Leusink Peter, van Moorsel Daphne, Bor Hans, Donker Gé A, Lucassen Peter, Teunissen Doreth, Laan Ellen, Lagro-Janssen Antoine
GP, Department of Primary and Community Care, Unit Gender & Women's Health, Radboud University Medical Centre, Nijmegen, The Netherlands.
Senior Medical Student, Department of Primary and Community Care, Unit Gender & Women's Health, Radboud University Medical Center, Nijmegen, The Netherlands.
BJGP Open. 2017 May 31;1(2):bjgpopen17X100905. doi: 10.3399/bjgpopen17X100905.
A recent Dutch study in general practice showed a clear relationship between the diagnosis of vulvovaginal candidiasis (VVC) and symptoms suggestive of provoked vulvodynia (PVD). PVD accounts for the largest group of vulvar pains, but is often not recognised by GPs.
To investigate whether diagnostic uncertainty about VVC in general practice could also point to the diagnosis of PVD, and whether and how this diagnostic uncertainty affects management.
DESIGN & SETTING: An observational study in 2014 in Dutch general practices of the NIVEL Primary Care Database.
Women with an uncertain diagnosis of VVC were distinguished from those with certain VVC based on the occurrence of recurrent episodes and persisting complaints, despite treatment. Factors known to be associated with PVD were hypothesised to be more prevalent in women with uncertain VVC. Data on symptom management by GPs were collected.
In total 7066 women with VVC or uncertain VVC were included. Uncertain VVC was found to account for 28% of these patients. Compared to VVC, the group uncertain VVC included significantly more women with female genital symptoms, tiredness, irritable bowel syndrome (all <0.001), feeling anxious, reduced sexual desire, depressive disorder, relationship problems, and micturition symptoms (all <0.05). Compared to VVC, the group uncertain VVC included significantly higher mean numbers of telephone consultations (<0.001), more referrals to gynaecology ( = 0.009), and higher mean numbers of prescriptions per patient (<0.001).
This study's findings indicate that uncertain VVC could be a marker of PVD. GPs might reconsider their diagnostics and management when women present recurrent and persistent vulvovaginal complaints, especially if accompanied by dyspareunia, functional syndromes, micturition symptoms, and psychological conditions.
荷兰近期一项针对全科医疗的研究表明，外阴阴道念珠菌病（VVC）的诊断与疑似激发性外阴痛（PVD）的症状之间存在明确关联。PVD是外阴疼痛最主要的类型，但全科医生往往未能识别。
探讨全科医疗中对VVC的诊断不确定性是否也能提示PVD的诊断，以及这种诊断不确定性是否以及如何影响治疗管理。
2014年在荷兰NIVEL初级医疗数据库的全科医疗机构中进行的一项观察性研究。
根据复发情况和治疗后持续存在的症状，将VVC诊断不明确的女性与确诊VVC的女性区分开来。假设已知与PVD相关的因素在VVC诊断不明确的女性中更为普遍。收集全科医生对症状管理的数据。
总共纳入了7066例患有VVC或VVC诊断不明确的女性。发现VVC诊断不明确的患者占这些患者的28%。与VVC相比，VVC诊断不明确的组中女性生殖器症状、疲劳、肠易激综合征（均P<0.001）、焦虑、性欲减退、抑郁症、人际关系问题和排尿症状（均P<0.05）的患者明显更多。与VVC相比，VVC诊断不明确的组平均电话咨询次数明显更多（P<0.001），转诊至妇科的次数更多（P = 0.009），每位患者的平均处方数量更高（P<0.001）。
本研究结果表明，VVC诊断不明确可能是PVD的一个标志。当女性出现复发性和持续性外阴阴道症状时，尤其是伴有性交困难、功能性综合征、排尿症状和心理状况时，全科医生可能需要重新考虑他们的诊断和治疗管理。
