Diagnosis Of Genital Warts Research Articles

2013 Trends in anogenital warts incidence: Potential impact of human papillomavirus vaccination, TennCare 2006–2015

OBJECTIVES/SPECIFIC AIMS: We aimed to assess trends in incidence of genital warts across human papillomavirus (HPV) vaccine-eligible and nonvaccine-eligible age groups to determine the impact of the HPV vaccine among Medicaid enrollees in the state of Tennessee. METHODS/STUDY POPULATION: We analyzed 2006–2014 medical and pharmaceutical claims data from TennCare (Tennessee’s Medicaid program) enrollees aged 15–64 years. Incident cases of genital warts were defined as persons 12 months disease free and: (1) a diagnosis of condyloma acuminatum, or (2) a diagnosis of viral warts and genital-specific procedure, or (3) a prescription for genital warts medication and genital-specific procedure. Mann-Kendall trend tests were performed to assess for significant trends in incidence of genital warts by sex and age group; average annual percent changes were calculated to quantify these trends. RESULTS/ANTICIPATED RESULTS: Our analysis is in progress. We hypothesize that we will observe declines in genital warts among younger, vaccine-eligible age groups and no changes in older, nonvaccine-eligible age groups, with largest declines among females aged 15–19 years from 2006 to 2014. We also expect to see declines among younger males due to herd protection, with greater declines after 2011, when the vaccine was approved for males. DISCUSSION/SIGNIFICANCE OF IMPACT: Significant declines among younger compared with older age groups would suggest HPV vaccine effectiveness for preventing genital warts.

Clinical analysis of 51 female children with condyloma acuminatum

Objective To analyze clinical features and treatment outcomes of female children with condyloma acuminatum. Methods Female outpatients with condyloma acuminatum aged less than 12 years were enrolled into this study. Through a questionnaire survey, medical histories were collected, and a physical examination was performed in these patients. Polymerase chain reaction (PCR) was conducted to determine the genotypes of human papillomavirus (HPV) . Descriptive statistical methods were used to identify high risk factors for condyloma acuminatum, manifestations of skin lesions, and results of HPV test. The number of sessions of laser therapy and photodynamic therapy was also recorded. Results A total of 51 female children aged under 12 years with a diagnosis of condyloma acuminatum were enrolled into this study. Their median age and course of disease (M[P25-P75]) were 3 (2-5) years and 6 (4-8) months respectively. Of the 51 patients, 29 (56.9%) lived in the small towns or suburb of a city, and 16 (31.4%) lived in the rural areas. Only 2 children′s parents had a definite HPV infection history. Twelve children (23.6%) usually wore open-seat pants, 24 (47%) often took a bath in public bath houses, and only 1 child had a definite history of sexual assault. Among these patients, 39 (76.5%) mainly had perianal skin lesions, and all cauliflower-like lesions occurred on the perianal area. A total of 35 patients underwent the HPV test in the exfoliated cells. The positive rate of HPV was 71.4%, and all the HPV-positive patients were infected by low-risk HPV types (HPV6/11) . During the treatment, 5 patients were lost to follow-up. In the remaining 46 patients, the median number of sessions of laser therapy and photodynamic therapy was 2 (1-4) and 3 (3-4) respectively. The median course of treatment was 4 (2-6) months. After the treatment, all the remaining 46 patients were cured with a recovery rate of 90.2% (46/51) . Conclusions In these female children with condyloma acuminatum, the source of infection may maninly come from the environment, and skin lesions mostly occur on the perianal area. The prognosis is good after laser and photodynamic therapy. Key words: Condylomata acuminata; Child; Skin manifestations; Treatment outcome

Random Network Models to Predict the Long-Term Impact of HPV Vaccination on Genital Warts.

The Human papillomaviruses (HPV) vaccine induces a herd immunity effect in genital warts when a large number of the population is vaccinated. This aspect should be taken into account when devising new vaccine strategies, like vaccination at older ages or male vaccination. Therefore, it is important to develop mathematical models with good predictive capacities. We devised a sexual contact network that was calibrated to simulate the Spanish epidemiology of different HPV genotypes. Through this model, we simulated the scenario that occurred in Australia in 2007, where 12–13 year-old girls were vaccinated with a three-dose schedule of a vaccine containing genotypes 6 and 11, which protect against genital warts, and also a catch-up program in women up to 26 years of age. Vaccine coverage were in girls with three doses and with coverage rates decreasing with age until for 20–26 year-olds. A fast reduction in the genital warts diagnoses occurred in the model in the first years after the start of the program, similar to what was described in the literature.

