VIRAL IMMUNOLOGY

Volume 31, Number 5, 2018 Original Article

ª Mary Ann Liebert, Inc.
Pp. 1–6
DOI: 10.1089/vim.2017.0157

Prevalence and Burden Related to Genital Warts in India

Uday S. Khopkar,1 Murlidhar Rajagopalan,2 Anahita R. Chauhan,3 Smita Kothari-Talwar,4

Puneet K. Singhal,4 Karen Yee,5 Amit Kulkarni,4 Nuria Lara,6 Montserrat Roset,6
Anna R. Giuliano,7 and Suzanne M. Garland8

Abstract
Downloaded by University of Adelaide from www.liebertpub.com at 05/03/18. For personal use only.

The prevalence of genital warts (GW) and self-reported human papillomavirus (HPV) as well as disease-related
psychosocial impact among male and female patients aged 18–60 years in India were assessed. GW prevalence
was estimated using a 2-week daily log of patients examined from June 7-September 22, 2011 by 200 par-
ticipating physicians in 6 regions of India. Psychosocial impact was estimated using one-time, self-administered
surveys, including HPV Impact Profile (HIP), Cuestionario Especı́fico para Condiloma Acuminado ([Spanish]
CECA; ‘‘Specific questionnaire for Condylomata Acuminata’’) and EuroQol-5 Dimension survey. T-tests or
Mann–Whitney U-tests were used for continuous comparisons and Chi-square or Fisher exact tests were applied
for categorical comparisons. Overall GW prevalence in India was estimated at 1.07% (95% confidence inter-
val = 0.97–1.17) and was higher among men than women. Regional prevalence ranged from high in Delhi
(2.17%) to low in Bangalore (0.40%). Patients aged 25–29 years had the highest GW prevalence (1.42%). GW
patients were most often newly diagnosed (74.07%). Among those with existing GW, 56.24% were recurrent,
and 43.76% were resistant. According to total HIP scores, 55.4% of male GW patients and 20.0% of those
without GW reported moderate psychological impact ( p < 0.0001). HIP scores among women revealed that
patients with abnormal Papanicolaou (Pap) test results (34.3%), precancerous lesions (46.2%), external GW
(48.0%), and those without HPV-related disease (18.5%) reported moderate psychological impact ( p = 0.0089)
(Psychosocial impact results are reported in the Supplementary Data). Estimated national GW prevalence,
diagnosis, and treatment costs in India were higher for men than for women. GW in men and HPV infection in
women had a negative psychosocial impact on well-being and health-related quality of life (HRQoL) scores,
especially among women diagnosed with GW and precancerous lesions compared to those with other selected
HPV-related diseases. Despite its limitations, this study provides an estimation of GW data in India not
previously available.

Keywords: genital warts, prevalence, India

Background cancer (13). Two prophylactic HPV vaccines (Cervarix, Gar-

dasil) are currently available and offer protection against high-

T he human papillomavirus (HPV) is one of the most

common sexually transmitted infections (STIs) (1,18,19).
More than 130 virus types have been identified to date (9) with
HPV types 6 and 11 causing *90% of genital warts (GW)
cases (1). The high-risk HPV group, including HPV subtypes
16 and 18, induces precancerous lesions such as cervical in-
traepithelial neoplasia (CIN), cervical cancer, and anogenital
risk HPV types 16 and 18 (*70% of all cervical cancer
diagnoses). Gardasil, in addition, offers protection against
HPV types 6 and 11. Cryotherapy is the most commonly used
agent to treat anogenital warts (2). Podophyllotoxin solution is
another cost-effective first-line treatment for clearing ano-
genital warts. In addition, carbon dioxide laser therapy may be
considered as an effective second-line treatment (23).

1
Department of Dermatology and Venereology, Seth GS Medical College and KEM Hospital, Mumbai, India.
2
Department of Dermatologist, Apollo Hospitals, Chennai, India.
3
Department of Obstetrics and Gynecology, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India.
4
Merck and Co., Inc., Kenilworth, New Jersey.
5
Cubist Pharmaceuticals, Lexington, Massachusetts.
6
IMS Health, Barcelona, Spain.
7
Center for Infection Research in Cancer (CIRC), Moffitt Cancer Center, Tampa, Florida.
8
Royal Women’s Hospital, Melbourne, Australia.

