{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T03:39:25Z","timestamp":1791689965459,"version":"4.3.4"},"reference-count":17,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2022,4,28]],"date-time":"2022-04-28T00:00:00Z","timestamp":1651104000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Vulvovaginal candidiasis (VVC) is a common cause of vaginitis, but the national burden is unknown, and clinical diagnosis without diagnostic testing is often inaccurate. We aimed to calculate rates and evaluate diagnosis and treatment practices of VVC and recurrent vulvovaginal candidiasis (RVVC) in the United States. We used the 2018 IBM\u00ae MarketScan\u00ae Research Databases, which include health insurance claims data on outpatient visits and prescriptions for &gt;28 million people. We used diagnosis and procedure codes to examine underlying conditions, vaginitis-related symptoms and conditions, diagnostic testing, and antibacterial and antifungal treatment among female patients with VVC. Among 12.3 million female patients in MarketScan, 149,934 (1.2%) had a diagnosis code for VVC; of those, 3.4% had RVVC. The VVC rate was highest in the South census region (14.3 per 1,000 female patients) and lowest in the West (9.9 per 1000). Over 60% of patients with VVC did not have codes for any diagnostic testing, and microscopy was the most common test type performed in 29.5%. Higher rates of diagnostic testing occurred among patients who visited an OB\/GYN (53.4%) compared with a family practice or internal medicine provider (24.2%) or other healthcare provider types (31.9%); diagnostic testing rates were lowest in the South (34.0%) and highest in the Midwest (41.0%). Treatments on or in the 7 days after diagnosis included systemic fluconazole (70.0%), topical antifungal medications (19.4%), and systemic antibacterial medications (17.2%). The low frequencies of diagnostic testing for VVC and high rates of antifungal and antibacterial use suggest substantial empiric treatment, including likely overprescribing of antifungal medications and potentially unnecessary antibacterial medications. These findings support a need for improved clinical care for VVC to improve both patient outcomes and antimicrobial stewardship, particularly in the South and among non-OB\/GYN providers.<\/jats:p>","DOI":"10.1371\/journal.pone.0267866","type":"journal-article","created":{"date-parts":[[2022,4,28]],"date-time":"2022-04-28T20:05:02Z","timestamp":1651176302000},"page":"e0267866","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":30,"title":["Possible misdiagnosis, inappropriate empiric treatment, and opportunities for increased diagnostic testing for patients with vulvovaginal candidiasis\u2014United States, 2018"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0458-2493","authenticated-orcid":true,"given":"Kaitlin","family":"Benedict","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghan","family":"Lyman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3369-2408","authenticated-orcid":true,"given":"Brendan R.","family":"Jackson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,4,28]]},"reference":[{"issue":"11","key":"pone.0267866.ref001","doi-asserted-by":"crossref","first-page":"1368","DOI":"10.1001\/jama.291.11.1368","article-title":"Evaluation of Vaginal Complaints.","volume":"291","author":"MR Anderson","year":"2004","journal-title":"JAMA"},{"key":"pone.0267866.ref002","article-title":"Diagnosis and Treatment of Vaginal Discharge Syndromes in Community Practice Settings","author":"SL Hillier","year":"2020","journal-title":"Clinical Infectious Diseases"},{"issue":"1","key":"pone.0267866.ref003","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/1472-6874-14-43","article-title":"Highly-cited estimates of the cumulative incidence and recurrence of vulvovaginal candidiasis are inadequately documented.","volume":"14","author":"SD Rathod","year":"2014","journal-title":"BMC Women\u2019s Health"},{"issue":"1","key":"pone.0267866.ref004","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.ajog.2015.06.067","article-title":"Recurrent vulvovaginal candidiasis","volume":"214","author":"JD Sobel","year":"2016","journal-title":"American Journal of Obstetrics and Gynecology"},{"issue":"9","key":"pone.0267866.ref005","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/j.annepidem.2017.08.010","article-title":"Recurrent vulvovaginal candidiasis.","volume":"27","author":"F Blostein","year":"2017","journal-title":"Annals of Epidemiology"},{"key":"pone.0267866.ref006","unstructured":"CDC. Vulvovaginal Candidiasis 2021 [Available from: https:\/\/www.cdc.gov\/std\/treatment-guidelines\/candidiasis.htm."},{"issue":"4","key":"pone.0267866.ref007","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/cid\/civ933","article-title":"Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America","volume":"62","author":"PG Pappas","year":"2015","journal-title":"Clinical Infectious Diseases"},{"issue":"9","key":"pone.0267866.ref008","doi-asserted-by":"crossref","first-page":"1167","DOI":"10.1089\/jwh.1998.7.1167","article-title":"Frequency and response to vaginal symptoms among white and African American women: results of a random digit dialing survey.","volume":"7","author":"B Foxman","year":"1998","journal-title":"J Womens Health"},{"key":"pone.0267866.ref009","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1186\/1477-7525-11-169","article-title":"Subjective health status and health-related quality of life among women with Recurrent Vulvovaginal Candidosis (RVVC) in Europe and the USA.","volume":"11","author":"S Aball\u00e9a","year":"2013","journal-title":"Health Qual Life Outcomes."},{"key":"pone.0267866.ref010","unstructured":"Tsay S, Bartoces M, Vallabhaneni S, Jackson BR, Hicks L. Antifungal Prescribing Patterns in the Outpatient Setting\u2014United States, 2015. The Society for Healthcare Epidemiology of America Spring 2018 conference; April 18\u201320, Portland, Oregon2018."},{"key":"pone.0267866.ref011","volume-title":"Sexually Transmitted Disease Surveillance 2019.","author":"CDC","year":"2021"},{"issue":"3","key":"pone.0267866.ref012","first-page":"370","article-title":"Changes in US Outpatient Antibiotic Prescriptions From 2011\u20132016.","volume":"70","author":"LM King","year":"2020","journal-title":"Clinical infectious diseases: an official publication of the Infectious Diseases Society of America."},{"issue":"9577","key":"pone.0267866.ref013","doi-asserted-by":"crossref","first-page":"1961","DOI":"10.1016\/S0140-6736(07)60917-9","article-title":"Vulvovaginal candidosis.","volume":"369","author":"JD Sobel","year":"2007","journal-title":"Lancet"},{"issue":"1","key":"pone.0267866.ref014","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1186\/s12905-019-0748-8","article-title":"Current patient perspectives of vulvovaginal candidiasis: incidence, symptoms, management and post-treatment outcomes.","volume":"19","author":"J Yano","year":"2019","journal-title":"BMC Womens Health"},{"issue":"1","key":"pone.0267866.ref015","doi-asserted-by":"crossref","first-page":"27","DOI":"10.3390\/jof6010027","article-title":"Vulvovaginal Candidiasis: A Current Understanding and Burning Questions.","volume":"6","author":"HME Willems","year":"2020","journal-title":"J Fungi (Basel)."},{"key":"pone.0267866.ref016","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/1476-0711-5-4","article-title":"Throwing the dice for the diagnosis of vaginal complaints?","volume":"5","author":"A Schwiertz","year":"2006","journal-title":"Ann Clin Microbiol Antimicrob"},{"key":"pone.0267866.ref017","article-title":"Approves Pricey Pill to Treat Vaginal Yeast Infections","author":"S. 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Kaplan","year":"2021","journal-title":"The New York Times"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0267866","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,28]],"date-time":"2022-04-28T20:05:23Z","timestamp":1651176323000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0267866"}},"subtitle":[],"editor":[{"given":"Antonio Simone","family":"Lagan\u00e0","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,4,28]]},"references-count":17,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,4,28]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0267866","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,28]]}}}