Condyloma Acuminatum, Anal Intraepithelial Neoplasia, and Anal Cancer in the Setting of HIV: Do We Really Understand the Risk?

The gold standard for surveillance of patients with anal lesions is unclear. The aim of this study was to stratify patients for risk of progression of disease and to determine appropriate intervals for surveillance of patients with anal disease. This was a retrospective chart review for patients treated for anal lesions between 2007 and 2014. Only patients with ≥1 year of follow-up from index evaluation, pathology, documented physical examination, and anoscopy findings were included for analysis. The study was conducted at an urban university hospital. HIV-positive patients with anal lesions treated with excision and fulguration were included. Recurrence of anal lesions, progression of disease, and progression to cancer were measured. Ninety-one patients met inclusion criteria. The mean age was 41.6 years, and mean follow-up was 38.6 months (range, 11.0-106.0 mo). On initial pathology, 8 patients (8.8%) had a diagnosis of condyloma acuminatum without dysplasia, 20 patients (22%) had anal intraepithelial neoplasia I, 32 (35.2%) had anal intraepithelial neoplasia II, and 31 (34.1%) had anal intraepithelial neoplasia III. Sixty-nine patients (75.8%) had repeat procedures. Seven (87.5%) of 8 patients with condyloma and 6 (30%) of 20 patients with anal intraepithelial neoplasia I progressed to high-grade lesions. Five (15.6%) of 32 patients progressed from anal intraepithelial neoplasia II to III, and 2 patients with anal intraepithelial neoplasia III (6.5%) developed squamous cell carcinoma (2.3% for the entire cohort). This was a single institution study. High-resolution anoscopy was not used. All of the HIV-positive patients with condyloma or anal intraepithelial neoplasia, regardless of the presence of dysplasia, should be surveyed at equivalent 3-month time intervals, because their risk of progression of disease is high. Video Abstract at http://links.lww.com/DCR/A389.

Impact of Number of Human Papillomavirus Vaccine Doses on Genital Warts Diagnoses Among a National Cohort of U.S. Adolescents.

The impact of fewer than 3 doses of human papillomavirus (HPV) vaccine on genital warts is uncertain. Using the Truven Health Analytics Marketscan administrative database, we compared rates of genital warts among women receiving 0, 1, 2, or 3 doses of HPV vaccine. Females aged 9 to 18 years on January 1, 2007, who were continuously enrolled in the database through December 31, 2013, were included. Patients were assigned an HPV dose state (0, 1, 2, or 3) based on the last recorded dose. The exposure period began on January 1, 2007, or the date of the final HPV dose, and lasted until the first diagnosis of genital warts or December 31, 2013. Multivariable Poisson regression was performed to determine the risk of genital warts associated with vaccine doses. Among 387,906 subjects, mean age and exposure period were 14.73 and 5.64 years, respectively. The proportions of doses received were: 52.1%, 7.8%, 9.4%, and 30.7% for 0, 1, 2, and 3 doses, respectively. The rate of genital warts was 1.97/1000 person-years. Receipt of 0 or 1 dose was associated with more genital warts than 3 doses. The effectiveness of 2 doses following current Centers for Disease Control and Prevention guidelines was similar to 3 doses. The risk of genital warts rose with age. Prevention of genital warts is higher with completion of 3 vaccine doses than with 1 dose, though 2-dose recommendations appear to provide similar protection. Prospective effectiveness studies of recommended 2-dose schedules against clinical endpoints including persistent infection, genital warts, and cervical dysplasia are necessary to ensure long-term protection of vaccinated cohorts.

