Steep decline of HPV 6 and genital warts despite low HPV vaccination coverage in young women in Germany: a long-term, population-based cohort study

Background: The introduction of human papilloma virus (HPV) vaccination has resulted in a remarkable decline of genital warts in women and men, but in Germany historical rates of vaccination are relatively low. We report long-term surveillance data on changes in HPV 6 and 11 infection and the prevalence of genital warts in young women in the Wolfsburg HPV epidemiological study (WOLVES).Methods: Women born in 1983/84, 1988/89, and 1993/94 participated in four cohorts between 2009/10 and 2014/15. Vaccination coverage and prevalence of HPV 6/11 and genital warts are reported for participants aged 19−22 years and 24−27 years at the time of analysis. Statistical analyses were done to compare similarly aged participants using 2 x 2 contingency tables (Röhmel-Mansmann unconditional exact test; two-side alpha of 0.05).Results: A total of 2,456 women were recruited. In 2010, vaccination rates were 40/659 (6.1%) in women aged 24−27 years and 142/600 (23.7%) in those aged 19−22 years; 5 years later, vaccination rates had increased to 135/733 (18.4%) and 177/368 (48.1%), respectively. Between 2010 and 2015, there was a statistically significant decrease in the prevalence of HPV 6 among women aged 24−27 years (2.12% versus 0%; P