Systematic Review of the Incidence and Prevalence of Genital Warts

Harshila Patel; Monika Wagner; Puneet Singhal; Smita Kothari


BMC Infect Dis. 2013;13(39) 

In This Article


Anogenital human papillomavirus (HPV) is the most frequent sexually transmitted viral infection in the world, which can result in malignant cancers or benign skin and mucosal tumors, including anogenital warts (AGWs).[1] AGWs are categorized as a clinical anogenital HPV infection because they manifest as visible lesions, namely as single or multiple papules on the vulva, perineum, perianal area, vagina, cervix, penis, anus, scrotum and urethra.[1] Clinical symptoms may include pruritus, burning, vaginal discharge and bleeding.[2] Four distinct sub-types of AGWs have been described: condylomata acuminata (pointed warts), flat/macular lesions, papular, and keratotic lesions.[1] The first two sub-types are mainly found on moist, non-keratinized epithelia, while the latter two usually present on keratinized epidermis.[1] AGWs are also often referred to as genital warts, condylomata acuminata or genital verruca, although strictly speaking the first two terms are subsets of the AGW category.

HPV 6 and 11 account for the majority of AGW cases.[1,3–5] AGWs are highly infectious; approximately 65% of individuals with an infected partner develop AGWs within 3 weeks and 8 months.[6] In rare cases, AGWs can be associated with malignant lesions, namely Buschke-Lowenstein tumors.[5] Recent prospective studies reported that the median time between infection with HPV types 6 or 11 and the development of AGWs was 11 to 12 months among males[7,8] and 5 to 6 months among young females.[9] Although there are no severe health implications or mortality associated with AGWs, there are significant psychosocial issues which often ensue.[10,11]

Treatment options include patient-applied (home-based) chemical treatments (podofilox, imiquimod), physician-applied (office-based) chemical treatments (podophyllin, trichloracetic acid, interferon, green tea extract)[12] and ablative treatments (cryotherapy, surgical removal, laser treatment).[13–16] The main limitation of current therapies is the high recurrence rate after initial remission.[15,17,18] The quadrivalent HPV vaccine demonstrated high efficacy in preventing the onset of HPV 6/11-related AGWs in both males[19] and females.[20]

Although AGWs rank among the most frequent sexually transmitted diseases (STD)[21,22] the epidemiology of AGWs is not well characterized. A recent review by Scarbrough and colleagues reported the epidemiology of AGWs only in the USA, UK and France.[23] Syrjanen and colleagues evaluated the clinical burden of HPV 6 and 11 infections in Finland, including AGWs.[24] Other reviews summarized the epidemiology associated with HPV infections in general (including genital warts, oropharyngeal cancer and ano-genital cancers such as vulvar, vaginal, anal and penile cancers).[5,25,26] Although providing important data, the primary focus of these reviews was not AGWs. Given the lack of systematic reviews focusing on the epidemiology of AGWs in the literature, the objective of this study was to review the recent published literature on the global epidemiology (incidence and prevalence) of AGWs in the general adult population.