Infect Dis Obstet Gynecol 2001;9:149–154 Female genital warts: global trends and treatments Stanley A. Gall Department of Obstetrics and Gynecology, University of Louisville, Louisville, KY The increasing incidence of human papillomavirus (HPV) infection and HPV-associated conditions such as genital warts in women is a global concern. Genital warts are a clinical manifestation of HPV types 6 and 11, and are estimated to affect 1% of sexually active adults aged between 15 and 49. HPV infection is also strongly associated with cervical cancer, and is prevalent in as many as 99% of cases. The psychological stress of having genital warts is often greater than the morbidity of the disease, and therefore successful treatment is crucial. Current treatments are patient-applied and provider-administered therapies. Imiquimod 5% cream, a patient-applied therapy, is an efficacious treatment with tolerable side-effects and a low recurrence rate, and has the potential to be an effective strategy for the management of genital warts. Key words: HUMAN PAPILLOMAVIRUS; ANOGENITAL CANCER; PATIENT-APPLIED THERAPY; IMIQUIMOD PREVALENCE OF HUMAN PAPILLOMAVIRUS AND GENITAL WARTS Human papillomavirus (HPV) infection is one of the three most common sexually transmitted diseases (STDs) in the United States, along with gonorrhea and chlamydia1. It is estimated that as many as 20–40% of sexually active women are infected with HPV2. In the US, the estimated number of new HPV infections each year is 5.5 million, with an estimated total prevalence of 20 million3. Over 100 different types of HPV exist, and they can be grouped according to their oncogenic potential (Table 1)4. HPV 6 and 11 are termed ‘low risk’, as they are rarely associated with carcinomas5 and most commonly manifest as external genital warts6. Genital warts, however, have been found to be induced by other ‘high’ or ‘intermediate’ risk HPVs5. Genital warts are exophytic, confluent, cauliflower tumors and their typical morphologies Table 1 Human papillomavirus (HPV) types and related oncogenic risk of cervical squamous carcinoma4 Oncogenic potential HPV type 16, 18 High risk 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68 Intermediate risk 6, 11, 26, 40, 42–44, 53–55, 62, 66 Low risk aid their diagnosis. Their most common location in women is the vulva (Figure 1)7. The annual incidence of genital warts has increased steadily among women since the early 1950s, when the estimated incidence in the US was only 13 per 100 000 for the female population8. During the late 1970s genital wart prevalence increased to 106 per 100 000, and at present 1% of sexually active adults aged 15–49 are estimated to have genital warts6. The incidence of genital warts has also increased in Europe, with an approxi- mately five-fold increase for females in the United Kingdom between 1971 and 19949, where they are Correspondence to: Stanley A. Gall, MD, Department of Obstetrics and Gynecology, University of Louisville, 550 South Jackson Street, Louisville, KY 40202, USA. Email: sagall@louisville.edu Review 149