Follow-up studies of 95 women approached as they were buying these over-the-counter treatments in cities across the United States found that 33.7 percent had vulvovaginal candidiasis, a yeast infection.
But this study, published in the March issue of Obstetrics & Gynecology, also found that 20 percent had a yeast infection plus another type of infection; over 30 percent had totally different infections – such as the more common, but less well-known bacterial vaginosis; and nearly 14 percent had no infection, according to Dr. Daron G. Ferris, MCG professor in the Departments of Family Medicine and Obstetrics and Gynecology and lead author on the article.
"Ready access to these products is associated with wasted financial expenditures, unfulfilled expectations and a delay in correct diagnosis for a substantial number of women," Dr. Ferris wrote.
"Almost 15 percent of women treated themselves needlessly. And, really and truly, half of the women bought a product they didn’t need to buy," he said of the women in Augusta, Philadelphia, Detroit, Charleston and Omaha who were studied between September 1997 and December 1999.
He suggests that women first see their doctor and confirm the diagnosis. At that point, over-the-counter treatments, effective when used in the right patients, could still be used, he said.
"Women who have been, on multiple occasions, diagnosed by a doctor and have learned what the symptoms are may be OK to use the product on their own," Dr. Ferris said, but noted that previous studies, including one at MCG, showed that even many doctors have difficulty correctly diagnosing a yeast infection.
While acknowledging that some of the women in the study did a good job assessing their symptoms, making the diagnosis and seeking proper treatment, he disputes the Food and Drug Administration’s assumptions that women who have had a previous diagnosis by a doctor and who read the medication label correctly will make a proper diagnosis. " ... Our data clearly indicate that a prior clinician-based diagnosis of vulvovaginal candidiasis and reading the label do not improve women’s ability to properly diagnose vulvovaginal candidiasis," he wrote.
Rather, the study found that women who correctly diagnosed their yeast infection were no more likely to have the condition previously diagnosed by a doctor than those without a current, pure diagnosis of a yeast infection. Most women who correctly diagnosed themselves did read the labels, but the women who read the labels were no more likely to have yeast infections than those who did not.
The study also found that nearly 19 percent of the women actually had bacterial vaginosis, the most common vaginal infection. Lack of treatment of this condition can alter the acidity level of the vagina, creating an easy target for other infectious agents, such as HIV or human papilloma virus, which can cause genital warts and cervical cancer.
"Yeast infections are not the most common type of vaginal infections," he said. "So, right from the start, you know you are in trouble if you assume that everything is a ‘yeast’ infection. It’s like the flu. Everybody says they have the flu when most of the time you really don’t have the flu. You have a virus but not the real influenza."
Twenty percent of the women in the study had mixed infections, 10.5 percent had one of the other dozen or so vaginal infections and 2.1 percent had the sexually transmitted trichomonas vaginitis. "A woman could have a sexually transmitted disease and not be aware of it," he said.
Although these products may cure yeast infections even in women with mixed infections, symptoms likely will persist due to co-existing infections that require clinical and laboratory evaluation, he said. "These women, an additional 32 percent (or 51 percent total) needed a clinician-prescribed pharmaceutical product for adequate therapy," Dr. Ferris wrote, so half of the women using these products may eventually still need to see a doctor.
The sale of yeast infection treatments tripled "overnight" when the FDA approved over-the-counter treatment of vaginal yeast infections nearly a decade ago, Dr. Ferris said. During that time, he and other physicians have seen many patients with a history of diagnosing themselves with yeast infections who don’t have them.
Part of the confusion by consumers and health care professionals alike is the symptoms many of these infections share, including abnormal discharge and itching and irritation, said Dr. Ferris, who is a family medicine physician and colposcopist. But a thorough history, physical exam and microscopic exam of cells in the vagina should result in a correct diagnosis, he said.
For purposes of the study, the women, who were approached by pharmacists and store workers, had much more extensive testing to provide conclusive evidence. Those who agreed to be in the study had tamper-proof seals placed on their product and were seen at one of the study sites within 24 hours.
Co-authors on the study include researchers at Jefferson Medical College in Philadelphia, Wayne State University in Detroit, Medical University of South Carolina in Charleston and the University of Nebraska in Omaha.
The study was funded by an unrestricted grant from Pfizer, Inc., in New York.
Journal
Obstetrics and Gynecology