P245 Monitoring the uptake and early impact of targeted hpv vaccination among men who have sex with men (msm) attending gum and hiv clinics in england

IntroductionMSM are at high risk for HPV infection and associated disease (genital warts and anal, oropharyngeal, and penile cancers). Additionally, MSM will receive little or no herd protection from the existing national vaccination programme for females. Following Joint Committee on Vaccination and Immunisation (JCVI) advice, a targeted HPV MSM vaccination pilot was introduced in GUM and HIV clinics across England from June 2016. We present plans for monitoring vaccination uptake and surveillance of infection and early disease outcomes.MethodsUptake (of three doses over a two year period) will be monitored via two existing surveillance and reporting systems: the Genitourinary medicine clinic activity dataset (GUMCADv2) and the HIV and AIDS reporting system (HARS). A seroprevalence study conducted in selected clinics for validation of these data will be considered in due course.Early impact of targeted HPV vaccination of MSM on the epidemiology of HPV infection will be detected by HPV DNA testing of rectal swabs (residual specimens following chlamydia testing) from MSM attending selected GUM clinics, starting with largely baseline collection in 2017.Expected early effects on genital warts diagnoses will be monitored (via GUMCADv2). A decline in HPV-associated cancers is not expected to be seen for some years.DiscussionA comprehensive surveillance strategy has been established to evaluate targeted HPV vaccination of MSM at GUM/HIV clinics. During the pilot, uptake will be the main outcome measure available, and surveillance systems will be established and baseline data collected to evaluate the outcomes of national implementation on infection and disease.

A cross-sectional study estimating the burden of illness related to genital warts in South Korea

ObjectivesEstimate the prevalence of genital warts (GW) and GW-related healthcare resource use and costs among male and female patients seeking treatment in South Korea.DesignTo estimate GW prevalence, physicians in five...

Prevalence and incidence of external genital warts in a sample of Italian general female population

BackgroundThe Human papillomavirus is the most common sexually transmitted virus worldwide. The objective of this study was to estimate: 1) the prevalence and the incidence of external genital warts (eGW) in a sample of women attending community outpatient clinics and 2) the total number of eGW cases in the Italian female population aged 15–64 years.MethodsA prospective study was performed for a 12-month period between 2009 and 2010, among a sample of women attending community gynecological outpatient clinics located throughout Italy. Demographic data, for every woman aged 15–64 years, were collected. For women diagnosed with eGW, behavioral and clinical data were recorded. Prevalence of eGW was calculated as the proportion between the number of women with eGW and that of women visiting any of the participating gynecologists; incidence of eGW was calculated as the proportion between the number of women with a new diagnosis of eGW and that of women visiting any of the participating gynecologists. Standardized prevalence by age was used to estimate the number of eGW cases occurring in the Italian female population aged 15–64 years.ResultsIn 2009–2010, 44 community gynecologists were included in the network. In one-year period, 16,410 women visited any of the participating gynecologists; 63 women were diagnosed with eGW, corresponding to a prevalence of 3.8 cases per 1,000 women per year (95%CI: 2.9-4.9). The incidence of eGW was 3.0 cases per 1,000 women per year (95%CI: 2.2-3.9). Women aged 15–24 years showed both the highest prevalence and incidence. Prevalence and incidence significantly decreased by increasing age group (p <0.001), and were higher in Southern Italy compared to Central-Northern Italy. The estimated number of women with eGW among women aged 15–64 years in Italy, in 2010, was approximately 69,000.ConclusionsThese data show a high prevalence and incidence of eGW among young women in Italy, stress the effectiveness of community clinical networks in investigating STI epidemiology among women from the general population, confirm the relevance of HPV vaccination programs among adolescents, and underscore the need of promoting safe sex, implementing early diagnosis, treatment and prevention of genital warts.

Kératoses séborrhéiques géantes de siège inhabituel

Seborrhoeic keratoses (SK) are benign tumors that mainly occur in the head and in the trunk. Their size generally varies from a few millimeters up to a few centimeters. Giant lesions are very rare but pose a problem in terms both of treatment and transformation. Their occurrence in the genital area is even more rare, posing a problem in differential diagnosis of genital warts. Differentiation is only based on histopathology. We report the case of a 80-year old man, with no particular past medical history, who presented with asymptomatic abdominal and genital lesions evolving over the last twenty years. Clinical examination showed four hyperpigmented, humped, well-defined tumors, with warty surface measuring 2-10 cm along its longer axis (A). Dermoscopic examination showed cerebriform convolutions appearance suggesting seborrhoeic keratoses (B). Histology confirmed the diagnosis, without signs of viral infection or malignant transformation. The patient underwent surgical resection resulting in permanent scar.

Human Papillomavirus Types Involved in External Genital Warts in a Group of Argentinian Women in Buenos Aires.

