An audit of treatment of genital warts: opening the feedback loop

An audit of the treatment of patients (100 men and 90 women) presenting with a first episode of anogenital warts to the Genitourinary Medicine Department at Leeds General Infirmary was performed. Treatment of patients was monitored for a period of 6 months from the time of presentation. The management of patients with genital warts lacked a clearly defined strategy and treatment was unselective and poorly monitored. Excluding patients who defaulted, at follow-up 44 (44%) men and 36 (38%) women still had genital warts at 3 months. Of those patients clear of warts at 3 months, the mean time to remission for men and women was 7.1 and 8.3 weeks respectively. Podophyllin 25% in tincture of benzoin was by far the predominant therapeutic modality used. A total of 96 (96%) men and 76 (84%) women received treatment with podophyllin. Both male and female patients had a mean of 5 treatments with podophyllin 25% (range 1-19 and 1-12 respectively). Physical methods of treatment i.e. cryotherapy and electrocautery, were underutilized, both as primary therapies and when topical agents had failed. Patients saw an average of 3 (range 1-7) doctors over the course of their treatment. Patients with warts affecting 2 or more sites, male patients with anal/perianal warts, and female patients with cervical and vaginal warts had higher failure rates from treatment at 3 months. On the basis of these findings, specific treatment protocols for the management of anogenital warts have been devised.