Dr Anatole Menon-Johansson

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2 THIRD JOINT CONFERENCE OF BHIVA AND BASHH 2014 Dr Anatole Menon-Johansson Guy s and St Thomas NHS Foundation Trust, London 1-4 April 2014, Arena and Convention Centre Liverpool

3 THIRD JOINT CONFERENCE OF BHIVA AND BASHH 2014 Dr Anatole Menon-Johansson Guy s and St Thomas NHS Foundation Trust, London COMPETING INTEREST OF FINANCIAL VALUE > 1,000: Speaker Name Statement Dr Anatole Menon-Johansson Date April April 2014, Arena and Convention Centre Liverpool

4 The BASHH national audit on the management of anogenital herpes Dr Anatole S Menon-Johansson on behalf of the National Audit Group Clinical Lead, Guy s & St Thomas NHS Foundation Trust Third Joint Conference of BHIVA with the BASHH 3 rd April, 2014 anatole.menon-johansson@gstt.nhs.uk

5 Benchmark herpes audit

6 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

7 Methods Each service reviewed forty clients seen BEFORE 31 December 2013 and to submit one form for each client Twenty clients with new anogenital herpes (C10a) and 20 with a recurrent episode (C10b) Timeline 1 st Feb 28 th March, 2014 During the first form submission the auditor was requested to add data about their service

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9 Diagnosis status and testing Was this the first episode? First diagnosis Recurrent episode Number (%) Number (%) Confirmatory testing 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 patients diagnosis status not specified

10 First diagnosis and time of treatment Was 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%)

11 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%)

12 Number of recurrences in the last year

13 Number of recurrences in the last year 227 with >6 episodes / year

14 Offer of suppressive treatment Optimal management of recurrent genital herpes Number (%) Suppressive treatment offered 176 (77.5%) Episodic treatment provided 28 (12.3%)

15 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%)

16 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%

17 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

18 Acknowledgements Position Name Region Name Chair Hugo McClean Anglia Meena Gupta Vice Chair Chris Carne Essex Martin Lechelt Hon Sec Ann Sullivan Merseyside John Evans-Jones Director of Development Anatole Menon-Johansson N West Ashish Sukthanker Co-opted David Daniels Northern Sarup Tayal BCCG Phillip Kell Northern Ireland Say Quah BHIVA HPA Ed Wilkins Alison Roger Lynsey Emmett Oxford Scotland Gill Wildman Anthony Rae Junior Doctors NCSP Public Health SIG Derval Harte Michael Rayment Erna Buitndam Helen Ward South West Thames North Thames South East Andrew DeBurgh-Thomas Vanessa Apea Andy Williams Amelia Hughes SSHA Jamie Hardie Thames South West Steve Estreich Nicola Low Trent Jyoti Dhar Wales Meena Sethupathi Wessex Leela Sanmani West Midlands William Spice Yorkshire Maneh Farazmand

19 Any questions?

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