Open Access Highly Accessed Research article

Estimation of the incidence of genital warts and the cost of illness in Germany: A cross-sectional study

Peter Hillemanns1*, J Gabrielle Breugelmans27, Friederike Gieseking3, Stève Bénard4, Emilie Lamure28, Kavi J Littlewood5 and Karl U Petry6

Author Affiliations

1 Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany

2 Sanofi Pasteur MSD, Lyon, France

3 Universitätsklinikum Hamburg, Germany

4 st[è]ve consultants, 14 rue Grenette, 69002, Lyon, France

5 Mapi Values, Houten, The Netherlands

6 Frauenklinik im Klinikum der Stadt Wolfsburg, Wolfsburg, Germany

7 Agence de Médecine Préventive, Paris, France

8 IMS Health, 92800, Puteaux, France

For all author emails, please log on.

BMC Infectious Diseases 2008, 8:76  doi:10.1186/1471-2334-8-76

Published: 2 June 2008



Human papillomavirus (HPV) is a necessary cause of cervical cancer. HPV is also responsible for benign condylomata acuminata, also known as genital warts. We assessed the incidence of genital warts in Germany and collected information on their management to estimate the annual cost of disease.


This was a multi-centre observational (cross-sectional) study of genital warts in Germany. Data were collected from gynecologists, dermatologists, and urologists seeing patients with genital warts between February and April 2005. The number of patients with new and recurrent genital warts was used to estimate the incidence in Germany. We assessed resource use for patients with genital warts seen during a two-month period as well as retrospective resource use twelve months prior to the inclusion visit through a chart review. The mean costs of treatment of patients with genital warts from third-party payer and societal perspectives were estimated, and the total annual cost of genital warts was then calculated.


For the incidence calculation 217 specialists provided information on 848 patients and 214 specialists provided resource use data for 617 patients to assess resource consumption. The incidence of new and recurrent cases of genital warts was 113.7 and 34.7 per 100 000, respectively, for women aged 14–65 years consulting gynecologists. The highest incidence was observed in women aged 14–25 years (171.0 per 100 000) for new cases and in women aged 26–45 years (53.1 per 100 000) for recurrent cases. The sample size for males was too small to allow a meaningful estimate of the incidence. The mean direct cost per patient with new genital warts was estimated at 378 euros (95% CI: 310.8–444.9); for recurrent genital warts at 603 euros (95% CI: 436.5–814.5), and for resistant genital warts at 1,142 euros (95% CI: 639.6–1752.3). The overall cost to third-party payers was estimated at 49.0 million euros, and the total societal cost at 54.1 million euros, corresponding to an average cost per patient of 550 euros and 607 euros, respectively.


The societal burden and costs of managing and treating genital warts in Germany are considerable. A vaccination programme using the quadrivalent human papillomavirus vaccine could provide a substantial health benefit and reduce the costs associated with genital warts in Germany.