Anogenital warts (GW) are the most common HPV related disease. The GW incidence is more than 200 per 100.000 women, reaching about 8 per 1000 in women aged 20-25 years (1,2). Highly contagious, with elevated recurrence rates after treatment, GW are a relevant psychological and social problem (3). Although not associated to increased mortality GW are a social problem also in terms of costs, treatment is expensive, estimated cost over 800 USD per incident case in the United States (4). The major clinical problem of GW is the disease recurrence management, that is define as reappearance of GW within 12 months after complete clearance of the lesions. GW relapse, although related to type of surgical treatment and host's immuno-response, is around 50% (5). The aim of the study is to determine if HPV-vaccination post surgical treatment for GW can decrease the rate of disease recurrence.
We analysed the incidence of GW in women treated for cervical intraepithelial neoplasia. From a total of 398 enrolled patients we present data of women undergoing at least 6-months follow-up period (324 patients). We found 64 condylomatosis between the 324 patients (19%). All the patients were enrolled in a study for HPV quadrivalent vaccination after surgical treatment. 162 patients were enrolled in the vaccination arm (V-group) and 162 patients in the control unvaccinated group (C-group). Before treatment V-group GW incidence was 35/162 vs 29/162 of C-group. At 6 months follow-up visit, after treatment and vaccination, recurrence rates were analyzed into the two groups and statistical analysis by Pearson's chi squared test was performed.
At 6 months follow-up visit 14 out of 29 patients in C-group developed a GW recurrence (47%) versus 5 of 35 vaccinated women recurred (14%). The rate of recurrence was significantly higher in the unvaccinated group, with a p=0.0053 by Pearson's chi squared test.
According to our on-going studies and clinical findings from previous retrospective data, HPV-vaccination after treatment for GW may be useful in preventing recurrence of the disease. Vaccination could be useful in reducing social direct cost and psychological problems related to GW management.
1) Systematic review of incidence and prevalence of genital warts Patel H,Wagner M, Singhal P, Kothari S. BMC Infect Dis. 2013 Jan 25;13:39.
2) Rate and predictors of new genital warts claims and genital warts-related healthcare utilization among privately insured patients in the United States. Koshiol JE et al. Sex. Transm Dis 2004, 31(12): 748-752.
3) Human papillomavirus-related psychosocial impact of patients with genital warts in China: a hospital-based cross-sectional study.Qi SZ, Wang SM, Shi JF, Wang QQ, Chen XS, Sun LJ, Liu A, Zhang N, Jiang N, Siva P, Xu XL,Qiao YL. BMC Public Health. 2014 Jul 21;14:739.
4) Estimates of the annual direct medical costs of the prevention and treatment of disease associated with human papillomavirus in the United States.Chesson HW, Ekwueme DU, Saraiya M, Watson M, Lowy DR, Markowitz LE.Vaccine 2012 Sep 14;30(42):6016-9.
5) An evidence-based review of medical and surgical treatments of genital warts.Scheinfeld N, Lehman DS. Dermatol Online J. 2006 Mar 30;12(3):5.