WOMENS USE OF OVER-THE-COUNTER ANTIFUNGAL MEDICATIONS FOR GYNECOLOGICSYMPTOMS

Background. Over-the-counter (OTC) antifungal products for vulvovagina l candidiasis (VVC) have gained tremendous popularity, as evidenced by staggering increases in sales since the products were switched from p rescription-only to OTC status. The rapid escalation in the sale of th ese products may imply that women are using them inappropriately. The purposes of this study were to determine (1) whether women could corre ctly diagnose WC and common genitourinary tract problems after reading classic case scenarios, (2) whether women could correctly select the appropriate treatment for these cases, and (3) whether a previous diag nosis of WC by a clinician had any effect on a woman's ability to self -diagnose and self-treat VVC. Methods. Women 16 years of age and older were recruited from medical and community sites to complete a 63-ques tion survey instrument designed to assess their knowledge of the sympt oms and signs of pelvic inflammatory disease, bacterial vaginosis, acu te cystitis, vaginal trichomoniasis, and vulvovaginal candidiasis afte r reading classic case scenarios. Results. A total of 601 women comple ted the questionnaire, 552 subjects and 49 medically trained women who served as a criterion standard for comparison. Of the 552 subjects, 3 65 reported a prior diagnosis of VCC and 154 reported no such prior di agnosis. The medically trained cohort was more accurate in diagnosing WC (83.7% correct) than were subjects who had received a prior diagnos is of VVC (34.5% correct), and more accurate than subjects without a p revious diagnosis of VVC (11.0% correct, P<.001). A greater percentage of subjects in whom WC had been previously diagnosed, as compared wit h the medically trained cohort, would use OTC agents inappropriately f or pelvic inflammatory disease (6.7% vs 4.3%, respectively; P=NS), bac terial vaginosis (14.6% vs 6.4%, respectively; P=.028), urinary tract infection (2.0% vs 0%, respectively; P<.001), and vaginal trichomonias is (11.8% vs 6.6%, respectively; P=.048). Conclusions. A minority of w omen were able to correctly diagnose VVC from a classic case scenario. A prior clinical diagnosis of VVC had only a moderate positive effect on subjects' ability to correctly diagnose a classic case. Based on o ur findings, women likely use OTC antifungals inappropriately to treat gynecologic conditions that are similar but potentially more severe. Numerous adverse consequences may result from misdiagnosis. Improved p atient education by health care providers and the manufacturers of OTC antifungal drugs might improve this diagnostic problem.