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R E S E A R C H A R T I C L E Open Access
Decline in in-patient treatments of genital warts
among young Australians following the national
HPV vaccination program
Hammad Ali
1*
, Rebecca J Guy
1
, Handan Wand
1
, Tim RH Read
2
, David G Regan
1
, Andrew E Grulich
1
,
Christopher K Fairley
2,3
and Basil Donovan
1,4
Abstract
Background: There has been a rapid decline in the number of young heterosexuals diagnosed with genital warts
at outpatient sexual health services since the national human papillomavirus (HPV) vaccination program started in
Australia in 2007. We assessed the impact of the vaccination program on the number of in-patient treatments for
genital warts.
Methods: Data on in-patient treatments of genital warts in all private hospitals were extracted from the Medicare
website. Medicare is the universal health insurance scheme of Australia. In the vaccine period (2007–2011) and
pre-vaccine period (2000–2007) we calculated the percentage change in treatment numbers and trends in annual
treatment rates in private hospitals. Australian population data were used to calculate rates. Summary rate ratios of
average annual trends were determined.
Results: Between 2000 and 2011, 6,014 women and 936 men aged 15–44 years underwent in-patient treatment for
genital warts in private hospitals. In 15–24 year old women, there was a significant decreasing trend in annual treatment
rates of vulval/vaginal warts in the vaccine period (overall decrease of 85.3% in treatment numbers from 2007 to 2011)
compared to no significant trend in the pre-vaccine period (summary rate ratio (SRR) = 0.33, p < 0.001). In 25–34 year old
women, declining trends were seen in both vaccine and pre-vaccine periods (overall decrease of 33% vs. 24.3%), but the
rate of change was greater in the vaccine period (SRR = 0.60, p < 0.001). In 35–44 year old women, there was no
significant change in both periods (SRR = 0.91, p = 0.14). In 15–24 year old men, there was a significant decreasing trend
in annual treatment rates of penile warts in the vaccine period (decrease of 70.6%) compared to an increasing trend in
the pre-vaccine period (SRR = 0.76, p = 0.02). In 25–34 year old men there was a significant decreasing trend in the
vaccine period compared to no change in the pre-vaccine period (SRR = 0.81, p = 0.04) and in 35–44 year old men there
was no significant change in rates of penile warts both periods, but the rate of change was greater in the vaccine period
(SRR = 0.70, p = 0.02).
Conclusions: The marked decline in in-patient treatment of vulval/vaginal warts in the youngest women is probably
attributable to the HPV vaccine program. The moderate decline in in-patient treatments for penile warts in men probably
reflects herd immunity.
Background
Australia became the first country to introduce a na-
tional quadrivalent human papillomavirus (HPV) vaccine
(Gardasil, CSL Biotherapies, Melbourne, VIC, Australia)
program for young women in mid 2007 [1]. The ongoing
voluntary program provides free vaccine to 12–13 year
old girls and there was a catch-up program for women
up to 26 years from 2007 to 2009. In addition to providing
protection against HPV 16 and 18, the quadrivalent vaccine
provides protection against HPV 6 and 11 which causes
more than 90% of genital warts [2]. Vaccine coverage rates
have been reported to be very high in Australia with >80%
coverage rates for the first dose and ~70% for the three
doses in 12–17 year old girls [1]. Lower coverage rates have
* Correspondence: hali@kirby.unsw.edu.au
1
The Kirby Institute, The University of New South Wales, Sydney, NSW,
Australia
Full list of author information is available at the end of the article
© 2013 Ali et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
Ali et al. BMC Infectious Diseases 2013, 13:140
http://www.biomedcentral.com/1471-2334/13/140
been reported for women aged 18–19 years (64%) and
20–26 years (52%) for the first dose [1].
Before the vaccination program started, genital warts
were the most common condition diagnosed at sexual
health services in Australia [3]. Since then, sentinel surveil-
lancedatahasshownalargedecreaseintheproportionof
vaccine-eligible women diagnosed with genital warts at out-
patient sexual health services nationwide [4,5]. In addition,
data from the Victorian Cervical Cytology Registry has
shown a significant decrease in the incidence of high-grade
cervical abnormalities in girls younger than 18 years since
the vaccine program started [6].
Approximately 7% of genital warts cases end in
hospitalisations [7] and these are an important out-
come to monitor when assessing the impact of a public
health program due to the severity and associated cost.
