External genital warts occur as a result of underlying infection with HPV, and are considered among the most common sexually transmitted diseases affecting the general population. Between 3 and 6 million people will acquire symptomatic infections each year in the USA alone, representing approximately 1% of the sexually active population. Although there are over 120 different HPV types, approximately 90% of wart lesions are caused by infection with HPV types 6 and 11. These are considered to be low-risk types due to their limited malignant potential, and only rarely progress to cancerous lesions. Conversely, warts associated with the high-risk HPV types 16 and 18 may be predisposed to oncogenic transformation. Additionally, infection with these types has been linked to the development of a variety of different cancerous and precancerous lesions.
Current treatment options for genital warts mainly focus on removal of the superficial external lesion rather than targeting the underlying viral infection at the lesion source. Not surprisingly, these therapies have proven inadequate and ineffective in achieving long-term wart relief. Multiple different therapy modalities exist, ranging from topical treatments to surgical and immunomodulatory interventions, and these can differ dramatically with respect to cost, duration, dosing schedules and adverse effects. To date, no single therapy has emerged as significantly superior with respect to overall efficacy and wart clearance in both the short and long term. Selection of a given treatment is often patient dependent, and reflects both the needs and desires of the individual.
EGW and HPV infections remain a significant public health concern, with a remarkably high prevalence of disease and a lack of adequate therapy. These facts emphasize the importance of routine HPV vaccination with either HPV4 or HPV2, which may play a powerful role in reducing the burden of disease by preventing viral infection and transmission. Multiple large-scale randomized controlled trials evaluating the effectiveness of HPV vaccination have demonstrated it as both successful and safe in preventing genital wart infection in both sexes when administered prior to exposure. This supports the need for further research into the development of similar vaccines, which may target additional HPV types. As HPV vaccination continues to gain popularity and widespread approval for use in a broader population base, it may prove instrumental in decreasing the incidence of HPV infection and eventually eradicating genital warts.