1
 2 KHOPKAR ET AL.
In India, GW incidence has been reported to vary from
2% to 25% among STI clinic attendees. (22) However, data
on national GW incidence is limited, and prevalence esti-
mates range from 1.4% to 25.06% (4,6,8). Research con-
ducted in India has focused primarily on cervical cancer,
one of the most common cancers among women in India.
Cervical cancer constitutes from one-tenth to one-quarter of
all female cancers with age-adjusted incidence rates ranging
from 17.3 to 28.0 per 100,000 in the population-based
cancer registries in the country (12).
Although a large number of newly diagnosed GW cases
resolve without treatment, a GW diagnosis can have a tre-
mendous psychosocial impact on patients. Studies have
shown that GW can cause physical disfigurement, embar-
rassment, increased rates of anxiety and negatively impact
sexual relationships (11). Research by Maw et al. indicated
that up to two-thirds of male and female GW patients made
lifestyle changes that impacted their relationships (17).
Downloaded by University of Adelaide from www.liebertpub.com at 05/03/18. For personal use only.
Research conducted in India focuses on high-risk HPV ge-
notypes associated with cervical cancers. Current literature dis-
cussing GW caused by low-risk HPV infection in Indian society
is limited. The aim of this study was to estimate GW prevalence
in physician practices and to estimate self-reported HPV disease-
related psychosocial impact (Supplementary Data; Supplemen-
tary Data are available online at www.liebertpub.com/vim)
among women and men aged 18–60 years.
Materials and Methods
Study design
This was a cross-sectional study conducted by survey in
six regions in India including Mumbai, Bangalore, Hyder-
abad, Chennai, Kolkata, and Delhi.
Inclusion and exclusion criteria
Participating physicians. Participating physicians were
identified from the Intercontinental Marketing Services
(IMS) database in India, which includes information on
*191 obstetricians/gynecologists (OB/GYN), dermatolo-
gists (DERM), and medical doctor associations. In addition,
the snowball sampling method was applied once the list
from IMS data was exhausted. Physician offices located in
Mumbai, Delhi, Kolkata, Chennai, Bangalore, and Hyder-
abad were selected, and data collected from these physicians
were used to represent the entire country.
Physicians included in this study were those who:
(a) Provided informed consent to participate and were
specialists (primary care physicians [PCP], OB/GYN,
urologists [URO], DERM) with 2–30 years of prac-
tice experience;
(b) devoted at least 50% of their time to treating patients for
outpatient visits three or more work days per week (as
opposed to inpatient surgery, teaching, or other activities);
(c) treated at least 50 patients for outpatient visits in a
typical week; and
(d) treated at least 50% of patients aged 18–60 years for
outpatient visits.
Male patients. Male patients were included in the study if
they were aged 18–60 years, in good self-reported physical
health, and belonged to one of the following categories:
(a) Newly diagnosed or existing external GW within 3
months of study recruitment; and
(b) control group of patients who have never been diag-
nosed with GW, prescribed GW treatment, or had
surgery or therapy in the genital area.
Female patients. Female patients were included in the
study if they were aged 18–60 years, experienced an
HPV-related event within the past 3 months, were in good
self-reported health, and belonged to one of the following
categories:
(a) Abnormal Papanicolaou (Pap) test results with no
definitive histology, conforming to the Bethesda
Category-2001 category of squamous or glandular
cell abnormality (e.g., atypical squamous cells of unde-
termined significance, atypical glandular cells of unde-
termined significance, low-grade squamous intraepithelial
lesion, high-grade squamous intraepithelial lesion). Pa-
tients in this category were not diagnosed with precan-
cerous cervical lesions and were required to have no
previous high-risk HPV tests performed;
(b) diagnosis of external GW or treatment for recurrence;
(c) histological diagnosis of precancerous or cancerous
cervical lesion (e.g., CIN1, CIN2, CIN3). Patients
with precancerous cervical lesions and abnormal Pap
test results within the last 3 months were placed in
this category; and
(d) normal Pap results (no cellular evidence of neopla-
sia). Patients in this category were required to meet:
(i) No abnormal Pap test results within the past year;
and
(ii) never had definitive therapy.
Exclusion criteria. Patients were excluded from the study
as follows:
(a) Female GW patients with precancerous cervical le-
sions, abnormal Pap, and HPV-positive test results or
abnormal Pap test results;
(b) patients with presence of any other concurrent/active
STI;
(c) patients concurrently enrolled in clinical studies of
investigational agents;
(d) patients with a history of known prior HPV vaccina-
tion or recent (within 1 year from enrollment date) or
ongoing alcohol or other drug abuse;
(e) patients unable to give informed consent.
Statistical analysis
All study outcomes were summarized descriptively. For
continuous variables, strata or subgroups were compared by
Student’s t-tests or analysis of variance models or the
equivalent nonparametric tests depending on the normal
distribution of continuous variables. For categorical vari-
ables, the differences between strata or subgroups were
analyzed by Chi-square tests or Fisher exact tests depending
on the distribution of patients across response categories.
The corresponding p-values were provided. Data analysis
was performed with SAS version 9.1 statistics software.
Prevalence. The prevalence of GW was estimated from
a physicians’ daily log of patients seen over a 2-week
 PREVALENCE AND BURDEN: GENITAL WARTS IN INDIA 3