In-patient treatment under anaesthesia is usually
reserved for the most severe or intractable cases of
genital warts. The procedure is unpleasant for patients
and expensive for the health care system [7]. Genital
warts can be prolonged or recurrent and have a significant
impact on the quality of life of the patient [8]. In addition,
psychosexual vulnerability (including depression, anxiety
and anger) has been shown to increase with the number
of recurrences [9].
In this study, we assess for the first time the impact
of the national HPV vaccination program on private
in-patient treatments for genital warts.
Methods
Study design
We conducted a time-series analysis using data from a
national registry reporting numbers of patients treated
under anaesthesia for genital and anal warts in all private
hospitals in Australia.
Data source
Medicare is the universal health insurance scheme of
Australia and rebates services provided by private doctors
and laboratories. Services provided in the public sector are
funded by the state and territory governments and are not
rebated by Medicare. Each service has a unique item num-
ber [10] and aggregated data are publicly available from
the Medicare registry (the Medicare Benefit Schedule
website [11]).
We extracted data on in-patient treatments under
general anaesthesia or regional or field nerve block
(excluding pudendal block) requiring admission to a
hospital, among 15–44 year olds from 2000 to 2011.
Thedatawereaggregatedby6-monthtimeperiods,
sex, age-group (15–24 years, 25–34 years and 35–44 years),
and anatomical site (vulval/vaginal warts - Medicare item
numbers 35507, 35508; penile warts - Medicare item
number 36815; anal warts - Medicare item numbers 32177,
32180).
Statistical analyses
In the vaccine period (2007–2011) and pre-vaccine period
(2000–2007) we conducted a descriptive analysis of the
number of in-patient treatments per year stratified by sex,
age-group and anatomical site and calculated percentage
change in treatment numbers. We also calculated annual
treatment rates per 100,000 populations. Australian popu-
lation data (derived from the Australian Bureau of Sta-
tistics [12]) were used to calculate rates.
We used Box-Jenkins [13] time-series methodology to
determine average annual trends in rates of in-patient treat-
ments. Residuals from the time-series models were exam-
ined by autocorrelation and partial autocorrelation
methods to detect potential serial dependence in the data.
When significant serial dependence was detected, Newey-
West [14] autocorrelation and heteroscedasticity-corrected
standard errors were used in the relevant regression model
assuming that the count data (i.e. number of diagnoses
per year) followed a Poisson distribution. Estimated
models were considered most appropriate if they typically
simulated historical behaviour.
Finally, we compared the average annual treatment
rates in the pre-vaccine and vaccine periods and describe
summary rate ratios along with 95% confidence intervals.
Analyses were conducted and all models were fitted
using STATA v12.1 (StataCorp, Texas, US).
Results
Vulval/vaginal warts in women
Between 2000 and 2011, a total of 6,014 women aged
15–44 years underwent in-patient treatment for vulval/va-
ginal warts. In 15–24 year old women in the pre-vaccine
period the number of treatments did not change (266 treat-
ments in 2000 and 285 in 2007) and there was no signifi-
cant trend in treatment rates (p = 0.56). In the vaccine
period the number of treatments declined by 85.3% to 42
treatments in 2011 (p < 0.001) (Figure 1). The summary
rate ratio in the vaccine versus pre-vaccine period in
15–24 year olds was 0.33 (p< 0.001) (Table 1).
Among women aged 25–34 years, the number of treat-
ments decreased by 24.3% in the pre-vaccine period from
202 in 2000 to 153 in 2007 (p = 0.001) and decreased by
33% to 102 in-patient treatments in 2011 in the vaccine
period (p < 0.001). The summary rate ratio in vaccine vs
pre-vaccine period in 25–34 year olds was 0.60 (p < 0.001).
Among women aged 35–44 years, there was no signifi-
cant trend either in the pre-vaccine (98 treatments in 2000
and 87 in 2007; p = 0.12) or vaccine period (94 treatments
in 2011; p = 0.11). The summary rate ratio in vaccine vs
pre-vaccine period in this age group was 0.91 (p = 0.14).
