Primary prevention

Awareness of human papillomavirus (HPV) infection and transmission may help prevent its spread through behaviour modification. Abstinence prevents transmission of HPV.[3][28]​ Barrier methods of contraception such as condoms may also decrease the risk of HPV transmission, but they are not entirely effective.[28] CDC: condom fact sheet in brief Opens in new window

There are three HPV vaccines available: bivalent (types 16 and 18); quadrivalent (types 6, 11, 16, and 18); and 9-valent (types 6, 11, 16, 18, 31, 33, 45, 52, and 58). The quadrivalent and 9-valent vaccines are approved to prevent genital warts. In the US, only the 9-valent vaccine is available, and is approved for use in females and males aged 9-45 years. In the UK, both the quadrivalent and 9-valent vaccines are available. Vaccine availability and immunisation schedules vary between countries; healthcare providers should consult local guidance.

The US schedule for HPV immunisation: CDC: recommended immunization schedule for children and adolescents ages 18 years or younger Opens in new window CDC: recommended adult immunization schedule for ages 19 years or older Opens in new window

  • All children and adults ≤26 years should receive a two- or three-dose series of HPV vaccine, depending on age at initial vaccination or condition.​[29]​​​​ Routine HPV vaccination is recommended for adolescents at age 11 or 12 years, although it can be given from age 9 years.​[29]​​​​

  • Healthy adolescents aged 9 to 14 years should receive two doses of HPV vaccine; the second dose should be administered 6 to 12 months after the first dose.[29] For those initiating vaccination on or after their 15th birthday, three doses of HPV vaccine are recommended (0, 1-2, 6 month schedule).[29] Immunocompromised people should receive a three-dose series, even if vaccination is initiated at age 9-14 years.​[29]​​​​

  • Shared clinical decision-making regarding HPV catch-up vaccination is recommended in people aged 27 to 45 years who were not adequately vaccinated when younger.​[30]

  • HPV vaccination is not recommended in pregnant women.[30]​​​

The ​UK schedule for HPV immunisation: UK HSA: routine childhood immunisation schedule Opens in new window

  • Routine HPV vaccination is recommended for all children aged 12-13 years, usually offered as part of school vaccination programmes.[31]​ A one-dose schedule is recommended for immunocompetent children, adolescents, and adults aged <25 years from September 2023.[31][32]​​​​ Those who have received one dose by September 2023 are considered fully vaccinated. Catch-up vaccination recommended up to age 25 years.

  • HPV vaccination is also recommended for gay, bisexual, and other men who have sex with men aged ≤45 years attending specialist sexual health services or HIV clinics.[31][32]​​​ Other people with a similar risk (e.g., transgender people, sex workers, men and women with HIV) may also benefit from HPV vaccination. Eligible adolescents and adults aged <25 years should receive one dose. Eligible adults aged 25-45 years should receive two doses (0, 6-24 month schedule).[32]

  • People who are immunocompromised or HIV-positive, including those on antiretroviral therapy, should receive three doses (0, 1, 4-6 month schedule).[32]

If a patient has previously had an abnormal Pap test or history of genital warts, HPV vaccination is still recommended.[33]​​

Male circumcision may protect against HPV infection, and therefore related disease, in both men and women.[34] Further research is required.

Impact of HPV vaccination

Within 6 years of HPV vaccination availability, HPV 6/11/16/18 infections among Australian women (aged 18-24) and sexually active US females (aged 14-24) decreased by 86% after three doses, and 76% after at least one dose, respectively, compared with contemporaneous unvaccinated women.[35] Decreased HPV infection prevalence among unvaccinated females in the vaccine era compared with the pre-vaccine era suggested herd protection.[35]

In 2011, genital wart prevalence had decreased by up to 92.6% among HPV vaccine-eligible Australian females aged <21 years (from 11.5% in 2007 to 0.85% in 2011).[36][37]​ None of the females aged <21 years who had been vaccinated were diagnosed with genital warts.[36][37]

Secondary prevention

All women with genital warts, as with all sexually active females, should undergo annual cervical cytological screening.[70] After 3 negative annual screenings, women may be screened at less frequent intervals as directed by their healthcare provider.​[6]​

Screening for other STIs, such as chlamydia, gonorrhoea, syphilis, hepatitis B, and HIV infection, should be performed in patients with genital warts.[71][72]

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