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Rate of venereal disease goinfections in women with vaginal candidiasis: Michigan medicaid
Author(s) -
Gable Carol Brignoli,
Holzer Susan Sedory,
Engelhart Luella,
Sarma Syam,
Smeltz Frank,
Schroeder Donald A.,
Friedman Rhonda B.
Publication year - 1992
Publication title -
pharmacoepidemiology and drug safety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.023
H-Index - 96
eISSN - 1099-1557
pISSN - 1053-8569
DOI - 10.1002/pds.2630010306
Subject(s) - medicine , syphilis , disease , chancroid , medicaid , population , medical prescription , trichomoniasis , sexually transmitted disease , epidemiology , gonorrhea , gynecology , pediatrics , family medicine , environmental health , health care , human immunodeficiency virus (hiv) , economics , pharmacology , economic growth
This study was designed to address a concern about the conversion of vaginal imidazoles from prescription only to over‐the‐counter OTC status. The Food and Drug Administration (FDA) was concerned that women may misdiagnose a venereal disease as candidiasis and delay effective medical therapy for the venereal disease by using the OTC product. We conducted an epidemiology study in Michigan Medicaid (1984) to determine the rate of venereal disease in women with vaginal candidiasis. The Medicaid population was selected because it was high‐risk markers for sexually transmitted diseases (STD) — low socioeconomic status and a high proportion of blacks. We used the medical and pharmaceutical claims of a 5% random sample of 98,020 women aged from 10 to 60 years with vaginal infections, who were continuously enroled in Medicaid and had no other known medical insurance. We defined a candidiasis episode as beginning with a diagnosis or prescription for candidiasis and followed by a 2 week study period. We excluded episodes with antibiotic therapy or venereal disease in the preceding 2 weeks. The study population included 2518 women with 3507 candidiasis episodes. We used a conservative approach in defining venereal disease to include Trichomonas, chancroid, gonorrhoea, herpes, syphilis, pelvic inflammatory disease (PID) and non‐specific or unidentified STD. These venereal diseases were identified by diagnosis, specific prescription medication or antibiotic therapy for the disease during the 2 week study period. The incidence rate of venereal coinfections was 15.3% and the prevalence rate was 17.0%, predominantly Trichomonas, non‐specific or unidentified STD and PID. The prevalence rate varied with age (10–19 years and 20–40 years) and race (white and black women) from 12.6 to 20.8%. These prevalence rates are probably an overestimate for the general United States population because of the high‐risk population in Michigan Medicaid and the conservative approach used to identify venereal disease. In 1990 after reviewing this study and clinical trial data, the FDA approved prescription vaginal candidiasis medications for OTC use.