The aim of the study was to understand which human papillomavirus (HPV) types are involved in external genital warts (GWs) in a group of Argentinian women in Buenos Aires. One hundred sixty consecutive women 15 to 45 years old with GWs were enrolled. All patients underwent confirmatory biopsy. In 150 of 160 patients, the diagnosis of GWs was confirmed by histology, DNA-HPV was investigated using polymerase chain reaction, and sequence analysis with generic primers MY09/11 was performed. HPV 6 and/or 11 was detected in 93.3% patients (140/150). HPV 6 was by far the most common type (80%), followed by HPV 11 (12.7%). Coinfection with these 2 types occurred in 0.7%. HPV 16 was found in 2% and HPV 73 in 0.7%. HPV 6 and/or 11 are present in 93.3% (95% confidence interval, 0.9-1.0) of external genital warts in a group of Argentinian women in Buenos Aires and, therefore, could be prevented with HPV vaccine (NCT 015998779).

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

BackgroundFor 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...

Trends in Male and Female Genital Warts Among Adolescents in a Safety-Net Health Care System 2004-2013: Correlation With Introduction of Female and Male Human Papillomavirus Vaccination.

Human papillomavirus (HPV) vaccination remains underused in the United States, and few population-level studies on effectiveness exist. We examined trends in rates of genital warts diagnoses and HPV vaccination rates (defined as receipt of 1 or more vaccine doses) among low-income and minority adolescents between 2004 and 2013. Data were obtained from a database containing de-identified medical record information including all outpatient visits to an urban medical center and 6 affiliated community health centers. International Classification of Diseases, Ninth Revision codes were used to determine genital warts diagnoses. We estimated annual rates of genital warts for each period for females and males using an interrupted time-series Poisson regression model. As HPV vaccination rates in low-income, minority adolescents rose from 0% to 59% (females) and 0 to 41% (males) between 2004 and 2013, genital warts rates decreased from 3.5% (females) and 3.6% (males) to 1.5% (females) and 2.9% (males). Rates of genital warts decreased significantly for both females and males from the prevaccination to the postvaccination periods (P < 0.05 for both comparisons). Genital warts rates for males began to decrease after the introduction of female vaccination and continued to decrease after male vaccination was introduced. Introduction of HPV vaccination correlated with lower rates of genital warts among a cohort of low-income and minority adolescents. Rates of genital warts began to decrease in females and males following the introduction of female vaccination and continued to fall after the introduction of male vaccination, indicating that male vaccination may confer additional benefit to both males and females over herd immunity alone, especially when vaccination rates are suboptimal.

Trends in genital warts by socioeconomic status after the introduction of the national HPV vaccination program in Australia: analysis of national hospital data.

BackgroundHuman papillomavirus (HPV) vaccination targeting females 12–13 years commenced in Australia in 2007, with catch-up of females 13–26 years until the end of 2009. No analyses of HPV vaccination program impact by either socioeconomic or geographic factors have been reported for Australia.MethodsHospital admissions between July 2004-June 2011 involving a diagnosis of genital warts were obtained from a comprehensive national database. We compared sex- and age-specific admission rates in July 2006–June 2007 (pre-vaccination period) and July 2010–June 2011 (post-vaccination period) according to Index of Relative Socio-economic Disadvantage, nationally and stratified by remoteness area relating to the individual’s area of residence, using Poisson/ negative binomial models.ResultsAdmission rates per 100,000 population in females aged 10–19 years (predominantly vaccinated at school), reduced from 42.2 to 6.0 (rate reduction 86.7 %; 95 % CI:82.2–90.0 %) in more disadvantaged areas and from 26.8 to 4.0 (85.0 %; 95 % CI:79.7–88.9 %) in less disadvantaged areas. In females aged 20–29 years (predominantly vaccinated in the community), the decreases were from 73.9 to 26.4 (66.0 %; 95 % CI:57.7–72.6 %) and from 61.9 to 23.8 (61.6 %; 95 % CI:52.9–68.7 %) in more and less disadvantaged areas, respectively. The reductions were similar in more vs less disadvantaged areas both inside major cities (88.6 %; 95 % CI: 82.2–92.7 % vs 87.9 %; 95 % CI:82.6–91.6 % in females aged 10–19 years; 64.0 %; 95 % CI:57.0–69.9 % vs 63.8 %; 95 % CI:52.9–72.1 % for females aged 20–29 years) and outside major cities (88.8 %; 95 % CI: 83.7–92.3 % vs 85.8 %; 95 % CI:73.5–92.4 % in females aged 10–19 years; 71.1 %; 95 % CI:58.8–79.7 % vs 67.6 %; 95 % CI:48.2–79.8 % for females aged 20–29 years). Admission rates in males aged 20–29 years also reduced, by 23.0 % (95 % CI:4.8–37.8 %) and 39.4 % (95 % CI:28.9–48.3 %) in more versus less disadvantaged areas respectively.ConclusionsThe relative reduction in genital warts appears similar in young females across different levels of disadvantage, including within and outside major cities, both for females predominantly vaccinated at school and in the community.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1347-z) contains supplementary material, which is available to authorized users.

