HPV pathology, the role of testing in cervical screening ... · 1-4 April 2014, Arena and...
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Transcript of HPV pathology, the role of testing in cervical screening ... · 1-4 April 2014, Arena and...
1-4 April 2014, Arena and Convention Centre Liverpool
THIRD JOINT CONFERENCE
OF BHIVA AND BASHH 2014
Dr Anatole Menon-JohanssonGuy’s and St Thomas’ NHS Foundation Trust, London
1-4 April 2014, Arena and Convention Centre Liverpool
THIRD JOINT CONFERENCE
OF BHIVA AND BASHH 2014
Dr Anatole Menon-JohanssonGuy’s and St Thomas’ NHS Foundation Trust, London
COMPETING INTEREST OF FINANCIAL VALUE > £1,000:
Speaker Name Statement
Dr Anatole
Menon-Johansson
Date April 2014
The BASHH national audit on
the management of
anogenital herpes
Dr Anatole S Menon-Johansson on behalf of the National Audit GroupClinical Lead, Guy’s & St Thomas‘ NHS Foundation Trust
Third Joint Conference of BHIVA with the BASHH3rd April, 2014
Benchmark herpes audit
Auditable outcome measures
All have a target of 100%
Virological confirmation should be attempted in all patients
At least one viral isolate should be typed
Patients presenting early in the course of first episode genital
herpes should be offered antiviral therapy
Patients with a diagnosis of genital herpes should be offered
counselling, support, and written information
Suppressive therapy should be offered to all patients with
more than six recurrences annually
If suppressive therapy is commenced, a clear plan of duration
of treatment should be entered in the notes & patient review
2012 UK National Guideline for the Management of Genital Herpes http://bit.ly/1cP4uN4
Methods
• Each service reviewed forty clients seen
BEFORE 31 December 2013 and to submit
one form for each client http://bit.ly/17JLZLF
• Twenty clients with new anogenital herpes
(C10a) and 20 with a recurrent episode (C10b)
• Timeline 1st Feb – 28th March, 2014
• During the first form submission the auditor
was requested to add data about their service
Diagnosis status and testingWas this the first
episode?
Confirmatory testing
First
diagnosis
Number (%)
Recurrent
episode
Number (%)
Molecular test 2338 (94.8%) 718 (30.1%)
Culture & typing 93 (3.8%) 31 (13.0%)
No 16 (0.6%) 232 (9.7%)
Not recorded 5 (0.2%) 3 (0.1%)
Not applicable 1349 (56.6%)
Not specified 14 (0.6%) 50 (2.1%)
Grand Total 2466 2383
10 patients – diagnosis status not specified
First diagnosis and time of treatmentWas treatment offered? Yes
Number (%)
No
Number (%)
Day 1 of episode 118 (4.8%)
Day 2 of episode 340 (13.8%)
Day 3 of episode 361 (14.6%)
Day 4 of episode 306 (12.4%)
Day 5+ of episode 769 (31.2%)
Duration not recorded 82 (3.3%)
Treatment started elsewhere 35 (1.4%)
No 251 (10.2%)
Not recorded 200 (8.1%)
Declined 4 (0.2%)
Support, counselling and information
First episode Recurrent episode
Optimal management
of genital herpes
First episode
Number (%)
Recurrent episode
Number (%)
Support, counselling & information 1099 (44.5%) 403 (16.9%)
Not recorded 515 (20.8%) 1308 (54.9%)
Number of recurrences in the last year
Number of recurrences in the last year
227 with >6 episodes / year
Offer of suppressive treatment
Optimal management of recurrent genital herpes Number (%)
Suppressive treatment offered 176 (77.5%)
Episodic treatment provided 28 (12.3%)
Suppressive treatment details
Was it recorded? Duration
Number (%)
Follow up
Number (%)
Yes 554 (84.7%) 535 (81.8%)
No 38 (5.8%) 44 (6.7%)
Not recorded 62 (9.5%) 75 (11.5%)
Comparison of the two audits on the management of genital herpes
Was treatment offered? 2006
(%)
2013
(%)
Molecular diagnostics 28% 95%
Virus culture 71% 4%
Evidence of counselling 85% 63%
Summary• 19/20 are offered a molecular diagnostic test
at first presentation
• 8/10 were documented as treated at their first
episode
• Less than 5/10 were given support,
counselling and HSV information
• Nearly 8/10 with significant recurrences were
offered suppressive treatment
• 8/10 had the duration and follow up details for
their suppressive treatment documented
AcknowledgementsPosition Name
Chair Hugo McClean
Vice Chair Chris Carne
Hon Sec Ann Sullivan
Director of Development Anatole Menon-Johansson
Co-opted David Daniels
BCCG Phillip Kell
BHIVA Ed Wilkins
Alison Roger
HPA Lynsey Emmett
Junior Doctors Derval Harte
Michael Rayment
NCSP Erna Buitndam
Public Health SIG Helen Ward
SSHA Jamie Hardie
Nicola Low
Region Name
Anglia Meena Gupta
Essex Martin Lechelt
Merseyside John Evans-Jones
N West Ashish Sukthanker
Northern Sarup Tayal
Northern Ireland Say Quah
Oxford Gill Wildman
Scotland Anthony Rae
South West Andrew DeBurgh-Thomas
Thames – North Vanessa Apea
Andy Williams
Thames – South East Amelia Hughes
Thames – South West Steve Estreich
Trent Jyoti Dhar
Wales Meena Sethupathi
Wessex Leela Sanmani
West Midlands William Spice
Yorkshire Maneh Farazmand
Any questions?
