Quality of Life in Patients with Condyloma accuminata at Dr.

Sardjito General Hospital

Mochammad Rifky Luthfiandi, Hajar Imtihani, Hari Purwanto, Vika Fintaru, Angela Mistralina

Lukito, Nurwestu Rusetiyanti, Devi Artami Susetiati, Satiti Retno Pudjiati

Departement of Dermatology and Venerology, Faculty of medicine Universitas Gadjah Mada, Dr. Sardjito General

Hospital, Yogyakarta, Indonesia

Keywords: condyloma accuminata, quality of life, sexually transmitted diseases

Abstract: Condyloma accuminata is one of the most common Sexually Transmitted Diseases that can reduce the quality

of life, it can damage patient’s selves image as well as their social lives by the stigmatization. The aim of this

study is to evaulate the impact of Condyloma accuminata on quality of live in adult patients. This study used

cross sectional design. We interviewed 37 patients Condyloma accuminata with consecutive sampling, using

Dermatology Life Quality Index (DLQI) – Indonesian version. Most patient (43.2%) showed small effect,

32.4% patients had moderate effect, 10.8% patients had large effect, 10.8% patients had no effect, and 2.7%

patients had extremely large effect to quality of life. This study showed that condyloma accuminata mostly

give little influence to the patient quality of life. The most affected quality of life are symptoms, feeling,

personal relationship, and treatment.

1 INTRODUCTION

Condyloma accuminata (CA) is sexually transmitted

diseases (STD) that are quite common in specialized

outpatient clinics. The incidence has been increasing,

especially among individuals with more than three

sexuall partners and among those who begin their

sexual life at an early age (Camargo et al, 2017;

Fagundes et al, 2013). It is caused by human

papilloma virus (HPV) mostly types 6 and 11.

However, HPV types 16 and 18 are related to cervical

cancer and are considered high risk (Winer and

Koutsky, 2008).

Condyloma accuminata make up approximately

15%–20% of the population infected with an STD.

Annual incidence of CA is estimated to be 5.5 million

in the U.S. and estimated that 75% of sexually active

adults become infected with some form of genital

HPV once in their lifetime. The prevalence infected,

by age group, was as follows: 14–19 years: 35%; 20–

29 years: 29%; 30–39 years: 14%; 40–49 years: 12%;

and 50–65 years: 6% (Ros and Schmitts, 2008).

Quality of life (QoL) attempts to measure the

perceptions of individuals on their overall sense of

well-being, including some aspects such as happiness

and satisfaction with life (Shittu et al, 2006).

Condyloma Accuminata is one of the most common

STD that can lower the QoL, it can make the patients

social lives were affected by the stigmatisation.

Patients found it hard to detach themselves from their

CA because of the repeated treatments, the social

maneuveres required to dissemble the disease and the

negative effects on their love and sex lives.

Quality

of Life assessment has become an important outcome

measure in clinical trials as well as in routine clinical

practice, and such information is also used by health

policy makers in making health care resource

allocation and reimbursement decisions (Shittu et al,

2006).

The Dermatology Life Quality Index (DLQI),

developed in 1994, was the first dermatology-specific

QoL instrument. It is a simple 10 question validated

questionnaire that has been used in over 40 different

skin conditions. Its total score is calculated by the

sum of ten evaluated items and is interpreted as

follows: no effect at all on QoL (0 to 1), small effect

(2 to 5), moderate effect (6 to 10), large effect (11 to

20), or extremly large effect (21 to 30) (Finlay and

Khan, 1994)

The aim of this study is to evaluate the impact of

CA in QoL of adult patient. So we can evaluate the

treatment and patients’education that can make better

QoL.

Luthﬁandi, M., Imtihani, H., Purwanto, H., Fintaru, V., Lukito, A., Rusetiyanti, N., Susetiati, D. and Pudjiati, S.

Quality of Life in Patients with Condyloma accuminata at Dr. Sardjito General Hospital.

DOI: 10.5220/0008153201670171

In Proceedings of the 23rd Regional Conference of Dermatology (RCD 2018), pages 167-171

ISBN: 978-989-758-494-7

167

2 METHOD

This is cross-sectional study with the subject were

new patient older than 18 years old, who come to STD

polyclinic in Dr. Sardjito general hospital that have

been diagnosed CA between December 2017 -

January 2018. We collected 30 patients with

consecutive sampling method. We asked the inform

consent to interview thepatients.. Condyloma

accuminata was diagnosed based on the anamnesis,

physical examination, and laboratory examination

(acetowhite). Descriptive statistic was used to present

and summarize the data.

The The Dermatology Life Quality Index

(Indonesia version) was used in this study to evaluate

QoL of patients with CA. This questionnaire are

consist of six sections which are: section Symptoms

and feelings for question (Q) number 1 (Q1) and 2

(Q2), Daily activities for Q3 and Q4, Leisure for Q5

and Q6, Work and School for Q7, Personal

relationships Q8 and Q9, then Treatment for Q10

Finlay and Khan, 1994) .

3 RESULT

We interviewed 30 patients that have been diagnosed

with CA, that consist of 26 (70.3%) man and 11

(29.7%) woman. From the demographic data (tabel 1)

the average of age were 30.65. Fourteen (33.3%)

patients were HIV positif, which all are male patients.

