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Hail the Vaccine: Fewer Genital Warts Diagnosed in the Golden State

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Researchers in California say a decrease in the diagnosis of genital warts in the state may indicate HPV vaccine programs are working.

The first HPV vaccine came on the U.S. market in 2006, and it protects against four HPV types: the two types that cause most cervical cancers, along with two additional types found in most cases of genital warts. The vaccine is recommended for use with adolescent and young adult males and females.

Using data from the California Family Planning Access Care and Treatment (Family PACT) program, Dr. Heidi Bauer and colleagues examined clinical claims data from the California Family Planning Access Care and Treatment (Family PACT) program and found that in the years 2007-2010, external genital warts diagnosis fell 35% among females in the program who are under 21 years of age. Extern warts diagnosis among males in the same age group also fell, by 19%. Family PACT provides healthcare services to clients in California with low income.

Genital warts diagnosis in the same time period also dropped among both males (11%) and females (10%), respectively, between the ages of 21-25. With older groups, however, there was no decrease in the rate at with genital warts were diagnosed, offering strong evidence the vaccine is working. The authors say the decreases observed with males are potentially attributable to herd immunity, where even those who don’t receive the vaccine may benefit because there is less HPV in the population.

Read more at http://www.ncbi.nlm.nih.gov/pubmed/22420808.


Fewer Warts Down Under

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HPV vaccine has impact in Australia

Rates of genital warts sharply decreased in young women in the years after the launch of Australia’s national HPV vaccine program, and young men from Down Under seem to have benefited, too.

In 2007, Australia began a program of free school-based HPV vaccination for all girls aged 12 and older, and also offered a free “catch-up” vaccine program for all female Australian residents up to age 26, administered through primary and community-based health care providers.

To determine how effective all these “needles in arms” have been in actually preventing genital warts, Australian researchers looked at rates of genital warts, HPV vaccine status and sexual behavior (to determine gender of sex partners) among clients of eight urban sexual health services around the country from 2004-2009.

The investigators note that vaccine uptake has been good: in the school-based program, 70% of vaccine-eligible females have received all three doses in the immunization series (compared to about 32% in the U.S.).

Of 112,083 new patients at sexual health services clinics, 9% (9,867) were diagnosed with warts. The rate of genital warts in young women residents using the sexual health services declined from 11.7% in 2007 to 4.8% in 2009, a 59% reduction.

The impact wasn’t limited to women, as external genital warts in heterosexual males decreased 28% in the same period. The reduction was especially pronounced among younger men (ages 12-26), whose rate of genital warts dropped 39%.

No significant reduction in warts was seen among men who have sex with men, women older than 26, or non-Australian residents in the country, leading the researchers to conclude the HPV vaccination program for girls and young women has indeed reduced the burden of genital warts, making this the first study to show a population-effect decrease in warts following implementation of an HPV vaccine program.

The quadrivalent vaccine used in Australia’s national program protects against the HPV type found in most cervical cancers (HPV 16 and HPV 18) and also covers the types associated with about 90% of genital warts (HPV 6 and HPV 11). Another study, looking at the vaccine’s potential impact on cervical precancers, found the incidence of high-grade cervical diseases decreased by nearly half among girls under age 18 in the first three years of the HPV vaccination program. “High-grade” diseases in this study were defined as cervical intraepithelial neoplasia (CIN) and adenocarcinoma in situ (AIS), both of which are considered precursors to invasive cervical cancer.

Donovan B, Franklin N, Guy R, Grulich A, Regan D, Ali H, Wand H, Fairley C. Quadrivalent human papillomavirus vaccination and trends in genital warts in Australia: analysis of national sentinel surveillance data. The Lancet Infectious Diseases, 2011. 11:39-44.
Brotherton J, Fridman M, May C, Chappell G, Saville A, Gertig D. Early effects of the HPV vaccination programme on cervical abnormalities in Victoria, Australia: an ecological study. The Lancet, 2011. 377(9783):2085-2092.


