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Decline in genital warts diagnoses among young women and young men since the introduction of the bivalent HPV (16/18) vaccination programme in England: an ecological analysis
  1. M Canvin,
  2. K Sinka,
  3. G Hughes,
  4. D Mesher
  1. HIV & STI Department, Public Health England (PHE), London, UK
  1. Correspondence to David Mesher, Public Health England, Centre for Infectious Disease Surveillance and Control, 61 Colindale Avenue, London NW9 5EQ, UK; david.mesher{at}


Background For several decades, diagnoses of genital warts at genitourinary medicine (GUM) clinics in England had been increasing. In 2008, a national human papillomavirus (HPV) vaccination programme was introduced using the bivalent vaccine (types 16 and 18 only). A decrease in genital warts was not anticipated. However, rates of genital warts in GUM clinics have declined significantly since the introduction of the vaccine.

Methods Using data from GUM clinics across England, we analysed rates of genital warts by age, gender, sexual orientation and estimated vaccine coverage.

Results The reduction in rates of genital warts diagnoses at GUM clinics between 2009 and 2014 was 30.6% among young women aged 15–19 years and 25.4% among same age heterosexual young men. Overall there was an association showing higher warts reduction with increasing vaccination coverage with the largest declines in warts diagnoses observed in young women aged 15 years (50.9%) with the highest vaccination coverage. No such declines were observed in men who have sex with men (MSM) of the same age.

Conclusion The results of these ecological analyses are strongly in keeping with the bivalent HPV vaccine providing modest protection against genital warts.

  • HPV

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  • Handling editor Jackie A Cassell

  • Contributors This work was initiated and designed by MC, DM and KS. GH was responsible for the data collection and management. MC conducted the statistical analysis. MC and DM wrote the first draft of the manuscript. All authors contributed to and approved the final draft.

  • Ethics approval PHE has permission to handle data obtained by GUMCADv2 under section 251 of the UK National Health Service Act of 2006 (previously section 60 of the Health and Social Care Act of 2001), which was renewed annually by the ethics and confidentiality committee of the National Information Governance Board until 2013. Since then the power of approval of public health surveillance activity has been granted directly to PHE.

  • Funding This work was supported by Public Health England.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data on diagnoses of genital warts are publicly available. All data sources are cited in the reference list.