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Genital warts in young Australians five years into national human papillomavirus vaccination programme: national surveillance data

BMJ 2013; 346 doi: (Published 18 April 2013) Cite this as: BMJ 2013;346:f2032

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  1. Hammad Ali, lecturer1,
  2. Basil Donovan, professor12,
  3. Handan Wand, senior lecturer1,
  4. Tim R H Read, sexual health physician34,
  5. David G Regan, senior lecturer1,
  6. Andrew E Grulich, professor1,
  7. Christopher K Fairley, professor34,
  8. Rebecca J Guy, associate professor1
  1. 1The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia
  2. 2Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW 2000, Australia
  3. 3Melbourne Sexual Health Centre, Carlton, VIC 3053, Australia
  4. 4School of Population Health, University of Melbourne, Parkville, VIC 3010, Australia
  1. Correspondence to: B Donovan bdonovan{at}
  • Accepted 14 March 2013


Objective To measure the effect on genital warts of the national human papillomavirus vaccination programme in Australia, which started in mid-2007.

Design Trend analysis of national surveillance data.

Setting Data collated from eight sexual health services from 2004 to 2011; the two largest clinics also collected self reported human papillomavirus vaccination status from 2009.

Participants Between 2004 and 2011, 85 770 Australian born patients were seen for the first time; 7686 (9.0%) were found to have genital warts.

Main outcome measure Rate ratios comparing trends in proportion of new patients diagnosed as having genital warts in the pre-vaccination period (2004 to mid-2007) and vaccination period (mid-2007 to the end of 2011).

Results Large declines occurred in the proportions of under 21 year old (92.6%) and 21-30 year old (72.6%) women diagnosed as having genital warts in the vaccination period—from 11.5% in 2007 to 0.85% in 2011 (P<0.001) and from 11.3% in 2007 to 3.1% in 2011 (P<0.001), respectively. No significant decline in wart diagnoses was seen in women over 30 years of age. Significant declines occurred in proportions of under 21 year old (81.8%) and 21-30 year old (51.1%) heterosexual men diagnosed as having genital warts in the vaccination period—from 12.1% in 2007 to 2.2% in 2011 (P<0.001) and from 18.2% in 2007 to 8.9% in 2011 (P<0.001), respectively. No significant decline in genital wart diagnoses was seen in heterosexual men over 30 years of age. In 2011 no genital wart diagnoses were made among 235 women under 21 years of age who reported prior human papillomavirus vaccination.

Conclusions The significant declines in the proportion of young women found to have genital warts and the absence of genital warts in vaccinated women in 2011 suggests that the human papillomavirus vaccine has a high efficacy outside of the trial setting. Large declines in diagnoses of genital warts in heterosexual men are probably due to herd immunity.


  • We thank the staff at the services that provided data for this study (Phillip Read, Heng Lu—Sydney Sexual Health Centre, Sydney, NSW; Stephen Davies, Amanda Rickett—Royal North Shore Hospital Sexual Health, Sydney, NSW; Nathan Ryder, Peter Knibbs—Darwin Clinic 34, Darwin, NT; Darren Russell, Colette Cashman—Dolls House Sexual Health Clinic, Cairns, QLD; Maree O’Sullivan, Stuart Aitken, Simon White—Gold Coast Sexual Health, Gold Coast, QLD; Louise Owen, Barb Lennox—Hobart Sexual Health Service, Hobart, TAS; Christopher Fairley, Marcus Chen, Afrizal Afrizal—Melbourne Sexual Health Centre, Melbourne, VIC; Lewis Marshall—Fremantle Hospital, Fremantle, WA) and CaraData for their help with data extraction.

  • Contributors: BD, CKF, and AEG designed and were principal investigators of the study, with assistance from RJG and DGR. HA coordinated the surveillance network, collated data for this study, did the analysis with HW, and wrote the first draft. BD, RJG, THRR and CKF advised on analysis and interpretation. All authors contributed to the final report. BD and HA are the guarantors.

  • Funding: CSL Biotherapies funded the surveillance network but had no role in study design; data collection, analysis, or interpretation; or writing the report. Only the Kirby Institute had access to the study data, and the authors had sole responsibility of decision for publication.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at (available on request from the corresponding author) and declare: CKF owns shares in CSL Biotherapies; CKF, AEG, DGR, RJG, and BD have received honorariums from CSL Biotherapies; BD and RJG have received honorariums from Sanofi Pasteur MSD; BD, CFK, DGR, AEG, and RJG receive research funding from CSL Biotherapies; BD, CFK, and AEG have received honorariums from Merck; AEG sits on the Australian advisory board for the Gardasil vaccine; TRHR is a site investigator for a Merck human papillomavirus vaccine study.

  • Ethical approval: Ethical approval for the study was provided by the St Vincent’s Hospital’s ethics committee (EC00140) and the University of New South Wales ethics committee (EC00142). Further approval was provided by local research ethics committees of all sites.

  • Data sharing: Study protocol and data dictionary are available from the first author at hali{at}

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