Ali et al. BMC Infectious Diseases 2013, 13:140 Page 2 of 6
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Penile warts in men
Between 2000 and 2011, a total of 936 men aged 15–
44 years underwent in-patient treatment for penile
warts. The number of 15–24 year old men undergoing in-
patient treatment for penile warts in the pre-vaccine period
increased by 200% from 17 in 2000 to 51 in 2007 (p <
0.001) and in the vaccine period decreased by 70.6% to
15 treatments in 2011 (p < 0.001) (Figure 2). In this youn-
gest age-group, the summary rate ratio in the vaccine vs
pre-vaccine period was 0.76 (p = 0.02) (Table 1).
In the pre-vaccine period, there was no significant
trend in in-patient treatments in 25–34 year old (42 in
treatments 2000 and 39 in 2007; p = 0.14) or 35–44 year
old men (15 in 2000 to 18 in 2007; p = 0.12). In the vac-
cine period the number of treatments declined by 59.0%
to 16 in 2011 in 25–34 year olds (p = 0.001) and there
was no significant trend in treatments in 35–44 year old
men (p = 0.16). The summary rate ratio in vaccine vs
pre-vaccine period was 0.81 (p = 0.04) for the 25–34 year
olds and 0.70 (p = 0.02) for 35–44 year olds.
Anal warts in men
Between 2000 and 2011, a total of 2,237 men aged
15–44 years underwent in-patient treatment for anal
warts. The number of 15–24 year old men undergoing
in-patient treatment for anal warts in the pre-vaccine
period increased by 89.6% from 29 in 2000 to 55 in
2007 (p = 0.003) and in the vaccine period the numbers
decreased by 49.1% to 28 treatments in 2011 (p = 0.05)
(Figure 3). In this youngest age-group, the summary rate
ratio for in-patient treatments of anal warts in vaccine
vs pre-vaccine period was 0.92 (p = 0.37) (Table 1).
Among men aged 25–34 years, there was no significant
trend either in the pre-vaccine (77 treatments in 2000 and
Figure 1 Numbers of in-patient treatments for vulval/vaginal warts in women by age-group, 2000–2011.
Table 1 Average annual trends in the numbers of in-patient treatment of warts with summary rate ratios, 2000–2011
Pre-vaccine period Vaccine period Pre-vaccine vs vaccine period
Average
annual trend
95% CI p-value Average
annual trend
95% CI p-value Summary
rate ratio
95% CI p-value
Female –vulval/vaginal
15-24 years 1.00 0.99 - 1.01 0.556 0.76 0.73 - 0.79 <0.001 0.33 0.30 - 0.37 <0.001
25-34 years 0.98 0.97 - 0.99 0.001 0.93 0.90 - 0.97 <0.001 0.60 0.54 - 0.66 <0.001
35-44 years 0.99 0.97 - 1.00 0.116 1.03 0.99 - 1.07 0.115 0.91 0.81 - 1.03 0.145
Male –penile
15-24 years 1.1 1.04 - 1.1 <0.001 0.86 0.80 - 0.93 <0.001 0.76 0.62 - 0.96 0.022
25-34 years 0.98 0.95 - 1.01 0.144 0.90 0.84 - 0.96 0.001 0.81 0.66 - 0.99 0.040
35-44 years 0.97 0.93 - 1.01 0.125 0.93 0.84 - 1.03 0.161 0.70 0.51 - 0.95 0.024
Male –anal
15-24 years 1.08 1.03 - 1.14 0.003 0.90 0.81 - 1.00 0.055 0.92 0.77 - 1.10 0.370
25-34 years 0.97 0.94 - 1.01 0.143 0.95 0.87 - 1.04 0.241 0.69 0.59 - 0.79 <0.001
35-44 years 0.99 0.95 - 1.03 0.559 0.91 0.83 - 0.99 0.027 0.86 0.74 - 0.99 0.036
CI = confidence interval.
Ali et al. BMC Infectious Diseases 2013, 13:140 Page 3 of 6
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71 in 2007; p = 0.14) or vaccine period (65 treatments in
2011; p = 0.24). The summary rate ratio in vaccine vs pre-
vaccine period in this age group was 0.69 (p < 0.001). There
was no significant trend in the number of in-patient treat-
ments among 35–44 year old men in the pre-vaccine
period (55 treatments in 2000 to 66 in 2007; p = 0.56).
In the vaccine period there was a 21.2% decline in
number of treatments to 52 in 2011 (p = 0.03). The
summary rate ratio in vaccine vs pre-vaccine period
was 0.86 (p = 0.04).
