Estimating the Burden of Illness Related to Genital Warts in Russia: A Cross-Sectional Study

Background Human papillomavirus (HPV) infections are the etiologic agents of genital warts (GW). HPV is one of the most frequent sexually transmitted viral infections, and nearly 65% of individuals with partners who have GW also develop GW. In Russia, as in many other countries, overall GW prevalence data are scarce. Given the lack of Russian data, our study estimated GW prevalence in physician practices and GW-related health care resource use in Russia among male and female patients aged 18–60 years. Methods Russian physicians recorded daily patient logs for a two-week period and conducted a 30-minute survey to estimate GW prevalence and related resource use between January and June 2012. Age, gender, and GW diagnosis status was recorded. Prevalence was obtained for each physician and calculated into a single estimate across all physician types. Overall prevalence estimate and 95% confidence interval were weighted by the estimated number of physicians in each specialty and the proportion of total patients visiting each specialist type. Health care resource use was reported and compared among different physician specialties. Results The overall GW prevalence estimate was 9162 cases per 100 000 for male and female patients aged 18–60 years, with 9917 for obstetrician/gynecologists (OB/GYN), 8298 for urologists (URO), and 7833 for dermatologists (DERM). For males, GW prevalence was 8769 cases per 100 000, with the highest prevalence in the 30–34 age group. In females, GW prevalence was 9304 cases per 100 000, with the highest prevalence in the 18–24 age group. Among overall existing GW cases, 63.1% were recurrent and 34.2% were resistant. For all patients in our study, GW prevalence was higher in females. Male patients had the highest prevalence for those aged 30–34 years, and female patients for those aged 18–24 years. These results are consistent with data reported in other countries. Study limitations include estimates and results representative of the urban population of Russia. Despite its limitations, this study provides a GW prevalence estimate in Russia not previously available. Conclusions GW is a significant public health concern in Russia, and the GW prevalence was higher in female patients compared to male patients.

The primary diagnostic technique utilized was clinical examination by visual examination (98%; Figure S1a). Seventyeight physicians reported using HPV polymerase chain reaction to diagnose GW patients, and 71.4% of all patients received the test on average. Six physicians (1 URO, 5 DERM) reported using other diagnostic tools as well as performing full sexually-transmitted viral infection screens (including bacterioscopy, enzyme immunoassay, and serology for human immunodeficiency virus [HIV], hepatitis B virus carriage, hepatitis C, and syphilis tests) for 91.7% of their male patients.
The use of in-office treatment or procedures was also reported by participating physicians based on the last 20 male GW patients seen ( Figure S2a). Results suggest that 80 out of 87 physicians provided a basic patient visit and 88.5% of all patients received treatment at that visit. Sixty-two physicians used electrosurgery for patient cases, including URO (54.3%) and DERM (26.2%). Thirty physicians, including URO (34.2%) and DERM (65.0%) of patients, used other treatments and procedures, including pheresolum (a solution used for radio wave surgery and the treatment of skin lesions like warts) and solcoderm (a solution which, in the past, was considered suitable for the treatment of malignant and benign skin lesions.) Topical medication use for in-office treatment, based on the last 20 male GW patients seen, is presented in Figure S3a. Out of 87 physicians, 42 reported administering podofilox for male patients, and an average of 16.7% of all patients received this treatment. Twenty-five physicians reported using other topical medications for in-office treatment (cryopharma spray, curiosin, cycloferon, levomekol, panavir, pheresolum, pimafucort, rebif, resorcinol, solcoderm, triderm, ferrovir solution, lactic acid, salicylic acid) for 36.6% of male patients.

Journal of Health Economics and Outcomes Research
Prilepskaya VN, et al.

S2
Female patients. Of the 118 physicians who completed the 30-minute survey and saw female patients, an average of 63.1% of the last 20 patients seen consulted the physician directly, while 36.1% were referred by another doctor. Of those last 20 female patients seen, an average of 65.3% were treated by the participating physician directly, 28.7% were referred to another physician, 4.3% were first treated and then referred, and 1.0% were left untreated or not referred. URO referred more of their female patients (43.0%) to another physician compared to other specialists (Table S1).
In female GW patients, the diagnostic tools and techniques used most frequently by physicians to diagnose GW were visual examination (92.7%; Figure S1b). Ninety-two physicians reported using the HPV polymerase chain reaction test to diagnose GW, and 64.3% of all patients received the test on average. Sixty-three physicians reported using Papanicolaou (Pap) tests with 91.7% (OB/GYN), 44.5% (DERM), and 12.0% (URO) of patients. Seven physicians reported using other tools and techniques (bacterioscopy, enzyme immunoassay and HIV, hepatitis B, hepatitis C and syphilis tests, colpocytogram) for 92.9% of female patients.
The use of in-office treatment or procedures was also reported by participating physicians based on the last 20 female GW patients seen ( Figure S2b). Of the physicians surveyed, 95 out of 120 completed a basic visit, and 77.4% of all patients received this treatment. Fifty-two physicians used electrosurgery for in-office treatment, and 22.5% of all female patients received the procedure. Forty-six physicians used other treatments and procedures-including Condyline, laser surgery, radio wave surgery, and solcoderm-for 48.5% of female patients.
Topical medication use for in-office treatment is displayed in Figure S3b, based on the last 20 female GW patients seen. For female patients, 44 out of 119 physicians reported using other topical medications for in-office treatment (cryopharma spray, curiosin, cycloferon, epigen, genferon levomekol, panavir, pheresolum, pimafucort, rebif, resorcinol, solcoderm, Tricresolum, triderm, lactic acid, salicylic acid) for 35.9% of patients. Forty-three physicians reported using podofilox and 13.4% of all female patients received this treatment.