Vulvovaginal Candidiasis as a Chronic Disease: Diagnostic Criteria and Definition

J Low Genit Tract Dis. 2013 Jun 11. [Epub ahead of print]
Vulvovaginal Candidiasis as a Chronic Disease: Diagnostic Criteria and Definition.
Hong E, Dixit S, Fidel PL, Bradford J, Fischer G.
Source
1Northern Clinical School, University of Sydney; 2Department of Dermatology, Royal North Shore Hospital, St Leonards, NSW, Australia; 3Louisiana State University Health Sciences Center School of Dentistry, New Orleans, LA; and 4University of Western Sydney, NSW, Australia.
Abstract
OBJECTIVE:
Although recurrent vulvovaginal candidiasis is defined as 4 or more discrete attacks of vulvovaginal candidiasis per year, there is no diagnostic nomenclature or definition for the many women who are chronically symptomatic. This study aims to establish and propose a definition and a set of diagnostic criteria, which would enable clinicians to promptly identify and treat women with chronic vulvovaginal candidiasis (CVVC).
DESIGN:
Prospective cohort study.
SETTING:
Public and private vulvar dermatology outpatient clinics in Sydney, Australia.
PARTICIPANTS:
Data were obtained prospectively from 50 women with presumptive CVVC and 42 controls. Historical and clinical features of CVVC identified by expert consensus were compared between the 2 groups. Diagnostic criteria were then prospectively applied to a further 163 patients to verify their accuracy.
OUTCOME MEASURES:
Signs and symptoms diagnostic of CVVC.
RESULTS:
The following characteristics were found to be significantly more common in women with CVVC compared to controls (p ≤ .001): a history of positive vaginal Candida swab, discharge, dyspareunia, soreness, swelling, cyclicity, and exacerbation of symptoms with Antibiotics .
CONCLUSIONS:
We propose that CVVC can be confidently diagnosed using the major criteria of a chronic nonspecific and nonerosive vulvovaginitis that includes at least 5 or more properties from the following criteria: soreness, dyspareunia, positive vaginal swab either at presentation or in the past, previous response to antifungal medication, exacerbation with Antibiotics , cyclicity, swelling, and discharge. This condition responds reliably to oral antifungal medication.
PMID: 23760143 [PubMed - as supplied by publisher]