Discussion
This is the first study to look at the impact of the HPV
vaccine program on in-patient treatment of genital warts
in Australia. We found that there was a large (85.3%)
decline in the number of in-patient treatments for genital
warts in the youngest (15–24 year old) women after the
HPV vaccination program began in 2007; the decline in
the 25–34 year old age-group was more modest and there
was no significant decline in the numbers of in-patient
treatments in older (35–44 year old) women. There were
also moderate declines in the numbers of treatments for
penile warts in 15–24 and 25–34 year old men and for
anal warts in 35–44 year old men.
The major strength of this analysis is the use of
nation-wide population-based data and a long follow-up
time, providing a complete picture of the private in-patient
treatment of genital and anal warts in Australia. Use of
a national register eliminates the problem of recall bias
from self-reported information. The major limitation
of this study is that Medicare data only represents
treatments in private hospitals and does not include
treatments in publicly funded hospitals; thus the data
are not representative of all in-patient treatments. Another
limitation of the study is that the hospital data extracted
may contain repeat in-patient treatments for the same
individual but numbers would be limited and we do not
anticipate this pattern to have changed during the study
period. Lastly, as sexual behaviour data were not available
we were unable to adjust for any change in sexual risk
behaviour –a decline for example could have contributed
to decreasing trends observed. However, national surveys
show that sexual risk taking behaviour has increased in
adolescents [15] and gay men [16] in the vaccine period
compared to pre-vaccine period and these changes have
Figure 2 Numbers of in-patient treatments for penile warts in men by age-group, 2000–2011.
Figure 3 Numbers of in-patient treatments for anal warts in men by age-group, 2000–2011.
Ali et al. BMC Infectious Diseases 2013, 13:140 Page 4 of 6
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been associated with an increase in the prevalence of
chlamydia in both populations [17,18].
A number of factors could potentially influence the
trends observed. Firstly, socio-economic status of a person
or a family could theoretically affect both going to private
hospitals and the uptake of vaccine. However, we don’t
believe the vaccine uptake would vary considerably by
socio-economic status as the HPV vaccination program in
Australia provides vaccines free of charge to all young
women, and boasts high coverage rates (>80% in school-
girls [1]). Second, a decline in the proportion of the popu-
lation with insurance coverage over time could explain the
trends observed. However, data from the Australian
Private Health Insurance Administration Council shows
that there was a significant increase in the proportion of
population which have hospital treatment insurance
coverage; from 45.4% in Dec 2000 to 46.3% in Dec 2011
(p < 0.001) [19]. Third, any changes in healthcare-seeking
behaviour or clinical practices could also influence the
declining trends observed. It is possible that an increase in
the use of self-applied topical treatment of genital warts
over time may have contributed to the decline in the
surgical treatments seen in our analysis. However, topical
treatments were available throughout the study period
and the price did not change substantially over time.
Furthermore, if there was a decline due to increase in the
use of topical treatments we would expect it to have been
seen in all age-groups, thus the decline observed only in
young people cannot be explained by changes in the
topical treatment patterns. Lastly, the national incidence
of genital warts has been reported to be 2.2 per 1,000
persons (2.1 in males and 2.3 in females) in the pre-
vaccine period [7], thus the few hundred cases of genital
warts treated in the private hospitals is a relatively small
proportion compared to ~45,000 cases of genital warts
in 2006 nationally. However, this is an important pro-
portion of clients as mainly chronic and/or severe cases
are likely to be referred to a hospital for in-patient treat-
ment (surgery under anaesthesia is not recommended as
a first-line therapy for the treatment of genital warts [20]
and cannot be performed in a general practice or sexual
health clinic setting).
The results from our study validate findings from a
national sentinel surveillance system at sexual health ser-
vices [4,5] and confirm that the numbers of cases of geni-
tal warts are declining in young women since the vaccine
roll out (the 15–24 year old women in our study were all
eligible for free HPV vaccination between 2007 and 2009).
We believe that the smaller decline in 25–34 year old
women is because only a proportion of these women were
vaccinated as part of the initial vaccine catch-up program
[1]. Men were not eligible for the free HPV vaccination
and thus the decline in penile warts in men after 2007 is
likely to reflect herd immunity, as observed in the sentinel
surveillance system [4]. Our study also showed that a
higher number of women underwent inpatient treatment
compared to men. That could be because penile warts are
easier to treat in the out-patient setting (and to self-treat),
compared to vulval/vaginal warts.
