Can inflammation predict recurrence? A study on genital warts in men

Abstract

Background

Recurrence of genital warts remains a significant clinical challenge despite various treatment options. Systemic inflammatory indices derived from routine blood counts, such as the systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), have recently been investigated as potential prognostic markers in HPV-related diseases.

Methods

This retrospective study included 217 male patients who underwent electrocauterisation for penoscrotal warts between March and September 2024. Patients were classified as having primary or recurrent lesions at presentation. Preoperative neutrophil, lymphocyte, and platelet counts were used to calculate inflammatory indices, and their associations with recurrence were analysed. Primary patients were also followed for 6 months to assess post-treatment recurrence.

Results

Recurrent cases (44.2%) exhibited significantly higher SII, NLR, and PLR values compared with primary cases (p = 0.004, p = 0.011, and p = 0.047, respectively). Smoking prevalence was greater among recurrent patients (p = 0.008). Among primary patients, those who experienced recurrence at 6 months had higher SII (p = 0.006) and NLR (p = 0.014). Multivariate analysis identified SII as an independent predictor of recurrence (OR = 1.42, 95% CI 1.08–1.91, p = 0.027).

Conclusions

Elevated SII and NLR levels are associated with an increased risk of genital wart recurrence, and SII independently predicts recurrence among primary cases. These inexpensive and readily available markers may aid in recurrence risk stratification and follow-up planning. Longer prospective studies incorporating HPV genotyping and behavioural risk factors are warranted to confirm these findings.