title: Incidence of anogenital warts in Germany: a population-based cohort study.
abstract: BACKGROUND
  Human papilloma virus (HPV) types 6 and 11 account for 90 percent of anogenital warts (AGW). Assessment of a potential reduction of the incidence of AGW following introduction of HPV vaccines requires population-based incidence rates. The aim of this study was to estimate incidence rates of AGW in Germany, stratified by age, sex, and region. Additionally, the medical practitioner (gynaecologist, dermatologist, urologist etc.) who made the initial diagnosis of AGW was assessed.
  
  
  METHODS
  Retrospective cohort study in a population aged 10 to 79 years in a population-based healthcare insurance database. The database included more than 14 million insurance members from all over Germany during the years 2004-2006. A case of AGW was considered incident if a disease-free period of twelve months preceded the diagnosis. To assess regional variation, analyses were performed by federal state.
  
  
  RESULTS
  The estimated incidence rate was 169.5/100,000 person-years for the German population aged 10 to 79 years. Most cases occurred in the 15 to 40 years age group. The incidence rate was higher and showed a peak at younger ages in females than in males. The highest incidence rates for both sexes were observed in the city-states Berlin, Hamburg and Bremen. In females, initial diagnosis of AGW was most frequently made by a gynaecologist (71.7%), whereas in males, AGW were most frequently diagnosed by a dermatologist (44.8%) or urologist (25.1%).
  
  
  CONCLUSIONS
  Incidence of AGW in Germany is comparable with findings for other countries. As expected, most cases occurred in the younger age groups. The frequency of diagnoses of AGW differs between sexes and women and men receive treatment by doctors of different specialties.
authors.affiliation: Department of Clinical Epidemiology, Bremen Institute for Prevention Research and Social Medicine BIPS, Achterstrasse 30, 28359 Bremen, Germany.
authors.forename: Angela A
authors.initials: AA
authors.lastname: Kraut
authors.forename: Tania
authors.initials: T
authors.lastname: Schink
authors.forename: Renate
authors.initials: R
authors.lastname: Schulze-Rath
authors.forename: Rafael T
authors.initials: RT
authors.lastname: Mikolajczyk
authors.forename: Edeltraut
authors.initials: E
authors.lastname: Garbe
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001604:Berlin; D002648:Child; D015331:Cohort Studies; D003218:Condylomata Acuminata / Q000453:epidemiology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000453:epidemiology*; D012189:Retrospective Studies; D012737:Sex Factors; D055815:Young Adult