Condyloma incidence. England and Wales implemented registration of condylomas in the 1970s, but condyloma surveillance has not been conducted in other countries. Consequently, the epidemiology and public health burden of condylomas is not well known. However, symptomatic condylomas appear to be quite common and the age-specific incidence curve of first-attack condyloma appears to be similar to Chlamydia incidence. As the incubation time from exposure to clinical condyloma
is between 3 and 12 months, and because some 90% of condylomas are caused by HPV types included in the quadrivalent HPV vaccine, reduction in the occurrence of condylomas in sexually active young populations is the first clinical end-point Selleckchem Acalabrutinib that can be detected following implementation of the quadrivalent HPV vaccine. In Australia, where rapidly a high coverage with quadrivalent vaccine was built up, a significant Selleckchem 5-Fluoracil decrease in incidence of genital warts was observed among young women (≤26 years) and heterosexual men, but not among older women and homosexual men [88]. If a reduction in condylomas
is not seen, then this will serve as an early warning that the control of HPV infection is not adequate and prompt investigation of possible reasons for the failure, such as inadequate population coverage, type-replacement or vaccine breakthrough. Cervical screening results. For Europe, the proportion Phenylethanolamine N-methyltransferase of low-grade cervical dysplasia attributable to HPV vaccine types has been estimated to 26% and the proportion of high-grade cervical dysplasia to be greater than 50% [89]. With incubation times from 1 to 4 years, effective control of HPV should
result in a significant decline in the burden of screen-detected precursor lesions requiring follow-up and treatment on medium-term follow-up. To use screen-detected lesions as an end-point for vaccine surveillance requires that screening practices and methods are not impacted by vaccination. In addition, determining the types that are associated with these lesions will be required, and that in turn will rely upon HPV typing of these lesions. Clinical HPV assays differ from HPV assays used in epidemiological studies as well as in vaccine clinical trials in that they have a lower sensitivity and do not commonly provide type-specific results. Therefore, clinical results may not be optimally informative for surveillance. We suggest that strategies using residual clinical samples could be developed, whereby a random sample of positive and negative samples could be retested with quality-assured HPV typing assays. HPV-associated malignancies. A recent IARC review concluded that essentially all cervical cancer is HPV-associated; the proportion of cancers in other anatomic sites that are HPV-associated varies: penis 40%, anus 90%, vulva/vagina 40% and oropharynx 12% [90].