Declining Incidence of Genital Warts in a College Student Population

Background: Genital warts are a common sexually transmitted disease seen in college students and sexual health clinics. Following introduction of the quadrivalent HPV vaccine in 2006, the uptake of vaccine in U.S. college students has been reported to be only moderate, particularly for men. We assessed the impact of vaccination on the incidence of disease in a college student population.

Methods: Visit diagnosis data from medical encounters in a student health center at a large public university were abstracted from an electronic health record system for the period January 2008 through December 2013 and stratified by year. Incident case data from 2006 was used for baseline comparison. Changes in disease incidence were compared with HPV vaccination history reported by entering students during this same period.

Results: Overall, the incidence of genital warts seen in the health center declined by 69% between 2006 and 2013, from 1.6% (n=222) to 0.5% (n=88) of medical patients seen annually (p<.0001). Incidence declined progressively each year between 2008 and 2013 (p<.0001 for linear trend). Rates of decline were similar in women and men despite differences in vaccination history. Among students entering the university between 2008 and 2013, 64.0% of women and 14.7% of men reported prior receipt of one or more doses of HPV vaccine.

Conclusions: These data demonstrate striking decreases in the incidence of genital wart diagnoses after the introduction of a quadrivalent HPV vaccine in the United States. Declines occurred rapidly over seven years in this population of sexually active young adults, despite less than optimal levels of vaccine coverage. As rates of immunization increased for women who entered college after 2006, some cross protection for male partners was apparent as well. Colleges and universities should continue to promote and provide HPV vaccine to their students to achieve further reductions in disease incidence.