Impact on quality of life of recurrent thrush
November 05 2013
Recurrent vulvovaginal candidosis (rVVC) is a chronic condition causing pain and discomfort. In a masterful international study, Samuel Aballéa and colleagues of the Université of Lyon describe the numerous depression and anxiety problems suffered by women with recurrent vulvovaginal candidiasis (rVVC). An online survey of women reporting rVVC using the EQ-5D and SF-36 questionnaires was done in France, Germany, Italy, Spain, UK and the USA. Of 12,834 women previously identified with VVC, 620 women with rVVC were studied. The quality of life scores were compared among those with current symptoms to assess the direct impact of a VVC attack, and the whole group compared with peers without rVVC.
During an acute episode of VVC, 68% of women reported depression/anxiety problems, and 54% between episodes, compared to less than 20% in general population (p < 0.001). All SF-36 domain scores in those with rVVC were significantly below general population norms. Mental health domains were the most affected. The difference was largest in Italy, where 60% reported anxiety/depression problems outside episodes vs. 9.3% in the general population. The impact on productivity was estimated at 33 lost work hours per year on average, corresponding to estimated costs between €266/year and €1,130/year depending on the country.
Subjective quality of life during and between acute episodes of thrush in women are both significantly worse than in the general population, despite the use of antifungal therapy. The average index score in women with rVVC is comparable to other diseases such as asthma or COPD and worse than diseases such as headache/migraine according to US and UK catalogs of index scores. There was a high level of consistency across countries. Limitations that the authors reported included precise linguistic comparability and a lack of co-morbidity data.
Stress is clearly associated with rVVC but whether it is causal, or secondary, or part of an amplifying negative loop is not clear. Long term antifungal therapy was associated with worse subjective health status compared to others; this was probably related to the fact that those who sought treatment were the women in whom subjective health status was most affected.