OBJECTIVE: Human Papillomavirus (HPV) is the main cause of genital warts (GWs) and a necessary cause of cervical cancer (CC). There is a lifetime HPV infection risk in women of 55-75%. Genitourinary Medicine (GUM) clinics and CC screening programmes help in the detection and treatment of GWs and deceleration of progression to cancerous lesions. This study estimated the annual National Health Service (NHS) costs of diagnosing and managing HPV related diseases in a pre-HPV vaccine era. METHODS: Data for first and recurrent GWs episodes were obtained from the Health Protection Agency and management pathways from GUM clinicians. The number of women screened for CC, results, and procedures undertaken for abnormal findings were obtained from a variety of sources (e.g., Government Statistical Service, Regional Screening Programmes; adjusted to 2003). Annual new cases of CC were obtained from GLOBOCAN, 2002. Resource costs (2003) included screening tests, clinician visits, diagnostic and treatment procedures, hospital admissions and drugs. Sensitivity analyses examined the range of treatment patterns and costs. RESULTS: In 2003, GUM clinics treated almost 114,000 patients with GWs. Topical creams were the first line treatment for the majority (77%) followed by cryotherapy or combination of the two. An average 26% of patients returned to complete their treatment. Total annual costs for GWs were £22.4million. In 2003, 4.8 million CC screening tests were conducted at a cost of £104.5million. Over 227,209 women were referred for colposcopy, costing £34 million for the diagnosis and treatment of precancerous lesions. Newly identified CC cases (N=3,308) and hospital admissions for prevalent CC cases in 2003 cost £43.7 million. Estimated total 2003 NHS costs related to HPV were £204.6 million (range: £181.3-£209.7 million). CONCLUSION: Preventing HPV related diseases through vaccination with a quadrivalent vaccine could result in cost offsets and more efficient resource allocation.