JMIR Publications

ABSTRACT

Background:

Condyloma acuminata (CA), or genital warts, is one of the most prevalent sexually transmitted infections worldwide. The global annual incidence of CA is estimated at 160–289 per 100,000 people, and in South Korea, reported cases have increased steadily since 2001. However, most epidemiological studies of CA have focused on individual risk factors, with limited attention to spatial or community-level determinants

Objective:

This study aimed to identify high-risk geographic clusters of CA in South Korea and determine the regional factors associated with its incidence.

Methods:

We conducted an ecological analysis using 2019 municipal-level data from the National Health Insurance Service of Korea. Spatial autocorrelation of CA incidence was evaluated using Moran’s I, and clustering was assessed with Getis-Ord Gi* to detect high-risk clusters. We then analyzed potential regional determinants using two Bayesian spatial regression models: the intrinsic conditional autoregressive model and the Besag–York–Mollié model. Key municipal-level variables included health behaviors, socioeconomic indicators, healthcare access, adult entertainment venue density, and risk of sexual violence. Results are reported as relative risks (RR) with 95% credible intervals (CrI).

Results:

A total of 52,009 CA cases were identified in 2019, 70.0% of which were in men. We found significant positive spatial autocorrelation in CA incidence (Moran’s I > 0, P < .001), indicating non-random spatial clustering. Getis-Ord Gi* analysis revealed several high-incidence clusters (“hotspots”) in metropolitan and southeastern regions of South Korea. In the Bayesian spatial models, higher CA incidence was associated with a greater share of the municipal budget spent on social welfare (RR 1.005, 95% CrI 1.001–1.009), a higher percentage of single-person households (RR 1.034, 95% CrI 1.025–1.043), and more adult entertainment establishments per 10,000 people (RR 1.006, 95% CrI 1.001–1.012).

Conclusions:

We identified significant geographic hotspots of CA and several community-level risk factors driving these patterns in South Korea. These findings highlight the importance of spatial surveillance and targeted public health interventions in high-risk areas. Adapting STI prevention programs to address local social determinants may help reduce the spread of CA in the identified hotspots.