The most common location of CA in woman were

vulvovaginal (10) and penis (10) in man. The DLQI

score predominantly between mild (16) and moderate

(12) effect to QoL. The most affected part of DLQI

were section symptom and feelings, personal

relationships, and treatment.

Table 1. Dermographic variable

Variable Data (%)

ears

)

–

avera

e 30,65

Gender

an 26

(

70.3

)

Woman 11 (29.7)

HIV state

Yes 14 (37.8)

o 23

(

62.2

)

Location of CA

nal 5

Perianal 8

Uretra

(

OUE

)

Penis 10

Cervix 2

Vulvovaginal 10

DLQI interpretation

o effect 4 (10.8)

Small e

ect 16

(

43.2

)

oderate effect 12 (32.4)

e e

ect 4

(

10.8

)

extreemly large effect 1 (2.7)

RCD 2018 - The 23rd Regional Conference of Dermatology 2018

168

Graphic 1. Frequency of DLQI questionnaire according to each question

Graphic 2. DLQI interpretation in HIV and non-HIV patients

4 DISCUSSION

This study found that mostly patients with CA had

small (43.2%) and moderate (32.4%) effect to QoL,

. Other study in CA patients predominantly showed

no and small effect to QoL (Camargo et al, 2017). It

might be correlate with the lack of symptoms in

patient with CA, so they can tolerate the disease for

long period of time, which can cause increasing rate

of the disease transmission (Fagundes et al, 2013)

In CA patients with HIV positive (37.8%), most

of them showed moderate effect on their QoL. It was

a bit different from non-HIV patients, which showed

small effect on their QoL. Itis probably associated

with HIV status, location of the disease and the longer

period of treatment which might lead to distress,

anxiety and depression (Lee and Larsen, 2010)

Condyloma accuminata can cause psychological

distress by making patients feel ashamed and less

attractive, thereby reducing their quality of life. It has

been shown that a high level of anxiety, anger and

Quality of Life in Patients with Condyloma accuminata at Dr. Sardjito General Hospital

169

depression is associated with the diagnosis and

treatment of CA, and approximately most of the

patients had lifestyle changing regarding to sexual

activity and relationship (Vilata et al, 2008 ; Clarke et

al, 1996 ; Ireland et al, 2005). This result consistent

with our study, which around two-third of the patient

had complain about their symptom and felling. But,

most of them just had a few complain, it might be due

to condition that CA rarely causing pain and

sometimes accompany with itch. The felling of

ashamed and uncomfortable might be related with the

size and quantity of CA. Other study showed that the

majority of respondents noted a range of negative

feelings when they first discovered they had HPV

with initial reactions included anger, depression,

isolation, shame and guilty (Clarke et al, 1996)

Personal relationship of CA patients were also

affected in this study, such as relationship with

family, friend, and sexual partner. Condyloma

accuminata causes embarrassment and limitations to

patient QoL, especially when the genitals are

exposed, such as during sexual intercourse, and even

more when having sex with multiple partners.

This

can influence their sexual behaviour and sexual

relationships. Other study by Clark et.al found that

86% patient said that their disease reduce their ability

to had a new partner; 73% were less spontaneous in

their sexual activity; and 72% had less frequently of

sexual intercourse (Clarke et al, 1996)

The primary aim for treating genital warts is to

relieve symptoms and ultimately, eliminate of the

warts. Regiment therapy for CA can be divided into

two groups, home therapy and clinic therapy. Home

therapy including topical treatment with

podophyllotoxin 0.5%, imiquimod 5%, and

sinecathecins 15%. Therapy in STD clinics consist of

trichloroacetic acid 80-90%, cryotherapy, and

surgery (excision or electrosurgery) (Frieden et al,

2015 ; Lacey et al, 2011)

The treatment, dominantly gave effect in this

study where 86.5% patients have disturbance in their

QoL. It might be cause there are pain or discomfort

while having the therapy, especially for those who

require many sessions of treatment.

So, we need to

communicate clearly with the patient about treatment

modality and treatment which is less morbid to the

patient (Lopaschok , 2013 ; Camargo et al, 2017)

Daily activities, leisure, work and school were

dominantly not affected by the disease. It is probably

due to the location of CA, where mostly in genital

area, which is covered by clothes. Also, the symptoms

like pain and itch was not dominant, so not interfere

their activity

5 CONCLUSSION

This study showed that CA mostly only give small

effect to patients QoL in general The most affected

QoL are symptoms, feeling, personal relationship,

and treatment. In the other way, CA in HIV patients

can make moderate effect to patients QoL. The

limitation of this study is there were no severity levels

of the disease related to disturbance in patients QoL,

therefore further research is needed.

ACKNOWLEDGEMENT

The author would like to thank Nurul Inayati, Hagia

Sofia Adeeva, and Zooey Qiana Ellora for supporting

me until this manuscript finished. Satiti Retno

Pudjiati and Sri Awalia Febriana for being my

mentors. And all staff of Dermatology and

Venereology UGM for the guidance during my

residency programme.

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