Table 1. Genital Warts Prevalence by Sex and Physician Specialty in India

Male Female Overall
a a
(n/N) (%, 95% CI) (n/N) (%, 95% CI) (n/N) (%, 95% CI)a
PCP 56/7,269 0.77 (0.57–0.97) 33/6,566 0.50 (0.33–0.67) 89/13,835 0.64 (0.51–0.78)
b b
OB/GYN 166/13,788 1.20 (1.02–1.39) 166/13,798 1.20 (1.02–1.39)
URO 43/3,306 1.30 (0.91–1.69) 4/792 0.50 (0.01–1.00) 47/4,098 1.15 (0.82–1.47)
DERM 150/6,607 2.27 (1.91–2.63) 64/5,717 1.12 (0.85–1.39) 214/12,324 1.74 (1.51–1.97)
Overallc 249/17,182 1.22 (1.06–1.39) 267/26,863 0.99 (0.87–1.11) 516/44,045 1.07 (0.97–1.17)
a
Percentage and 95% CI calculated accounting for the number of patients with identified GW status.
b
Due to the low number of male patients treated by OB/GYN (only 10), these patients have been excluded.
c
Data weighted according to specialty type.
GW, genital warts; CI, confidence interval; PCP, primary care physician; OB/GYN, obstetrician/gynecologist; URO, urologist; DERM,
dermatologist.

period. The number of new or existing GW cases was study sample of 200 physicians included 52 PCP, 50 DERM,
captured during consultations recorded in the physicians’ 72 OB/GYN, and 26 URO (Appendix Table A1). Overall,
Downloaded by University of Adelaide from www.liebertpub.com at 05/03/18. For personal use only.

