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

Llata, Eloisa MD*; Stenger, Mark MA*; Bernstein, Kyle PhD; Guerry, Sarah MD; Kerani, Roxanne PhD§; Pugsley, River MPH; Pathela, Preeti PhD; Tabidze, Irina MD MPH**; Weinstock, Hillard MD MPH*SSuN GW Working Group

doi: 10.1097/OLQ.0000000000000077
Original Study

Background 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.

Methods 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 2 statistics for the association between GW diagnosis and demographic, behavioral, and clinical characteristics.

Results 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.

Conclusions 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.

We found the prevalence of genital warts in SSuN sexually transmitted disease clinics among women was 2.4% compared with 7.5% among men who have sex with men and men who have sex with women. Given the observed low prevalence among women, these findings provide baseline data that can be used to measure human papillomavirus vaccine impact in men.

From the *Division of STD Prevention, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, Georgia; †San Francisco Department of Public Health, San Francisco, California; ‡Los Angeles Department of Public Health, Los Angeles, California; §Public Health–Seattle & King County and University of Washington Center for AIDS and STD Research, Seattle, Washington; ¶Virginia Department of Health, Richmond, Virginia; ∥New York City Department of Health and Mental Hygiene, New York City, New York; and **Chicago Department of Public Health, Chicago, Illinois

Acknowledgments: The authors thank Susan Hariri and Eileen Dunne for their assistance and critical feedback of this manuscript.

Conflict of interest: None declared.

The SSuN GW Working Group: Lenore Asbel, Kyle Bernstein, Jim Braxton, Sarah Guerry, Heidi Jenkins, Megan Jespersen, Roxanne Kerani, Eloisa Llata, Christie Mettenbrink, Preeti Pathela, River Pugsley, Jane Schwebke, Mark Stenger, Irina Tabidze, Hillard Weinstock, Jonathan Zenilman

Correspondence: Eloisa Llata, MD, Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, MS E-02, Atlanta, GA 30333. E-mail:

Received for publication June 21, 2013, and accepted November 13, 2013.

© Copyright 2014 American Sexually Transmitted Diseases Association