Evaluating the Role of the 9-Valent HPV Vaccine in Preventing Recurrence of Genital Warts - European Medical Journal

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Evaluating the Role of the 9-Valent HPV Vaccine in Preventing Recurrence of Genital Warts

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Urology
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Authors:
* Etan Eigner , 1,2 Nicola Fazaa , 1,2 Ameer Nsair , 1,2 Melissa Atallah , 1,2 Kamil Malshy , 3 Gilad E. Amiel , 1,2 Michael Mullerad 1,2
  • 1. Rappaport Faculty of Medicine, Technion Haifa, Israel
  • 2. The Department of Urology, Rambam Health Care Campus, Haifa, Israel
  • 3. Department of Urology, University of Rochester Medical Center, New York, USA
*Correspondence to [email protected]
Disclosure:

The authors have declared no conflicts of interest related to this work.

Citation:
EMJ Urol. ;14[1]:54-55. https://doi.org/10.33590/emjurol/38VL7YI4.
Keywords:
CO2 laser treatment, genital warts, human papillomavirus (HPV) vaccination, predictors of repeat treatment.

Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.

BACKGROUND

Human papillomavirus (HPV) is the most common sexually transmitted infection worldwide,1 with most sexually active individuals acquiring infection during their lifetime.2,3 Low-risk human papillomavirus Types 6 and 11 account for the majority of anogenital warts,4 a condition that affects approximately 1% of sexually active adults at any given time.5 Although benign, genital condyloma imposes a significant psychosocial and economic burden as a result of stigma, repeated treatments, and prolonged follow-up.6 The 9-valent human papillomavirus vaccine provides highly effective primary prevention against vaccine-type infection and genital warts in both women and men.4,7 However, whether vaccination administered after treatment reduces recurrence or the need for additional procedures remains uncertain, as there was limited and inconsistent evidence in previously infected individuals, as reported in other studies.8,9 The authors therefore evaluated the clinical predictors of recurrence after CO₂ laser ablation and examined whether post-treatment human papillomavirus vaccination is associated with reduced recurrence risk in a real-world male cohort who already had the infection.

METHODS

The retrospectively reviewed men (who were 17 years of age or older) were treated with CO₂ laser ablation for genital condyloma at a tertiary centre (June 2016–June 2025). The primary outcome was recurrence after documented clearance. Logistic and mixed-effects regression models tested associations between post-treatment vaccination and recurrence, adjusting for demographic and clinical factors.

RESULTS

Among the 560 patients included in the study (722 sessions), recurrence occurred in 28.4%. Those with recurrence were younger in age (32±10 versus 37±13 years; p<0.001) and more likely to need ≥2 sessions (18.6% versus 11.6%; p=0.02). Post-recurrence vaccination showed no significant association with reduced risk (adjusted odds ratio [aOR]: 0.49; 95% CI: 0.14–1.69; p=0.26). Independent predictors were younger age (aOR: 0.96 per year; p<0.001) and ≥2 sessions (aOR: 2.44; p=0.003).

CONCLUSION

Post-treatment human papillomavirus vaccination did not reduce recurrence of genital condyloma in patients who already had the infection. Younger age and multiple treatment sessions independently predicted recurrence, reinforcing the role of vaccinations primarily in primary prevention.

References
Eigner E et al. Evaluating the role of the 9-valent HPV vaccine in preventing recurrence of genital warts. Abstract A0055. EAU Congress, 13-16 March, 2026. Forman D et al. Global burden of human papillomavirus and related diseases. Vaccine. 2012;30:F12-23. Chesson HW et al. The estimated lifetime probability of acquiring human papillomavirus in the United States. Sex Transm Dis. 2014;41(11):660-4. Joura EA et al. A 9-Valent HPV vaccine against infection and intraepithelial neoplasia in women. N Engl J Med. 2015;372(8):711-23. Lewis RM et al. Estimated prevalence and incidence of disease-associated human papillomavirus types among 15- to 59-year-olds in the United States. Sex Transm Dis. 2021;48(4):273-7. Raymakers AJN et al. Economic and humanistic burden of external genital warts. Pharmacoeconomics. 2012;30(1):1-16. Goldstone SE al. Efficacy, immunogenicity, and safety of a quadrivalent HPV vaccine in men: results of an open-label, long-term extension of a randomised, placebo-controlled, phase 3 trial. Lancet Infect Dis. 2022;22(3):413-25. Coskuner ER et al. Impact of the quadrivalent HPV vaccine on disease recurrence in men exposed to HPV infection: a randomized study. J Sex Med. 2014;11(11):2785-91. Gilson R et al. Imiquimod versus podophyllotoxin, with and without human papillomavirus vaccine, for anogenital warts: the HIPvac factorial RCT. Health Technol Assess (Rockv). 2020;24(47):1-86.

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