daily logs. the weighted GW prevalence was estimated at 1.07% (95%

GW prevalence in physician practices was calculated CI: 0.97–1.17; Table 1). GW prevalence was higher in
using the number of new or existing GW cases observed, DERM practices (1.74%), followed by OB/GYN (1.20%),
divided by the total number of patients seen during the 2- URO (1.15%), and PCP (0.64%).
week study period. Prevalence was estimated and stratified A slightly higher overall prevalence was observed in male
by physician specialty, age group, and sex for all patients. patients (1.22%; 95% CI: 1.06–1.38) compared with female
GW prevalence was estimated according to the underlying patients (0.99%; 95% CI: 0.87–1.11). Prevalence differed
sample population to provide a national-level prevalence significantly ( p < 0.05) by region. The highest GW preva-
estimate. The national-level prevalence was estimated based lence was found in Delhi (2.17%), followed by Hyderabad
on the estimated prevalence for each specialty and the dis- (1.35%), and Kolkata (1.21%; Table 2).
tribution of GW patients who sought care. The proportion of Overall, the highest GW prevalence (1.42%) was found
GW patients at the national level seeing each specialty was among patients aged 25–29 years, and the lowest prevalence
calculated based on the formula, Gi = (Si · Di)/(Ri = 1–4 (0.54%) was found among those aged >54 years (Fig. 1).
Si · Di), where S is the number of physicians of a specific Among men, GW prevalence increased until age 30–34
specialty in the country (obtained from a database main- years, and among women, the highest prevalence was found
tained by IMS consulting), D is the mean number of patients in younger patients (aged 25–29 years). Prevalence was
with GW (based on 2-week daily logs) seen by the spe- lower among women than men aged 18–40 years, and
cific specialty, and i is the specialty (PCP, OBGYN, URO, among older patients aged >54 years. GW prevalence was
DERM). The proportions of patients seeing each specialty only higher among female patients aged 40–54 years.
were used in the following formula to derive weights ap- For GW patients visiting physician offices during the 2-
plied to patients included in the study database and then to week study period, the percentage of existing GW cases was
derive national-level prevalence estimate: W = (Gi · nT)/(ni), slightly higher in DERM offices (32.2%) than in the other
where Gi is the proportion of GW patients at a national level
attending to each specialty, nT is total number of patients
counted in the study, and ni is the total number of patients Table 2. Genital Warts Prevalence as Reported
counted in the study for specific specialty, i. Weighted by All Physician Specialties by Region in India
prevalence was calculated based on the proportion of GW (Weighted Data by Speciality, Age, and Sex)
patients at the national level for each specialty, multiplied Identified
by the total number of patients in the study, and divided by All GW status New or existing GW
the total number of patients seen by each specialist. In ad- patients a
y/nb
dition, prevalence was calculated using normal distribution, (n) (n) (n) (%, 95% CI)c
due to the large number of patients recorded in the daily logs
(2). Prevalence rates were stratified by age group, sex, and Mumbai 9,711 9,711 69 0.73 (0.52–0.94)
physician specialty. Number, mean, and 95% confidence Bangalore 9,662 9,662 42 0.40 (0.27–0.53)
intervals (CIs) were reported. Hyderabad 5,350 5,350 83 1.35 (1.05–1.65)
Additional methods used for evaluating the psychosocial Chennai 3,895 3,895 16 0.45 (0.22–0.68)
Kolkata 7,052 7,052 104 1.21 (0.99–1.43)
impact of GW and selected HPV diseases have been in- Delhi 8,391 8,391 202 2.17 (1.85–2.49)
cluded in the Supplementary Data. Total 44,061 44,061 516 1.07 (0.97–1.17)
Results Data weighted according to specialty type.
a
‘‘All patients’’ includes all patients reported in India.
b
Prevalence Includes those patients with available information (excluding
missing values) about GW status (yes/no).
A total of 322 physicians met the inclusion criteria, of c
Percentage and 95% CI calculated accounting for the number of
which 122 declined to participate in the study. The final patients with identified GW status.
 4 KHOPKAR ET AL.
Downloaded by University of Adelaide from www.liebertpub.com at 05/03/18. For personal use only.