We also reported on the numbers of treatment of anal
warts in men as a comparison. There was no decline in
the number of treatments for anal warts in the younger
men after 2007. The moderate decline in older men in
the vaccine period could also reflect herd immunity as
some men undergoing treatment for anal warts were
likely be heterosexual or bisexual. In one study 18.2% of
men with anal warts were heterosexuals [21]. A recent
review [22] of anal sexual practices in heterosexuals
highlighted the paucity of data in this area including
sexual practices such as anal digital stimulation of men
by their female partner. Ongoing monitoring of the im-
pact of the vaccine in men is warranted as the Australian
Government has extended the national HPV vaccination
program to include vaccination for boys in 2013 [23].
Conclusion
In conclusion, this study has confirmed the utility of using
readily available in-patient treatment data for monitoring
the impact of the HPV vaccine program. Further efforts
should be made to establish systems to collate and report
public hospital separations data on genital warts treatment.
Collation of a range of data sources is warranted for coun-
tries about to roll out the quadrivalent HPV vaccine includ-
ing: vaccine coverage, vaccine safety, surveillance, cervical
cytology coverage, incidence of cervical cancer, genital
warts and recurrent respiratory papillomatosis, treatment
data on cervical cancer and genital warts and knowledge,
attitudes and beliefs about HPV and HPV vaccination [24].
Key messages
Between 2007 and 2011, the number of in-patient
treatments for vulval/vaginal warts declined by
85.3% in 15–24 year old women, confirming the
population effect of the HPV vaccine program.
In the same time period, there was a more modest
decline in the number of in-patient treatments for
penile warts in men, suggesting herd-immunity.
Competing interests
CKF owns shares in CSL Biotherapies. CKF, AEG, DGR, RJG, and BD have
received honoraria from CSL Biotherapies. BD and RJG have received
honoraria from Sanofi Pasteur MSD. CFK, DGR, AEG, RJG and BD receive
research funding from CSL Biotherapies. BD, CFK and AEG have received
honoraria from Merck. AEG sits on the Australian advisory board for the
Gardasil vaccine. TR is a site investigator in a Merck vaccine study.
Authors’contributions
BD, RJG and HA conceptualized the study. HA extracted the data. HA and
HW conducted the analysis. HA wrote the first draft. BD, RJG, TRHR, DJR, AEG
Ali et al. BMC Infectious Diseases 2013, 13:140 Page 5 of 6
http://www.biomedcentral.com/1471-2334/13/140
and CKF advised on analysis and interpretation. All authors read and
approved the final manuscript.
Acknowledgements
The study was funded by CSL Biotherapies. However, CSL had no role in
study design, data collection, analysis, interpretation, or writing of the report.
The authors had sole responsibility of decision for publication.
Author details
1
The Kirby Institute, The University of New South Wales, Sydney, NSW,
Australia.
2
Melbourne Sexual Health Centre, Melbourne, VIC, Australia.
3
School of Population Health, University of Melbourne, Melbourne, VIC,
Australia.
4
Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW,
Australia.
Received: 9 August 2012 Accepted: 11 March 2013
Published: 18 March 2013
References
1. Gertig DM, Brotherton JML, Saville M: Measuring human papillomavirus
(HPV) vaccination coverage and the role of the National HPV Vaccination
Program Register, Australia. Sex Health 2011, 8(2):171–178.
2. Ball SLR, Winder DM, Vaughan K, Hanna N, Levy J, Sterling JC, Stanley MA,
Goon PKC: Analyses of human papillomavirus genotypes and viral loads
in anogenital warts. J Med Virol 2011, 83(8):1345–1350.
3. Brotherton JML, Heywood A, Heley S: The incidence of genital warts in
Australian women prior to the national vaccination program. Sex Health
2009, 6(3):178–184.
4. Donovan B, Franklin N, Guy R, Grulich AE, Regan DG, Ali H, Wand H, Fairley
CK: Quadrivalent human papillomavirus vaccination and trends in
genital warts in Australia: analysis of national sentinel surveillance data.
Lancet Infect Dis 2011, 11(1):39–44.
