50% OF WOMEN incorrectly attempt to self-treat vaginal infections

Vaginal symptoms, such as discharge, itching, and odor, are known frequently to cause distress, embarrassment, and discomfort in adult women.

In theUnited States, vaginal symptoms have long been established as one of the leading causes for women to seek advice from obstetricians /gynecologists and have been reported to account for more than 10 million office visits per annum. Data outside the United States are less readily available, although 1 UK study found vaginal discharge to be the most common symptom in women attending a genitourinary medicine clinic, affecting 40% of symptomatic patients.

The 2 most common causes of vaginal symptoms in women of childbearing age are bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC), which account for approximately 90% of cases of vaginitis. It is estimated that BV accounts for up to 50% of cases of vaginal symptoms in the United States and is reported to be twice as common as VVC. However, nearly half of women misdiagnose BV as a yeast infection (VVC).

Neither BV nor VVC is considered to be a sexually transmitted infection (STI). The primary symptom of BV is a malodorous discharge, usually described as thin and gray/white with a fishy odor. Vulvovaginal candidiasis is an overgrowth of the Candida species of yeasts (primarily Candida albicans).

The most common symptoms of VVC are itching and discharge, usually described as thick and white (cottage cheese like). Although the classic descriptions of the symptoms of these 2 conditions seem quite distinct, in practice, they are often difficult to distinguish, and misdiagnosis is common by both physicians and the women themselves.

This is exacerbated by a low awareness of BV, despite it being the most common cause of vaginal discharge. This lack of awareness can lead to an assumption that vaginal symptoms must be caused by VVC, and many women inappropriately treat themselves with an OTC anti-fungal, sometimes for years.

Many researchers have reported misdiagnosis of BV, and the clinical guidelines for VVC state that symptoms alone are not sufficient for a diagnosis; many women who self-diagnose themselves as having VVC will have other conditions. Because many women self-treat with OTC medicines, it is inevitable that many cases of BV will be missed.

Not all primary care providers will have the facilities or training to conduct confirmatory testing, and even if facilities are available, culture confirmation for the diagnosis of VVC is often not available for at least 48 hours of incubation. Patients are unlikely to want to return for treatment. Unsurprisingly, many women report that their health care provider does not usually test them.
Therefore, some misdiagnosis is likely. A more surprising finding is that almost half the women do not get examined when being diagnosed with BV/VVC.

Possible reasons for this include the return of a patient who frequently experiences BV/VVC and perhaps a desire by patients to avoid the embarrassment of an examination.

The defining symptoms of VVC are vulval itching, with redness and irritation, and there may be a vaginal discharge, often white and not offensive.

According to current guidelines, the most common symptoms of BV are an increase in vaginal discharge, which is usually white/gray, thin and homogenous, and an unpleasant odor described as fish-like. Itching is not usually considered to be a symptom of BV, but many women thought that it was associated with the condition.

Also, increased odor and unpleasant or fishy odor were erroneously stated to be symptoms of VVC. This would again suggest that there had been misdiagnosis of BV as VVC, with lack of awareness being a key factor.

Many women who self-diagnose and use an over-the-counter product for treatment of presumed vulvovaginal candidiasis do not have vulvovaginal candidiasis.
It’s also important to know that a history of a previous clinically based diagnosis of vulvovaginal candidiasis and reading the package label does not help self-diagnose vulvovaginal candidiasis properly.

Ready access to Over-the-Counter Antifungal products is associated with wasted financial expenditures, unfulfilled expectations, and a delay in correct diagnosis for a substantial number of women.