FIG. 1. Genital warts prevalence by age and sex in India (weighted data).

specialties (22.5–25.5). The distribution of existing cases
between recurrent and resistant cases was more heteroge-
neous by specialty. The percentage of resistant GW cases
ranged from 57.9% in PCP to 25.0% in URO (Table 3).
Additional results for the psychosocial impact of GW and
selected HPV diseases have been included in the Supple-
mentary Data.
Discussion
This cross-sectional study estimated the burden of GW in
India by determining GW prevalence.
The current study estimated national GW prevalence at
1.22% among men and 0.99% among women in India, which
is similar to reported estimates in recent literature (4,5,14,16).
When analyzing all patients included in the study, GW
prevalence was higher among male than female patients
(1.22% vs. 0.99%), although the difference was not as sig-
nificant as previously reported. In a previous study in India,
Ray et al. reported a male-to-female ratio of 3.7:1.0 (20),
including patients who visited a STI clinic for genital herpes
and for GW treatment in New Delhi over a 15-year period.
Differences were also obtained in the prevalence of GW
according to geographical regions. Higher prevalence rates
were obtained in Delhi (2.17%), followed by Hyderabad
(1.35%), and Kolkata (1.21%). These regional differences
should be interpreted with caution as the profile of partici-
pating physicians was not homogeneous across geography.
Delhi had a higher number of participating OB/GYN physi-
cians, which can be related to higher prevalence.
In terms of age, 62.5% of GW patients identified from the
physicians’ daily logs were 18–34 years, compared to 51.6%
of patients in this age range in the entire study sample,
showing a higher GW prevalence in younger patients. This
age group is also observed to be more frequently diagnosed
with STIs in other studies in India (3,7,10,15,21). In the Ray

