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Original article
Epidemiology of genital warts in the British population: implications for HPV vaccination programmes
  1. Pam Sonnenberg1,
  2. Clare Tanton1,2,
  3. David Mesher3,
  4. Eleanor King1,
  5. Simon Beddows4,
  6. Nigel Field1,
  7. Catherine H Mercer1,
  8. Kate Soldan3,
  9. Anne M Johnson1
  1. 1 Mortimer Market Centre, Institute for Global Health, University College London, London, UK
  2. 2 Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
  3. 3 Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, UK
  4. 4 Virus Reference Department, Public Health England, London, UK
  1. Correspondence to Professor Pam Sonnenberg, Mortimer Market Centre, Institute for Global Health, University College London, London WC1E 6JB, UK; p.sonnenberg{at}


Objectives To estimate the prevalence of, and describe risk factors for, genital warts (GWs) in the British population, following the introduction of the bivalent (human papillomavirus (HPV)-16/18) vaccination programme in girls, and prior to the switch to quadrivalent (HPV-6/11/16/18) vaccine (offering direct protection against GWs) and compare this with GW diagnoses in the prevaccination era.

Methods Natsal-3, a probability sample survey in Britain, conducted in 2010–2012, interviewed 9902 men and women aged 16–44. Natsal-2, conducted in 1999–2001, surveyed 11 161 men and women aged 16–44. Both surveys collected data on sexual behaviour and sexually transmitted infection diagnoses using computer-assisted interview methods.

Results In Natsal-3, 3.8% and 4.6% of sexually experienced men and women reported ever having a diagnosis of GWs, with 1.3% of men and 1.7% of woman reporting a GWs diagnosis in the past 5 years. GWs were strongly associated with increasing partner numbers and condomless sex. Diagnoses were more frequent in men who have sex with men (MSM) (11.6% ever, 3.3% past 5 years) and in women reporting sex with women (10.8% ever, 3.6% past 5 years). In the age group who were eligible for vaccination at the time of Natsal-3 (16–20 years), a similar proportion of same-aged women reported a history of GWs in Natsal-2 (1.9%, 1.1–3.4) and Natsal-3 (2.6%, 1.5–4.4).

Conclusions These data provide essential parameters for mathematical models that inform cost-effectiveness analyses of HPV vaccination programmes. There was no evidence of population protection against GWs conferred by the bivalent vaccine. Even with vaccination of adolescent boys, vaccination should be offered to MSM attending sexual health clinics.

  • probability sample survey
  • genital warts
  • HPV

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  • Handling editor Jackie A Cassell

  • Contributors PS, CT, DM, SB, NF and KS originally conceived this article. PS wrote the first draft, with extensive input from CT and DM and further contributions from EK, SB, NF, CHM, KS and AMJ. CT and EK conducted the statistical analysis. AMJ, CHM and PS, initial applicants on Natsal-3, wrote the study protocol and obtained funding. PS, CT, SB, NF, CHM, KS and AMJ designed the Natsal-3 questionnaire, applied for ethics approval, undertook piloting and managed the fieldwork. CT, EK and CHM managed data. All authors interpreted data, reviewed successive drafts and approved the final version of the article.

  • Funding Natsal-3 is a collaboration between University College London, London School of Hygiene and Tropical Medicine, National Centre for Social Research, Public Health England and the University of Manchester. The study was supported by grants from the Medical Research Council (G0701757) and the Wellcome Trust (084840), with contributions from the Economic and Social Research Council and Department of Health.

  • Competing interests AMJ has been a Governor of the Wellcome Trust since 2011. The other authors declare that they have no conflicts of interest.

  • Patient consent for publication Not required.

  • Ethics approval Oxford A MREC.

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

  • Data sharing statement The Natsal datasets are archived with the UK Data Service and are accessible from

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