The public impact of human papillomavirus (HPV) figures prominently this month. Samaranayake (see p 540)1 reports reduced diagnoses of genital warts following introduction of quadrivalent vaccine in Australia. Pirotta’s study (see p 508)2 of the psychosocial burden of HPV disease and screening interventions is timely, showing that external genital warts and cervical intraepithelia neoplasia 2/3 had similar negative psychosocial impact. This will re-ignite debate about quadrivalent versus bivalent vaccine.3 Treatment of warts remains unsatisfactory. A randomised controlled trial of cryotherapy (see p 514)4 with podophyllotoxin versus cryotherapy alone showed clearance of 68.6% and 64.3%, respectively, by 24 weeks. Larger trials are needed.

Prevention strategies for the longer term impacts of HPV on males, are poorly understood. Li et al (see p 503)5 report a 27% prevalence of abnormal anal …