Recurrent Yeast Infections and Vulvodynia: Can We Believe Associations Based on Self-Reported Data?
Recurrent Yeast Infections and Vulvodynia: Can We Believe Associations Based on Self-Reported Data?
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DOI：
10.1089/jwh.2016.5777
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发表时间：
2017-10-01
影响因子：
3.5
通讯作者：
Nguyen, Ruby H. N.
中科院分区：
文献类型：
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作者：
Harlow, Bernard L.;Caron, Rachel E.;Nguyen, Ruby H. N.
目的：我们确定自我报告的新的或复发的酵母菌感染是否是外阴痛的危险因素和/或后果，然后确定自我报告的酵母菌感染的各种错误分类影响这些结果的程度。材料与方法：在这项病例对照研究中，我们回顾性评估了216例临床确诊病例和224例一般人群对照组在首次外阴疼痛发作之前和之后自我报告的新发和复发性酵母菌感染。结果如下：外阴疼痛发作前有>10次酵母菌感染史与目前诊断的外阴疼痛有很强的相关性，但在校正年龄、首次性交年龄和尿路感染史后，相关性不准确[校正比值比=5.5，95%置信区间（CI）1.7-17.8]。同样，外阴痛病史与随后新发或复发性酵母菌感染的风险增加一倍，调整年龄、首次性交年龄和外阴痛发作前酵母菌感染史后（对照组间时间段相似，95%CI 1.5-2.9）。偏倚分析表明，我们观察到的协会是一个低估的真实协会时，自我报告的酵母菌感染和某些差分错误分类的情况下存在的非差分错误分类。然而，如果患有外阴痛的女性更频繁地误报她们实际上没有外阴痛，那么我们观察到的关联就高估了真相。结论：外阴痛诊断之前和之后的酵母菌感染之间似乎存在正相关，但这种关系从强到不存在不等，这取决于病例和对照组中酵母菌感染诊断的相对准确性。为了更好地了解酵母菌感染和外阴痛之间的双向关联，需要进一步的验证研究来确定自我报告的酵母菌感染的错误分类在有外阴痛和没有外阴痛的女性之间的差异程度。
Objective: We determined whether self-reported new or recurrent yeast infections were a risk factor for and/or consequence of vulvodynia and then determined the extent to which various levels of misclassification of self-reported yeast infections influenced these results. Materials and Methods: In this case-control study we retrospectively assessed self-reported new and recurrent yeast infections prior and subsequent to first vulvar pain onset among 216 clinically confirmed cases and during a similar time period for 224 general population controls. Results: A history of >10 yeast infections before vulvodynia onset was strongly but imprecisely associated with currently diagnosed vulvodynia after adjustment for age, age at first intercourse, and history of urinary tract infections [adjusted odds ratio=5.5, 95% confidence interval (CI) 1.7-17.8]. Likewise, a history of vulvodynia was associated with a twofold risk of subsequent new or recurrent onset of yeast infections after adjustment for age, age at first intercourse, and history of yeast infections before vulvodynia onset (comparable time period among controls, 95% CI 1.5-2.9). Bias analyses showed that our observed associations were an underestimation of the true association when nondifferential misclassification of self-reported yeast infections and certain differential misclassification scenarios were present. However, if women with vulvodynia more frequently misreported having them when they truly did not, our observed associations were an overestimate of the truth. Conclusions: There appears to be a positive relationship between yeast infections preceding and following the diagnosis of vulvodynia, but this relationship varies from strong to nonexistent depending on the relative accuracy of the recalled diagnosis of yeast infections among cases and controls. To better understand the bidirectional associations between yeast infections and vulvodynia, future validation studies are needed to determine the extent to which misclassification of self-reported yeast infections differs between women with and without vulvodynia.