Table 3. Genital Warts Case Description by Physician Specialty in India

PCP (n = 52) DERM (n = 50) OB/GYN (n = 72) URO (n = 26)
GW patients, n (%) 89 (0.6) 214 (1.7) 166 (1.2) 47 (1.1)
New or existing GW
New Case,a n (%) 69 (77.5) 145 (67.8) 126 (75.9) 35 (74.5)
Existing Case,b n (%) 20 (22.5) 69 (32.2) 40 (24.0) 12 (25.5)
Valid n 89 214 167 47
Existing cases
Recurrent,c n, (%) 8 (42.1) 47 (68.1) 20 (51.3) 9 (75.0)
Resistant,d n (%) 11 (57.9) 22 (31.9) 19 (48.7) 3 (25.0)
Valid n 19 69 39 12
a
New case: GW case that was not diagnosed previously by self or another physician.
b
Existing case: GW case that was diagnosed previously by self or another physician.
c
Recurrent case: GW case where previous episodes had resolved with treatment.
d
Resistant case: GW case where previous episodes had not resolved with treatment.
 PREVALENCE AND BURDEN: GENITAL WARTS IN INDIA
et al. study, most STI cases (68.5%) were reported to be
aged 21–30 years, followed by 28.1% of patients aged 31–
40 years (7).
After considering age distribution, GW prevalence further
differs by sex. Among the younger population, male patients
showed a higher GW prevalence rate than female patients.
However, in an older population, GW prevalence was higher
in females than in male patients. A retrospective study
consulting with an STI clinic in India reported that 59.7% of
male STI cases were aged 25–44 years (24). In the current
study, this age group was defined as being more sexually
active and at a higher risk of behavioral vulnerability to
acquiring STIs, given the higher number of sexual partners,
more concurrent partnerships, and frequent partner changes
compared with older age groups.
In the current study, GW patients were primarily newly
diagnosed (74.07%). Among those with existing GW,
56.24% were recurrent and 43.76% resistant. No previous
Downloaded by University of Adelaide from www.liebertpub.com at 05/03/18. For personal use only.
data have been published in India related to the proportion
of newly diagnosed or existing GW cases.
Additional discussion on the psychosocial impact of GW
and selected HPV diseases has been included in the Sup-
plementary Data.
Limitations
The current study has several limitations. Selection cri-
teria defined for participating physicians required a mini-
mum time to see patients for outpatient visits, which may
have resulted in some physicians seeing more GW patients
than other physicians of the same specialty, which may
overestimate GW prevalence when data for each specialty
office are projected at the national level. In addition, GW
patients who did not seek treatment were not included in the
study, which can underestimate the true prevalence in India,
since weighting was applied.
Conclusion
GW is the most commonly diagnosed STI worldwide. In
India, the overall GW prevalence was estimated at 1.07%. In
addition, GW imposes a significant psychosocial impact on
the individual and society. Study results also suggest that GW
among men and HPV-related disease among women have a
negative impact on patients’ well-being and health-related
quality of Life (HRQoL). In female cases, a major impact was
observed in those diagnosed with GW and precancerous le-
sions. Despite its limitations, this study provides an excellent
estimation of data not currently available. The results of this
study indicate that the burden of GW is substantial in India
and should be considered by physicians and public health
officials when making recommendations for measures aimed
to reduce GW-related prevalence.
Acknowledgments
The authors thank Furaha Kariburyo and Adesuwa Ogbo-
mo of STATinMED Research for medical writing assistance.
Author Disclosure Statement
U.S.K., M.R., and A.R.C. have no conflicts to disclose.
K.Y. was a paid contractor for Merck and Co. at the time of
5
the study and was an employee of Cubist Pharmaceuticals
December 2014–July 2015; it was acquired by Merck and Co.
in January 2015. A.K., S.K.-T., and P.K.S. are employees of
Merck and Co. S.M.G. received grants from the Common-
wealth Department of Health for HPV, Merck and Co., and
Glaxo Smith Kline to perform phase 3 clinical vaccine trials:
Merck to evaluate HPV in RRP postvaccination program;
CSL for HPV in cervical cancer study, and VCA for a study
on the effectiveness of a public health HPV vaccine study,
and a study on the associations of early onset cancers. Merck
and Co. paid for travel and accommodation to present at HPV
advisory board meetings. A.R.G. is a member of Merck and
Co, Inc. advisory boards. Her institution has received grants
and contracts to support HPV-related research. N.L. and M.R.
are employees of IMS Health Barcelona, which is a paid
consultant to Merck and Co.
References
1. Arima Y, Winer RL, Feng Q, et al. Development of genital
warts after incident detection of human papillomavirus in-
fection in young men. J Infect Dis 2010;202:1181–1184.
2. Bertolotti A, Dupin N, Bouscarat F, Milpied B, and
Derancourt C. Cryotherapy to treat anogenital warts in
nonimmunocompromised adults: systematic review and
meta-analysis. J Am Acad Dermatol 2017;77:518–526.
3. Brown LD, Cai TT, and DasGupta A. Interval estimation
for a binomial proportion. Statist Sci 2001;16:101–133.
4. Castellsagué X, Cohet C, Puig-Tintoré L, et al. Epide-
miology and cost of treatment of genital warts in Spain. Eur
J Public Health 2009;19:106–110.
5. Chandragupta TS, Badri SR, Murty SV, et al. Changing
trends of sexually transmitted diseases at Kakinada. Indian
J Sex Transm Dis 2007;28:6–9.
6. Clifford GM, Galios S, Herrero R, et al. Worldwide dis-
tribution of human papillomavirus types in cytologically
normal women in the International Agency for Research on
Cancer HPV prevalence surveys: a pooled analysis. Lancet
2005;366:991–998.
7. Devi SA, Vetrichevvel TP, Pise GA, and Thappa DM.
Pattern of sexually transmitted infections in a tertiary care
centre at Puducherry. Indian J Dermatol 2009;54:347–349.
8. Graziottin A, and Serafini A. HPV infection in women:
psychosexual impact of genital warts and intraepithelial
lesions. J Sex Med 2009;6:633–645.
9. Haupt RM, and Sings HL. The efficacy and safety of the
quadrivalent human papillomavirus 6/11/16/18 vaccine gar-
dasil. J Adolesc Health 2011;49:467–475.
10. Jain VK, Dayal S, Aggarwal K, and Jain S. Changing trends
of sexually transmitted diseases at Rohtak. Indian J Sex
Transm Dis 2008;29:23–25.
11. Jeynes C, Chung M, and Challenor R. ‘‘Shame on you’’–
the psychosocial impact of genital warts. Int J STD AIDS
2009;20:557–560.
12. Kaku M, Mathew A, and Rajan B. Impact of socio-
economic factors in delayed reporting and late-stage pre-
sentation among patients with cervix cancer in a major
cancer hospital in South India. Asian Pac J Cancer Prev
2008;9:589–594.
13. Kim MA, Oh JK, Kim BW, et al. Prevalence and ser-
oprevalence of low-risk human papillomavirus in Korean
women. J Korean Mel Sci 2012;27:922–928.
14. Kjaer SK, Tran TN, Sparen P, et al. The burden of genital
warts: a study of nearly 70,000 women from the general
 6 KHOPKAR ET AL.

