Western European best practice in primary healthcare

Objective: To establish how general practitioners (GPs) in the Netherlands diagnose and treat vaginal candidiasis. Methods: Questionnaires were sent to 1160 Dutch GPs. The GPs were asked to make an inventory of the annual number of consultations for vulvovaginal candidiasis. Furthermore, information was requested with regard to diagnostic examinations performed and preferred treatment when dealing with vulvovaginal candidiasis. Results: 380 (32.87%) GPs returned the questionnaire, of which 189 GPs worked in single-person practices (n=189). The group of 380 GPs consisted of 269 (70.8%) males and 111 (29.2%) females. On average, GPs reported 105.6 consultations concerning vaginal candidiasis per practice per year. Only 61 (16.1%) Dutch GPs always or often performed microscopy when diagnosing candidiasis, while 143 (37.6%) GPs never used a microscope to confirm their diagnosis. Furthermore, only 30 (7.9%) GPs regularly took Candida cultures, whereas 154 GPs (40.5%) never took a vaginal swab to diagnose acute candidiasis. Treatment of choice was mostly miconazole (50%) or clotrimazole (24%).

Conclusion: GPs often diagnose “vulvovaginal candidiasis” in their practices, but often do not perform the laboratory examinations required to confirm their putative diagnosis. This may lead to wrong diagnoses and maltreatment with antimycotics, without cure of the patients’ vaginal complaints.