title: Rapid decline in presentations of genital warts after the implementation of a national quadrivalent human papillomavirus vaccination programme for young women.
abstract: OBJECTIVE
  This study aimed to determine if the Australian human papillomavirus (HPV) vaccination programme has had a population impact on presentations of genital warts.
  
  
  METHODS
  Retrospective study comparing the proportion of new clients with genital warts attending Melbourne Sexual Health Centre (MSHC) from January 2004 to December 2008. Australia provided free quadrivalent HPV vaccine to 12-18-year-old girls in a school-based programme from April 2007, and to women 26 years and younger through general practices from July 2007.
  
  
  RESULTS
  36,055 new clients attended MSHC between 2004 and 2008 and genital warts were diagnosed in 3826 (10.6%; 95% CI 10.3 to 10.9). The proportion of women under 28 years with warts diagnosed decreased by 25.1% (95% CI 30.5% to 19.3%) per quarter in 2008. Comparing this to a negligible increase of 1.8% (95% CI 0.2% to 3.4%) per quarter from the start of 2004 to the end of 2007 also in women under 28 years generates strong evidence of a difference in these two trends (p<0.001). There was no evidence of a difference in trend for the quarterly proportions before and after the end of 2007 for any other subgroup, and on only one occasion was there strong evidence of a trend different to zero, for heterosexual men in 2008 in whom the average quarterly change was a decrease of 5% (95% CI 0.5% to 9.4%; p = 0.031).
  
  
  CONCLUSIONS
  The data suggest that a rapid and marked reduction in the incidence of genital warts among vaccinated women may be achievable through an HPV vaccination programme targeting women, and supports some benefit being conferred to heterosexual men.
authors.affiliation: Melbourne Sexual Health Centre, Alfred Hospital and School of Population Health, University of Melbourne, Carlton, Australia. cfairley@unimelb.edu.au
authors.forename: C K
authors.initials: CK
authors.lastname: Fairley
authors.forename: J S
authors.initials: JS
authors.lastname: Hocking
authors.forename: L C
authors.initials: LC
authors.lastname: Gurrin
authors.forename: M Y
authors.initials: MY
authors.lastname: Chen
authors.forename: B
authors.initials: B
authors.lastname: Donovan
authors.forename: C S
authors.initials: CS
authors.lastname: Bradshaw
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003218:Condylomata Acuminata / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D000068857:Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18; D006801:Humans; D017589:Immunization Programs; D015994:Incidence; D008297:Male; D053918:Papillomavirus Vaccines; D012189:Retrospective Studies; D014739:Victoria / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000068857:Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18; D053918:Papillomavirus Vaccines