Ongoing decline in genital warts among young heterosexuals 7 years after the Australian human papillomavirus (HPV) vaccination programme

BackgroundAustralia has provided free quadrivalent human papillomavirus (HPV) vaccines to school girls since mid-2007 and a catch-up programme in the community to women aged up to 26 years in 2007–2009....

Fall in Genital Warts Diagnoses in the General and Indigenous Australian Population Following Implementation of a National Human Papillomavirus Vaccination Program: Analysis of Routinely Collected National Hospital Data

Human papillomavirus (HPV) vaccination targeting females aged 12-13 years commenced in Australia in 2007, with catch-up vaccination of females aged 13-26 years continuing to 2009. Whole-population analyses, including effects on the Indigenous population, have not previously been reported. All hospital admissions between 1999-2011 involving a diagnosis of genital warts were obtained from a comprehensive national database. We compared the age-specific rates before to those after implementation of the vaccination program, according to sex and other characteristics. Admission rates decreased from mid-2007 in females aged 12-17 years (annual decline, 44.1% [95% confidence interval {CI}, 35.4%-51.6%]) and from mid-2008 in females and males aged 18-26 years (annual declines, 31.8% [95% CI, 28.4%-35.2%] and 14.0% [95% CI, 5.1%-22.1%], respectively). The overall reductions from 2006-2007 to 2010-2011 were 89.9% (95% CI, 84.4%-93.4%) for females aged 12-17 years, 72.7% (95% CI, 67.0%-77.5%) for females aged 18-26 years, and 38.3% (95% CI, 27.7%-47.2%) for males aged 18-26 years. Compared with the average annual number before program implementation, about 1000 fewer hospital admissions involved a warts diagnosis during 2010-2011. Reductions after program implementation were similar for Indigenous (86.7% [95% CI, 76.0-92.7]) and non-Indigenous (76.1% [95% CI, 71.6%-79.9%]) females aged 15-24 years (P(heterogeneity) = .08). National population-based hospital data confirm previous clinic-based reports of a marked decline in genital warts diagnoses among young people in Australia after program implementation, including indirect benefits to males. The impact of HPV vaccination appears to be similar in young Indigenous and non-Indigenous females.

Genital warts and chlamydia in Australian women: comparison of national population-based surveys in 2001 and 2011

ObjectivesAustralia introduced a nationwide human papillomavirus (HPV) vaccination programme for women aged 12–26 years in 2007 and has implemented various chlamydia control strategies over the last 10 years. We compared...

Significance of dermatoscopy in genital dermatoses

Dermatoscopy as a non-invasive technique has become an integrative part in the evaluation of pigmented and non-pigmented skin lesions, particularly for the early detections of melanoma. Although dermatoscopy improves diagnosis of pigmented and nonpigmented lesions of the skin, it is unknown if dermatoscopy improves the diagnostic accuracy of pigmented mucosal lesions. The “entodermatoscopy” is used for the dermatoscopy of skin infections and infestations and revised as entomodermatoscopy, as it connects the research fields of dermatology and entomology, with its roots being found in these two words. In genital dermatology along with the clinical examination, dermatoscopy is also used for the diagnosis and treatment follow-up of pediculosis pubis, genital warts, molluscum contagiosum, and scabies.