female population in the 4 Nordic countries. J Infect Dis
2007;196:1447–1454.
15. Kumarasamy N, Balakrishnan P, Venkatesh KK, et al.
Prevalence and incidence of sexually transmitted infections
among South Indians at increased risk of HIV infection.
AIDS Patient Care STDS 2008;22:677–682.
16. Lin C, Lau J, Ho KM, et al. Incidence of genital warts
among the Hong Kong general adult population. BMC In-
fect Dis 2010;10:727.
17. Maw R, Reitano M, and Roy M. An international survey of
patients with genital warts: perceptions regarding treatment
and impact on lifestyle. Int J STD AIDS 1998;9:571–578.
18. Patel H, Wagner M, Singhal P, and Kothari S. Systematic
review of the incidence and prevalence of genital warts.
BMC Infect Dis 2013;13:39.
19. Pirotta MV, Stein AN, Fairley CK, et al. Patterns of
treatment of external genital warts in Australian sexual
health clinics. Sex Transm Dis 2009;36:375–379.
20. Ray K, Bala M, Gupta SM, et al. Changing trends in sex-
Downloaded by University of Adelaide from www.liebertpub.com at 05/03/18. For personal use only.
care referral hospital. Indian J Dermatol Venereol Leprol
2009;75:329.
22. Sharma VK, and Khandpur S. Changing patterns of sexu-
ally transmitted infections in India. Natl Med J India 2004;
17:310–319.
23. Thurgar E, Barton S, Karner C, and Edwards SJ. Clinical
effectiveness and cost-effectiveness of interventions for the
treatment of anogenital warts: systematic review and eco-
nomic evaluation. Health Technol Assess 2016;20:1.
24. Vora R, Anjaneyan G, Doctor C, and Gupta R. Clinico-
epidemiological study of sexually transmitted infections in
males at a rural-based tertiary care center. Indian J Sex
Transmis Dis 2011;32:86–89.
Address correspondence to:
Dr. Amit Kulkarni
Merck and Co., Inc.
Global Health Outcomes
CORE PL Vaccines

ually transmitted infections at a Regional STD Centre in 2000 Galloping Hill Road, Bldg: RY32-204
north India. Indian J Med Res 2006;124:559–568. Kenilworth, NJ 07033
21. Saikia L, Nath R, Deuori T, and Mahanta J. Sexually
transmitted diseases in Assam: an experience in a tertiary E-mail: amit.kulkarni4@merck.com

Appendix

Appendix Table A1. Participating Physicians by Region in India

PCP (n = 52) DERM (n = 50) OB/GYN (n = 72) URO (n = 26) Overall (n = 200)
Region
Mumbai, n (%) 10 (19.2) 9 (18.0) 17 (23.6) 7 (26.9) 43 (21.5)
Bangalore, n (%) 8 (15.4) 7 (14.0) 11 (15.3) 5 (19.2) 31 (15.5)
Hyderabad, n (%) 7 (13.5) 7 (14.0) 13 (18.1) 2 (7.7) 29 (14.5)
Chennai, n (%) 7 (13.5) 5 (10.0) 3 (4.2) 15 (7.5)
Kolkata, n (%) 10 (19.2) 10 (20.0) 14 (19.4) 6 (23.1) 40 (20.0)
Delhi, n (%) 10 (19.2) 12 (24.0) 14 (19.4) 6 (23.1) 42 (21.0)
Valid n 52 50 72 26 200
Percentages calculated over the corresponding valid n.
PCP, primary care physician; DERM, dermatologist; OB/GYN, obstetrician/gynecologist; URO, urologist.