5. Read TRH, Hocking JS, Chen MY, Donovan B, Bradshaw CS, Fairley CK: The
near disappearance of genital warts in young women 4 years after
commencing a national human papillomavirus (HPV) vaccination
programme. Sex Transm Infect 2011, 87(7):544–547.
6. Brotherton JML, Fridman M, May CL, Chappell G, Saville AM, Gertig DM:
Early effect of the HPV vaccination programme on cervical abnormalities in
Victoria, Australia: an ecological study. Lancet 2011, 377(9783):2085–2092.
7. Pirotta M, Stein AN, Conway EL, Harrison C, Britt H, Garland S: Genital warts
incidence and healthcare resource utilisation in Australia. Sex Transm
Infect 2010, 86(3):181.
8. Woodhall S, Ramsey T, Cai C, Crouch S, Jit M, Birks Y, Edmunds WJ, Newton
R, Lacey CJN: Estimation of the impact of genital warts on health-related
quality of life. Sex Transm Infect 2008, 84(3):161–166.
9. Graziottin A, Serafini A: HPV infection in women: psychosexual impact of
genital warts and intraepithelial lesions. J Sex Med 2009, 6(3):633–645.
10. Medicare Benefit Schedule (MBS) Online. http://www.health.gov.au/internet/
mbsonline/publishing.nsf/Content/a-z?OpenDocument&TableRow=1.22#1.
11. Medicare Benefits Schedule (MBS) Item Statistics Reports. http://www.
medicareaustralia.gov.au/statistics/dyn_mbs/forms/mbs_tab4ag.shtml#info.
12. Australian Bureau of Statistics: Statistics. http://www.abs.gov.au/ausstats/
abs@.nsf/web+pages/statistics.
13. Box GEP, Jenkins GM, Reinsel GC: Time se ries analysis. San Francisco:
Holden-day; 1976.
14. Newey W, West K: A simple positive semi-definite heteroscedasticity and
autocorrelation consistent covariance matrix.InNBER technical paper
series. Cambridge: National Bureau of Economic Research; 1986.
15. Smith A, Agius P, Mitchell A, Barrett CMP: Secondary Students and Sexual
Health, 2008: Results of the 4th National Survey of Australian Secondary
Students, HIV/AIDS and Sexual Health. Melbourne: Australian Research Centre
in Sex Health & Society La Trobe University; 2009.
16. Zablotska IB, Kippax S, Grulich A, Holt M, Prestage G: Behavioural
surveillance among gay men in Australia: methods, findings and policy
implications for the prevention of HIV and other sexually transmissible
infections. Sex Health 2011, 8(3):272–279.
17. Ali H, Guy RJ, Fairley CK, Wand H, Chen MY, Dickson B, O’Connor CC,
Marshall L, Grulich AE, Kaldor JM, et al:Understanding trends in genital
Chlamydia trachomatis can benefit from enhanced surveillance: findings
from Australia. Sex Transm Infect 2012. doi:10.1136/sextrans-2011-050423.
18. The Kirby Institute: HIV/AIDS, Viral Hepatitis and Sexually Transmissible
infections in Australia: Annual Surveillance Report 2012. Sydney: The Kirby
Insititute University of New South Wales; 2012.
19. Statistical Trends in Membership and Benefits Data Tables. http://www.phiac.
gov.au/for-industry/industry-statistics/statisticaltrends/.
20. Sexual Health Society of Victoria: National management guidelines for sexually
transmitted infections. Melbourne: Sexual Health Society of Victoria; 2008.
21. Waugh M: Condyloma acuminata. BMJ 1972, 2(5812):527–528.
22. Heywood W, Smith A: Anal sex practices in heterosexual and male
homosexual populations: a review of population-based data. Sex Health
2012, 9(6):517–526.
23. The Hon Tanya Plibersek MP Minister for Health Australia. HPV vaccine
extended to boys. http://www.health.gov.au/internet/ministers/publishing.
nsf/Content/mr-yr12-tp-tp059.htm.
24. Brotherton JML, Kaldor JM, Garland SM: Monitoring the control of human
papillomavirus (HPV) infection and related diseases in Australia: towards
a national HPV surveillance strategy. Sex Health 2010, 7(3):310–319.
doi:10.1186/1471-2334-13-140
Cite this article as: Ali et al.:Decline in in-patient treatments of genital
warts among young Australians following the national HPV vaccination
program. BMC Infectious Diseases 2013 13:140.
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