Prevalence of Genital Warts Among Sexually Transmitted Disease Clinic Patients—Sexually Transmitted Disease Surveillance Network, United States, January 2010 to December 2011

A quadrivalent vaccine that prevents genital warts (GWs) has been recommended by the Advisory Committee on Immunization Practices for women since 2007 and for men since 2011. National estimates of GW burden in sexually transmitted disease (STD) clinic settings are useful to provide a baseline assessment to monitor and evaluate reductions in GW and serve as an important early measure of human papillomavirus (HPV) vaccine impact in this population. Genital wart prevalence among STD clinic patients from January 2010 to December 2011 was determined from a cross-sectional analysis of all patients attending STD clinics in the STD Surveillance Network (SSuN). We conducted bivariate analyses for women, men who have sex with women (MSW), and men who have sex with men (MSM) separately, using χ statistics for the association between GW diagnosis and demographic, behavioral, and clinical characteristics. Among 241,630 STD clinic patients, 13,063 (5.4%) had GWs. Wide regional differences were observed across SSuN sites. The prevalence of GW was as follows: 7.5% among MSW (range by SSuN site, 3.9-15.2), 7.5% among MSM (range, 3.3-20.6), and 2.4% among women (range, 1.2-5.4). The highest rate was among 25- to 29-year-old MSW (9.8%). Non-Hispanic black women and MSW had a lower prevalence of GWs than did women and MSW in other racial/ethnic groups. There is a significant burden of GW in STD clinic populations, most notably in men. Given the opportunity for prevention with a quadrivalent HPV vaccine, STD clinics may be an ideal setting for monitoring trends in GW prevalence among men (MSW and MSM). However, given the observed low GW prevalence among female STD clinic patients, STD clinics may not provide an appropriate setting to monitor the impact of HPV vaccine among women.

Prevalence and Determinants of High-Risk Human Papillomavirus Infection in Male Genital Warts

PurposeTo evaluate the prevalence and type distribution of high-risk human papillomavirus (HPV) infection in genital warts of Korean men, and for the first time, to describe the risk factors associated with high-risk HPV infection in male genital warts.Materials and MethodsIn a single private clinic, 150 consecutive male patients with histopathologic-confirmed genital warts who underwent HPV genotyping by use of polymerase chain reaction (PCR) were included in this study. We detected HPV DNA in male genital warts and evaluated HPV type distribution, especially high-risk HPV types, by use of PCR. The associations between HPV prevalence and various characteristics, such as age, circumcision status, type of genital warts diagnosis (new vs. recurrent), number of lesions, site of lesions, and gross morphology, were assessed by use of unconditional multiple logistic regression.ResultsHigh-risk HPV types were detected in 31 cases (23.5%), and of these, 27 cases (20.5%) contained both high-risk and low-risk HPV types. The most frequently detected high-risk HPV types were HPV16 (6.8%), HPV33 (4.5%), HPV18 (2.3%), and HPV68 (2.3%). In particular, the prevalence of infection with HPV16 and/or HPV18 was 8.3% (11 of 132). In the multivariate analysis, lesions located at sites including the base of the penis or the pubic area, papular or mixed genital warts, and lack of circumcision significantly increased the association with high-risk HPV infection in male genital warts.ConclusionsThe prevalence of high-risk HPV infection was substantial in male genital warts. The site and morphology of lesions and circumcision status were significantly associated with the prevalence of high-risk HPV infection.

Declining Genital Warts in Young Women in England Associated With HPV 16/18 Vaccination: An Ecological Study

Background. Diagnoses of genital warts (GW) in genitourinary medicine (GUM) clinics have been increasing in England for many years. In 2008, an HPV immunization program began with a bivalent vaccine (Cervarix). This was expected to markedly reduce infections and disease due to human papillomavirus (HPV) 16/18 but not HPV 6/11 infections or disease. However, from 2009 to 2011 there were decreases in reported diagnoses of GW in young females at GUM clinics.Methods. Using data from GUM clinics and a sample of general practices (GPs) throughout England, we analyzed rates of GW diagnoses by age, year of diagnosis, and estimated immunization coverage.Results. The overall reduction in GW diagnoses at GUM clinics between 2008 and 2011 was 13.3% among 16- to 19-year-old females, with the greatest decline of 20.8% in 17-year-olds. Declines were positively associated with estimated immunization coverage. A similar pattern was seen in GP diagnoses, but not among older women, and for other GUM consultations.Conclusions. Several factors might contribute to declines in GW. However, the size and pattern of the declines strongly suggest that we are observing an unexpected, moderately protective effect of HPV 16/18 vaccination against GW.