A tale of two audits: closing the feedback loop on clearance rates of anogenital warts at three months.

Our management of anogenital warts was audited. By case-note review 95% were clear of original warts by three months (assuming wart clearance if patients stopped attending). However, by confirmed outcome (documented in case-notes or verified by telephone) only 81% were clear. The main reason for failure was inconsistent patient attendance. Subsequently, clinic staff were advised to emphasize the importance of regular treatment. A second audit was performed after 12 months. By case-note review 127/134 (95%) had achieved wart clearance, but by confirmed outcome only 74/89 (83%) were clear (P = 0.004). More men (89%) achieved clearance than women (80%). Again, the main reason for failure was inconsistent attendance. There are few data of outcomes in clinical practice at three months. Auditable outcome measures should be challenging yet achievable. Perhaps 90% clearance at three months is not achievable in clinical practice when allowing for the evidence base and patient choice. Is it time to revise the standard?