Vulvovaginal candidiasis: Epidemiology and risk factors.

Abstract

Vulvovaginal candidiasis (VVC) is an inflammatory condition caused by vaginal overgrowth of Candida albicans and other yeast species. VVC affects most women at least once during their lives and often results in genital itching, abnormal discharge, and other vulvovaginal symptoms. Clinical observations and small studies have attempted to evaluate the many commonly mentioned risk factors for VVC, but few epidemiologic studies have explored the occurrence of and potential risk factors for VVC. This incidence, population-based case-control study was designed to estimate the age distribution of first clinical VVC, characterize the clinical presentation of VVC, and describe the associations between VVC and hypothesized risk factors (sexual behavior, contraceptive practices, feminine hygiene habits, and clothing patterns). All participants were female university students enrolled fall term, 1993. Symptomatic, culture-positive VVC cases (N = 64) and culture-negative clinic controls (N = 196) were recruited through the University Health Service. Population controls (N = 431) were enrolled through a mailing to a random sample of all female students. All participants completed a self-administered questionnaire; cases and clinic controls also consented to medical record review. A clinical diagnosis of VVC ever was reported by 37.5% of population controls, with the proportion reporting a past VVC diagnosis rising from 4.1% at age 16 to 68.3% at age 30. Cases reported all symptoms more frequently than controls, and were more likely to rate symptoms as moderate or severe and to report multiple symptoms. Nevertheless, over 50% of both control groups reported at least one symptom characteristic of VVC. In logistic regression models, risk of VVC was approximately tripled with participation in receptive oral sex twice or more in the previous two weeks (versus none); doubled by oral contraceptive use in the previous two weeks; tripled by spermicide use in the previous two weeks; tripled with another diagnosis of VVC in the previous year; doubled for Other and almost seven times higher for Black race (versus White). Possible explanations for and implications of these findings are discussed in more detail in the dissertation, which also includes an extensive review of the pertinent VVC literature and a detailed methods section.