Allison Becker

Health aimed to assess the number of women who have had VVC in the past year, the amount of VVC episodes in the past year, and the lifetime prevalence of VVC.

 Currently, it’s estimated that 75% of women will experience VVC in their lifetime and 5-10% will experience recurrent episodes.

In the fall of 2020, Porter Novelli—a public relations firm—conducted an online survey consisting of 4 questions about healthcare provider diagnosed VVC frequency and treatment. The survey was sent to 4548 people ages 18 and older with 3625 completing the survey. Survey participants were randomly recruited.

Researchers conducted multivariate analyses to assess demographic data and health-related factors associated with having VVC in the past year, number of VVC episodes in the past year, and lifetime prevalence of VVC. They used SAS to conduct their analyses.

Out of a total of 1869 women, 5.2% (n=98) reported having a health care provider diagnose them with VVC in the past year and of these, 4.7% (n=5) had recurrent VVC. More than half of the women (53%, n=991) reported having a health care provider diagnose them with VVC in their lifetime. Seventy-two percent of the women with VVC reported using prescription antifungal treatment, and 40% reported using over-the-counter antifungal treatment.

The likelihood of having VVC in the past year was highest for women with less than a high school education (aOR = 6.30, CI: 1.84-21.65) followed by those who completed some college (aOR = 2.62, CI: 1.21, 5.67). The odds were also higher in women with a child or children under 18 years old (aOR = 3.14, CI: 1.58-6.25), women with diabetes (aOR = 2.93, CI: 1.32-6.47), women who were part of a couple (aOR = 2.86, CI: 1.42-5.78), and women with a higher number of health care provider visits (aOR = 2.72, CI: 1.58-4.01). There were no significant differences in having VVC or the number of VVC episodes with regards to age, race, ethnicity, or metropolitan vs. non-metropolitan status. However, lifetime prevalence of VVC increased with age (aOR = 1.12, CI: 1.07-1.17).

Results from this study suggest that about 6.8 million women experience VVC and 325,000 women experience recurrent VVC each year, resulting in $374 million in related medical costs. The overall representation of demographics was the major strength of the study. The primary limitation was the self-reported nature of the data and not capturing the experiences of non-English speakers.

Overall, results from this survey can help contribute to an increased understanding of the estimated incidence and lifetime prevalence of VVC in the US. Increased attention to accurate diagnosis and appropriate treatment is also warranted. The results further support known clinical risk factors for VVC, underscoring the importance of targeting healthcare providers regarding VVC prevention, recognition, and treatment.

Benedict K, Singleton AL, Jackson BR, Molinari NAM. Survey of incidence, lifetime prevalence, and treatment of self-reported vulvovaginal candidiasis, United States, 2020. 

. 2022;22(1):147. Published 2022 May 10. doi:10.1186/s12905-022-01741-x

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Results from this study can help increase understanding of the estimated incidence and lifetime prevalence of VVC in the US.

Survey investigates incidence and lifetime prevalence rate of VVC in the US

The study, conducted in London, United Kingdom, gathered national and international guidelines for diagnosis and treatment of uterine fibroids and assessed quality using the Appraisal of Guidelines for Research and Evaluation II. Three reviewers were responsible for the independent appraisal of the included guidelines and 939 titles and abstracts were screened, with a total of 9 guidelines being selected.

There was consensus across guidelines regarding only 3 areas: 1) asymptomatic women with fibroids are best managed expectantly; 2) gonadotrophin-releasing hormone treatment is effective at improving blood levels preoperatively in women with anemia; 3) hysteroscopic myomectomy should be considered firstline treatment for management of symptomatic submucosal fibroids.

Otherwise, the recommendation content between guidelines varied or was inconsistently reported. For example, in 1 guideline, pregnant women with fibroids required increased monitoring, while in another guideline, they did not unless they were symptomatic. Researchers looked at assessment of fibroids, medical treatment, and surgical treatment when assessing for consistency of recommendations.

Most of the guidelines, 8 of 9, used methodology that described a systematic database search.The number of supporting citations ranged from 6 to 204. Only 25.3% of recommendations were developed using good-quality evidence. The number of Cochrane systematic reviews cited in each guideline ranged from 0 to 7 and the number of randomized controlled trials cited per guideline ranged from 0 to 25. 27.7% of guideline recommendations were based only on expert opinion or clinical consensus rather than evidence.

Researchers concluded that in this study, no published uterine fibroid practice guideline was considered high-quality. Seventy-eight percent of the guidelines scored as being low-quality. There was suboptimal transparency regarding the systematic review strategies used, tools to evaluate the evidence quality were inconsistently used, discussion of the barriers to guideline application was limited and none of the guidelines demonstrated an involvement of patients with fibroids as the primary stakeholders in the guideline development process.

The scope of guideline content varied. For example, 1 guideline was limited to the discussion of submucosal fibroids, while other guidelines discussed uterine fibroids in the context of fertility. Because of these inconsistencies, there are several contrasting recommendations that do not allow for comparison across the guidelines. The scope of each guideline limits discussion of the number of different treatments available.

From this study, many research questions remain unanswered. There is a lack of evidence regarding long-term treatment outcomes and it is still not fully understood how certain fibroid characteristics, such as size and number, affect clinical outcomes. The optimal perioperative therapy to assist in improving operative outcomes has not yet been determined. 

The authors suggest that future guideline development for uterine fibroids should be evidence-based with stronger research methodology, which will allow for validity of recommendations and the ability to cross compare guidelines. The current guidelines and their lack of cohesive recommendations could contribute to suboptimal clinical care and inconsistencies in assessment and management of fibroids among clinicians.

Amoah A, Joseph N, Reap S, Quinn S. Appraisal of national and international uterine fibroid management guidelines: a systematic review. [published online ahead of print, 2021 Sep 30]. 

2022; 129(3): 356-364. doi: 10.1111/1471-0528.16928. 

A study published in the BJOG: An International Journal of Obstetrics and Gynaecology reports a need for high-quality fibroid management and treatment guidelines.

Allison Becker

Articles

Survey investigates incidence and lifetime prevalence rate of VVC in the US

Appraisal of current uterine fibroid management guidelines