A Right Bloody Fortune: The Cost of Treating Genital Warts in England

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Research from across the pond indicates diagnosis and treatment of genital warts in England cost Britain’s National Health Service 17 million pounds – or $27 million- in 2008. Care for sexually transmitted infections and diseases in the United Kingdom largely occur in genitourinary medicine (GUM) clinics, the general equivalent of American public STD clinics.

Using figures from the GUM Activity Data Activity Dataset and General Practice Research Database and (which combined cover all visits and diagnosis in GUM clinics in addition to a number of patients seen by general practice health care providers in England) researchers from the UK’s Health Protection Agency estimate that in 2008 these clinics saw 148,790 cases of genital warts. Pointing to the frequency with which genital warts return, 68,259 cases (46%) were estimated to be recurrences. Warts were common in both genders, but both new and recurrent cases were diagnosed slightly more frequently in males.

The $27 million figure works out to roughly $183 (or 113 British Pounds) per case, which the authors describe as a “…exert[ing] a considerable impact on health services, a large proportion of which could be prevented through immunization using the quadrivalent human papillomavirus vaccine.” The population of England is approximately 50 million. The U.S., by comparison, has a population of 312 million and, according to an analysis in 2008 by Harvard researchers, an estimated annual cost of $171 million to care for genital warts.

Desai S, Wetten S, Woodhall SC, Peters L, Hughes G, Soldan K. Genital warts and cost of care in England. Sexually Transmitted Infections, 2011. Printed online August 3rd.


FDA Approves Zyclara to Treat Genital Warts

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Graceway pharmaceuticals announced in a press release that the Food and Drug Administration (FDA) has approved Zyclara® (imiquimod) 3.75% cream to treat genital and perianal warts in patients 12 years or age and older.

Zyclara® and another, older preparation of imiquimod, Aldara® 5% Cream, both are patient-applied topical agents that work by stimulating an immune response in the skin cells around the treated area. In Phase III trials Zyclara® used daily for up to eight weeks achieved total clearance of warts (including lesions present at enrollment as well as any that developed during the study) in 28.3% of those in the treatment group, compared with 9.4% of those who received a placebo. The cream worked better in females, with an efficacy of 37% compared to 19% in males.

The company touts Zyclara® as a “short acting” treatment: The cream can be applied daily for up to eight weeks, compared to Aldara’s® three-times weekly regimen used for up to 16-weeks.


Genital Warts Affect Quality of Life

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A new study points to the significant emotional impact of HPV and genital warts.

Working with Canadian physicians to recruit patients diagnosed with genital warts, Dr. Martin Sénécal and colleagues examined the psychological toll of the disease by having subjects complete a questionnaire adapted from the HPV Impact Profile (a tool that measures the psychosocial impact of diseases related to HPV). Just over half the subjects were female, the vast majority heterosexual, womanhpvand average age was 31.5 years.

The investigators found that compared to the general population, having genital warts was associated with lower quality of life scores. Anxiety, depression, pain and discomfort were trouble spots for patients with warts.

These findings are hardly surprising, as the negative impact of HPV is well documented. A study by Danish researchers Gitte Lee Mortensen and Helle K Larsen, MD, used focus groups to explore the impact of genital warts on a small group of young people recruited from an STD clinic. They found that frustration with treatment regimens, feelings of shame, and worries about relationships negatively affect quality of life for men and women with genital warts. Reflecting on their findings, the investigators added the psychosocial impact of warts should be considered when considering the value of HPV vaccination programs.

Martin Sénécal, Marc Brisson, Elizabeth Maunsell, Alex Ferenczy, Eduardo L Franco, Sam Ratnam, François Coutlée, Joel M Palefsky, James A Mansi. Loss of quality of life associated with genital warts: baseline analyses from a prospective study. Sexually Transmitted Infections, 2010. First published online February 18, 2011
Gitte Lee Mortensen and Helle K Larsen. The quality of life of patients with genital warts: a qualitative study. BMC Public Health, 2010. 10:113.