One in four women mistakenly treat nonexistent yeast infections

One in four women using over-the-counter antifungal infection medications doesn’t have a yeast infection, as disclosed at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology. Since 1990, when over-the-counter antifungal medications for yeast vaginitis became available, "they’ve seen skyrocketing sales of these agents" despite multiple studies showing very poor accuracy of self-diagnosing the condition. In a study that confirms these earlier reports, a colleague at the University of Pittsburgh followed 1,248 women, aged 18-30 years, to see if their symptoms and self-treatment patterns matched up with colonization findings. At baseline, all the women were asymptomatic for vaginal infections and had not recently used any intravaginal products or antibiotics. Vaginal swabs were collected at regular four-month intervals. At each visit, participants were also asked about pruritus symptoms and antifungal medication use. Among the 709 patients who completed all four visits, overall 70 percent (496) were colonized by vaginal yeast at least one during the year, but only foiur percent were colonized at all four visits. Interestingly, among the 30 percent (214) of women who were never colonized, 37 percent reported having pruritus at least once during the study. More importantly, there’s absolutely no correlation that they can find between colonization and use of these medications, Nearly one-quarter (24 percent) of the persistently uncolonized patients reported using antifungal medication at least once. Among the 470 women who were intermittently or transiently colonized with yeast at one to three visits, 45 percent reported pruritus at least once and 23 percent reported using antifungals at least once.

Finally, among the 26 women who were persistently colonized by yeast, 58 percent reported having experienced pruritus and 35 percent reported using antifungals. The vast majority (98 percent) of the collected specimens were Candida albicans. One of the things that’s emerging here is that symptoms are really very poor indicators of what’s going on, not only by patients out on their own, but also in the doctor’s office.

One doctor said that one of the strengths of his study is that they used not only agar plate, but also used a broth enrichment method, which would detect lower levels of years. On the other hand, his study is limited by its reliance on patient recall and by the fact that patients were evaluated at fixed points rather than at the time of their symptoms. It’s possible that they had yeast, received treatment, and that by the time we saw them, their culture was negative. Nevertheless, the findings along with others suggest high rates of misdiagnosis and overuse of antifungal medication by women for other conditions. In a similar study published earlier this year, about a third of women who were identified buying over-the-counter yeast infection medications actually had vulvovaginal candidiasis. Another 19 percent had bacterial vaginosis, 21 percent had a mixed vaginitis, and 14 percent had no infection.