While the HPV vaccine is an important weapon against cervical cancer, one of the vaccines (Gardasil) also provides coverage against HPV types 6 and 11, which cause genital warts. As this vaccine targets 4 types of HPV (16 and 18, which cause cervical cancer as well as 6 and 11) it is called a quadrivalent vaccine.
Now some people wonder why this is needed. After all, genital warts are benign. And it is true, a genital wart will not progress to cancer, but in addition to being irritating they cause a high degree of personal distress. While some will remit spontaneously or respond to treatment (which can be painful), recurrences are common. I have seen many women over the years who are plagued by warts that recur and recur. It can be devastating.
However, a new study (Ali et al BMJ 2013;346) suggests that the quadrivalent HPV vaccine could all but eliminate the treatment of genital warts from my practice. To this I say, “Wonderful!”
The study is from Australia which has a nationally funded program for the quadrivalent HPV vaccine for girls and women between the ages of 12 and 26. At least 83% of girls ages 12-18 have received one dose of the vaccine and 73% in this age range have received all three doses. In Australia, vaccination rates are lowest (52% receiving at least one dose) among women ages 20-26.
The Australians have been far better at HPV vaccination than we have in the Unites States where only 32% of girls ages 13-17 have been vaccinated (even more dismal, the rates of HPV vaccination is 14% for uninsured girls).
Early data from the Australian HPV vaccination experience indicated a drop in genital warts of 59% among women ages 12-26 years (and 39% among young men, who were typically unvaccinated) just two years after the national vaccine program was implemented. This new study provides 5 year follow-up data and the results are amazing.
Prior to starting the vaccination program 11.5% of women under the age of 21 had at some point been
diagnosed with genital warts, 5 years later that rate plummeted by 92% to 0.85%. Genital warts were all but eliminated in women 20 years of age and younger. Among the under 21 years age group the vaccination rate (3 doses) was 71%. The rate of genital warts also dropped significantly for women ages 21-30, from 11.3% to 3.1% (an almost 73% reduction).
What is even more interesting (and shows the widespread implications of the HPV vaccine) is the drop in the incidence of genital warts among men in the same age range as the men were largely unvaccinated. There was an 81% reduction in genital warts diagnoses among heterosexual sexually active men under the age of 21 and a 51% reduction for heterosexual men ages 21-30 years. The reducing in genital warts for men is likely the result of herd immunity.
What this study tells us is that genital warts could be all but eliminated for young women, although further follow-up is needed to make sure that the immunity of the vaccine doesn’t wane over time and there is simply a spike in genital warts 5 or more years down the road.
Currently, the Australian program has been expanded for universal vaccination for boys as well. With these kind of results the target of eliminating HPV from teenagers and young adults may well be achievable. Well, in Australia anyway.
Getting Americans to accept that the HPV vaccine doesn’t affect promiscuity, understand that the HPV vaccine is very safe, and invest in the concept that eliminating the burden of HPV is a worthy goal is another thing entirely.