contributing factors for self-diagnosing rather than seeking a medical diagnosis.

Methods: A cross-sectional cohort community-based study, over a 13-month period, was conducted. All women wishing to purchase a topical antifungal product for their personal treatment of presumed VVC, from participating community pharmacies within a nominated division of general practice in Perth, Western Australia, were invited to participate in the study. Participants completed a detailed questionnaire prior to their immediate referral for evaluation and examination by an experienced medical practitioner, and underwent a range of laboratory tests to determine the cause of their symptoms. Chi-square testing for association was performed for univariate comparisons with that of culture proven VVC.

Results: Ninety-four symptomatic women aged between 19 and 79 years were recruited. Of the 88 women who completed all aspects of the study, 41 (47%) were confirmed to have VVC by culture. The remaining 47 (53%) women either had another infectious cause (10 [11%]: urinary tract infection [4]; bacterial vaginosis [2]; chlamydia [2]; or genital herpes [2]) or their symptoms were not secondary to an infection (37 [42%]). Sixty-three percent of presumptive diagnoses made by medical practitioners were concordant with laboratory proven VVC. The women avoided seeking medical advice for a number of reasons.

Conclusions: Over half of the study population self-diagnosed VVC incorrectly. The proportion of correct presumptive diagnoses made by medical practitioners was only slightly greater. Diagnosis based on presenting signs and symptoms alone could result in an incorrect diagnosis and a proportion of STIs being missed. Improving the management of VVC will be dependent on addressing factors influencing women's reluctance to seek medical advice and in addressing the current diagnostic processes. Over-the-counter antifungals, whilst convenient, may well compromise women's health.