Epidemiologic challenges in studying sexual behavior and recurrent vulvovaginal candidiasis.

Sexually transmitted diseases (STDs) and sexually associated reproductive tract infections constitute a public health problem with serious health, economic and social consequences. Measurement of sexual behaviors that might increase STD risk has focused primarily on younger age groups. We described sexual and health behaviors of women aged 18--94, highlighting characteristics of older women (aged 60--94), among 2000 respondents to a random digit dialing survey living in the continental United States. Frequency and occurrence of sexual activity decreased with age. Married women in every age group were more likely to have engaged in recent sexual activity. Condom use decreased with age and lubricant use increased with age. Over one-third of all women reported douching in a typical month, with little variation in age. Sexual behavior varies with biologic and social stages of individual development. Taking a life course perspective, we developed the concepts of sexual trajectory and magnitude of concurrency, and used data from a random-digit dialing survey of individuals aged 18--39 living in Seattle, Washington, to illustrate these concepts. At least six trajectory types emerged, and traditional measures of STD risk were similar across trajectory types. Possible differences in self-reported history of STD and involuntary partnerships by trajectory type emerged. Little is known about risk factors for acute episodes among women with recurrent vulvovaginal candidiasis (RVVC), defined as four or more episodes of vulvovaginal candidiasis in one year. We followed a cohort of 65 women with RVVC over a 9-month period. Thirty-nine percent had at least one acute episode during follow-up. Use of sexual lubricants, panty liners, and nylon hosiery, both in the same week and previous week, were associated with a two-fold increased risk of an acute episode. Consumption of cranberry juice in the previous week and acidophilus-containing products in the same week was associated with a two-fold increased risk of an acute episode. Major challenges in researching STD and sexually associated reproductive tract infections involve study design and measurement. A clearer understanding of methodological issues in studies of sexually associated infections will have important implications for the design and evaluation of interventions at both the individual and population levels.PhDBiological SciencesHealth and Environmental SciencesMicrobiologyObstetricsPublic healthUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/123668/2/3096169.pd