A clinical audit on management of first episode of anogenital w arts in Sexually Transmitted Disease (STD) clinic, Chilaw

H P Wijayasinghe,R Fernando,U Jayasinghe

doi:10.4038/joshhm.v4i0.69

Abstract

Introduction: A clinical audit was carried out at STD clinic- Chilaw on management of first episode of anogenital warts. Objectives: The objective of the audit was to assess the management of patients with first episode of anogenital warts. Methods: The study population was all newly diagnosed patients with anogenital warts during 2016 in STD clinic, Chilaw (n=68). Patient management and documentation were assessed using a standard questionnaire from British Association for Sexual Health and HIV (BASHH) national audit group. Results: All patients were managed according to the clinic protocol. First line treatment option was trichloro acetic acid for 91 % of patients. None of the patients had documentation on factors that influenced the choice of treatment or offer of a self-applied method. Documentation of the site of warts was 88% at first visit. However, documentation on extent or description of warts was zero. Only seven percent of females were offered Pap smear. Follow up review was offered and documented in 12% of patients. Outcome of the patient after 3 months was documented in 19% of patients, whereas 53% of patients were loss to follow up. None of the patients had documentation on offering information on genital warts. Condom promotion was done on three percent of patients. No patient was offered partner notification for genital warts. All patients were offered the first line treatment according to the clinic protocol. However, documentation at first visit, offering follow up visits, health education and condom promotion were poor. Therefore, training of doctors to overcome the deficits and re-auditing is recommended. Conclusions: All patients were offered the first line treatment according to the clinic protocol. However, documentation at first visit, offering follow up visits, health education and condom promotion were poor. Therefore, training of doctors to overcome the deficits and re-auditing is recommended.

Highlights

A clinical audit was carried out at STD clinic- Chilaw on management of first episode of anogenital warts
According to the annual report of the National STD/AIDS Control Program (NSACP), Sri Lanka, there have been 21,973 new patients registered in STD clinics and out of them, 11,048 new patients were diagnosed with STDs in Sri Lanka in 2016.(1)
Management for anogenital warts according to the clinic protocol /algorhythm

Summary

Introduction

A clinical audit was carried out at STD clinic- Chilaw on management of first episode of anogenital warts. Most common STDs in 2016 in Sri Lanka were Genital herpes, Non Gonococcal Urethritis, Genital Warts, Syphilis, Gonorrhea and Trichomonaiasis in descending order of prevalence.(1). STDs are mostly transmitted via unprotected sexual intercourse but there can be other ways of transmission as well. Unprotected receptive anal sex is the most risky sexual practice but these diseases can be transmitted in vaginal or oral sex as well. There are several factors that contribute to transmission of STDs. Among them social factors like lack of knowledge and lack of access to affordable protective mechanisms, cultural and religious reasons, inability to negotiate with the partner for safe sex: biological factors like younger age, female gender, behavioural factors like multiple partners, regular changing of partners, injectable drug use are common contributors. Women are at a higher risk than men as their area of genital exposure is larger than men and they usually start sexual life earlier than men

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Conclusion