Anogenital warts guide: Prevention and control
This guide focuses on the assessment and management of external anogenital warts (AGW) caused by human papillomaviruses (HPV). HPV vaccination and HPV-related cancer screening recommendations are beyond the scope of this guide.
On this page
- General sexually transmitted and blood-borne infection prevention and control
- Prevention and control of anogenital warts
- References
General sexually transmitted and blood-borne infection prevention and control
Case finding, education, counselling, partner notification and treatment are critical in controlling sexually transmitted and bloode-borne infection (STBBI).
Healthcare providers should offer screening for STBBI as part of their prevention and control strategies. Since many STBBI are frequently asymptomatic and can lead to serious complications if left undiagnosed and untreated, offer STBBI screening as part of routine care, with particular attention to those with risk factors. Normalizing screening in this way can reduce barriers and stigma associated with STBBI.
Integrate STBBI prevention interventions such as counselling, vaccination, and education on preventive practices into routine care. Motivational interviewing may be used to identify barriers to adopting prevention practices and the means to overcome them.
Offer vaccination for hepatitis B (HBV), hepatitis A (HAV) and human papillomavirus (HPV) as per the Canadian Immunization Guide.
For many STBBI, partner notification has public health benefits (e.g., disease surveillance and control) and reduces the potential for onward transmission or re-infection.
Prevention and control of anogenital warts
Measures to prevent and control anogenital warts (AGW) include HPV vaccination, use of barrier protection, self-examination, prompt diagnosis and counselling.
Vaccination
Quadrivalent and nine-valent HPV vaccines protect against HPV 6 and 11, which are responsible for 90% of AGWFootnote 1Footnote 2Footnote 3Footnote 4Footnote 5Footnote 6Footnote 7Footnote 8Footnote 9Footnote 10Footnote 11. Vaccination is highly effective for preventing AGWFootnote 5Footnote 6Footnote 7Footnote 8Footnote 9Footnote 11Footnote 12. HPV vaccination prior to onset of sexual activity - and exposure to HPV – maximizes its benefitFootnote 3Footnote 7Footnote 8. HPV vaccination has no proven therapeutic effect for existing AGWFootnote 7Footnote 8Footnote 13. However, vaccination after the diagnosis of AGW provides protection against other HPV types included in the vaccineFootnote 7Footnote 8Footnote 13.
Regardless of history of AGW, offer vaccination for HPV as indicated in the Canadian Immunization Guide or provincial and territorial routine vaccination schedules and guidelines.
Barrier protection
Consistent and correct use of internal or external condoms and dental dams can reduce the transmission of AGW. Protection is not complete as exposure may occur through skin-to-skin contact of uncovered areasFootnote 3Footnote 4Footnote 8Footnote 13Footnote 14Footnote 15Footnote 16Footnote 17. Use of barriers is recommended for those diagnosed with AGW, having a partner with AGWs, or engaging in sexual activity with new sexual partnersFootnote 8Footnote 13.
Consult the STBBI prevention guide for more information on barrier protection.
References
References:
- Footnote 1
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Brianti P, De Flammineis E, Mercuri SR. Review of HPV-related diseases and cancers. New Microbiol. 2017;40(2):80-85.
- Footnote 2
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Chan PKS, Luk ACS, Luk TNM, Lee K-F, Cheung JLK, Ho K-M, et al. Distribution of human papillomavirus types in anogenital warts of men. J Clin Virol 2009;44(2):111-114.
- Footnote 3
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Chelimo C, Wouldes TA, Cameron LD, Elwood JM. Risk factors for and prevention of human papillomaviruses (HPV), genital warts and cervical cancer. J Infect 2013;66(3):207-217.
- Footnote 4
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Forcier M, Musacchio N. An overview of human papillomavirus infection for the dermatologist: Disease, diagnosis, management, and prevention. Dermatol Ther 2010;23(5):458-476.
- Footnote 5
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Karnes JB, Usatine RP. Management of external genital warts. Am Fam Phys 2014;90(5):312-318.
- Footnote 6
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O'Mahony C, Gomberg M, Skerlev M, Alraddadi A, de las Heras-Alonso ME, Majewski S, et al. Position statement for the diagnosis and management of anogenital warts. J Eur Acad Dermatol Venereol 2019;33(6):1006-1019.
- Footnote 7
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Public Health Agency of Canada. Human papillomavirus (HPV) vaccines: Canadian Immunization Guide For health professionals. 2017. Available at: https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines/page-9-human-papillomavirus-vaccine.html. Accessed February 9, 2023.
- Footnote 8
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Steben M, Garland SM. Genital warts. Best Pract Res Clin Obstet Gynaecol 2014;28(7):1063-1073.
- Footnote 9
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Steben M, Tan Thompson M, Rodier C, Mallette N, Racovitan V, DeAngelis F, et al. A Review of the Impact and Effectiveness of the Quadrivalent Human Papillomavirus Vaccine: 10 Years of Clinical Experience in Canada. J Obstet Gynaecol Can 2018;40(12):1635-1645.
- Footnote 10
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Tyros G, Mastraftsi S, Gregoriou S, Nicolaidou E. Incidence of anogenital warts: epidemiological risk factors and real-life impact of human papillomavirus vaccination. Int J STD AIDS 2021;32(1):4-13.
- Footnote 11
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Yanofsky VR, Patel RV, Goldenberg G. Genital warts: A comprehensive review. J Clin Aesthetic Dermatol 2012;5(6):25-36.
- Footnote 12
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Drolet M, Bénard É, Pérez N, Brisson M, Ali H, Boily M-C, et al. Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis. Lancet 2019;394(10197):497-509.
- Footnote 13
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Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021 07 23;70(4):1-187.
- Footnote 14
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Burchell AN, Tellier P-, Hanley J, Coutlée F, Franco EL. Human papillomavirus infections among couples in new sexual relationships. Epidemiology 2010;21(1):31-37.
- Footnote 15
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Nielson CM, Harris RB, Nyitray AG, Dunne EF, Stone KM, Giuliano AR. Consistent condom use is associated with lower prevalence of human papillomavirus infection in men. J Infect Dis 2010;202(3):445-451.
- Footnote 16
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Pierce Campbell CM, Lin H-Y, Fulp W, Papenfuss MR, Salmerón JJ, Quiterio MM, et al. Consistent condom use reduces the genital human papillomavirus burden among high-risk men: The HPV infection in men study. J Infect Dis 2013;208(3):373-384.
- Footnote 17
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Winer RL, Hughes JP, Feng Q, O'Reilly S, Kiviat NB, Holmes KK, et al. Condom use and the risk of genital human papillomavirus infection in young women. New Engl J Med 2006;354(25):2645-2654.
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