Objectives: To examine the frequency of post-antibiotic vulvovaginitis (PAV); describe how women prevent and treat PAV; and determine whether concern about PAV affects their decisions about taking antibiotics.
Design: Cross-sectional survey using a written questionnaire.
Setting and participants: Five general practice waiting rooms in north-western Melbourne, in February 2000. 1298 women aged 18–70 years were surveyed.
Main outcome measures: Self-reported symptoms and management of vulvovaginitis and PAV.
Results: The response rate was 86%. Thirty-five per cent of women reported ever having PAV and 73% reported ever having symptoms suggestive of vulvovaginal candidiasis. Antifungal medications and lactobacillus products or yoghurt were most popular for both prevention (49%, 40%) and treatment (63%, 43%) of PAV. Other home remedies such as tea tree oil, vinegar, and dietary and clothing modification were infrequently used by the women surveyed. Twenty-three per cent of women who had taken antibiotics in the previous month had experienced symptoms of vulvovaginitis. Of women who had ever had vulvovaginitis, 35% were moderately to very concerned about developing PAV when prescribed antibiotics. Because of this concern, around a fifth of these women would not take prescribed antibiotics.
Conclusions: Concern about PAV affects women's decision-making regarding antibiotic use. Many women use unproven complementary therapies to prevent or treat PAV. When prescribing antibiotics, doctors should discuss the risks of PAV and its management with patients.
- 1. Karasz A, Anderson M. The vaginitis monologues: women's experiences of vaginal complaints in a primary care setting. Soc Sci Med 2002; 56: 1013-1021.
- 2. O'Dowd T, Parker S, Kelly A. Women's experiences of general practitioner management of their vaginal symptoms. Br J Gen Pract 1996; 46: 415-418.
- 3. Chapple A, Hassell K, Nicolson M, Cantrill J. "You don't really feel you can function normally": women's perceptions and personal management of vaginal thrush. J Reprod Infant Psychol 2000; 18: 309-319.
- 4. Foxman B, Barlow R, D'Arcy H. Candida vaginitis: self-reported incidence and associated costs. Sex Transm Dis 2000; 27: 230-235.
- 5. Bessell TL, Hiller JE, Sansom LN. "Pharmacist only" medicines. Aust N Z J Public Health 1999; 23: 661-662.
- 6. Theroux R. Bypassing the middleman: a grounded theory of women's self-care for vaginal symptoms. Health Care Women Int 2002; 23: 417-431.
- 7. Ferris D, Nyirjesy P, Soble J, et al. Over-the-counter antifungal drug misuse associated with patient-diagnosed vulvovaginal candidiasis. Obstet Gynecol 2002; 99: 419-425.
- 8. Cross EW, Park S, Perlin DS. Cross-resistance of clinical isolates of Candida albicans and Candida glabrata to over-the-counter azoles used in the treatment of vaginitis. Microb Drug Resist 2000; 6: 155-161.
- 9. Nyirjesy P, Weitz M, Grody T, Lorber B. Over-the-counter and alternative medicines in the treatment of chronic vaginal symptoms. Obstet Gynecol 1997; 90: 50-53.
- 10. Lipsky MS, Taylor C. The use of over-the-counter antifungal vaginitis preparations by college students. Fam Med 1996; 28: 493-495.
- 11. Foxman B, Marsh JV, Gillespie B, Sobel JD. Frequency and response to vaginal symptoms among white and African American women: results of a random digit dialing survey. J Women's Health 1998; 7: 1167-1174.
- 12. Hart G. Risk profiles and epidemiologic interrelationships of sexually transmitted diseases. Sex Transm Dis 1993; 20: 126-136.
- 13. MacDonald TM, Beardon PH, McGilchrist MM, et al. The risks of symptomatic vaginal candidiasis after oral antibiotic therapy. Q J Med 1993; 86: 419-424.
- 14. Spinillo A, Capuzzo E, Acciano S, et al. Effect of antibiotic use on the prevalence of symptomatic vulvovaginal candidiasis. Am J Obstet Gynecol 1999; 180(1 Pt 1): 14-17.
- 15. Bluestein D, Rutledge C, Lumsden L. Predicting the occurrence of antibiotic-induced candidal vaginitis (AICV). Fam Pract Res J 1991; 11: 319-326.
- 16. Pirotta M, Gunn J, Harrison D. Accurate sampling in general practice waiting room surveys: methodological issues. Aust N Z J Public Health 2002; 26: 152-155.
- 17. Sobel JD, Faro S, Force RW, et al. Vulvovaginal candidiasis: epidemiologic, diagnostic, and therapeutic considerations. Am J Obstet Gynecol 1998; 178: 203-211.
- 18. Rao JNK, Scott AJ. The analysis of categorical data from complex sample surveys: chi-squared tests for goodness of fit and independence in two-way tables. J Am Stat Assoc 1981; 76: 221-230.
- 19. Stata Corporation. Stata Statistical Software, release 7.0. College Station, Tex: Stata Corporation, 2001.
- 20. Australian Bureau of Statistics. 1996 Census of population and housing. Canberra: ABS, 1998.
- 21. HealthWIZ. National social health statistical database. Version 5. Department of Health and Aged Care. Canberra: Prometheus Information, 2000.
- 22. Williams A, Yu C, Tashima K, et al. Evaluation of two self-care treatments for prevention of vaginal candidiasis in women with HIV. J Assoc Nurses AIDS Care 2001; 12: 51-57.
- 23. Shalev E, Battino S, Weiner E, et al. Ingestion of yoghurt containing Lactobacillus acidophilus compared with pasteurized yoghurt as prophylaxis for recurrent candidal vaginitis and bacterial vaginosis. Arch Fam Med 1996; 5: 593-596.
- 24. Hilton E, Rindos P, Isenberg HD. Lactobacillus GG vaginal suppositories and vaginitis. J Clin Microbiol 1995; 33: 1433.
- 25. Hilton E, Isenberg HD, Alperstein P, et al. Ingestion of yoghurt containing Lactobacillus acidophilus as prophylaxis for candidal vaginitis. Ann Intern Med 1992; 116: 353-357.
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