The approach to children with anogenital warts in the context of sexual abuse is
a challenge in clinical practice. This study aims to review the current
knowledge of anogenital warts in children, the forms of transmission, and the
association with sexual abuse and to propose a cross-sectional approach
involving all medical specialties. A systematic review of the literature was
conducted in Portuguese and English from January 2000 to June 2016 using the ISI
Web of Knowledge and PubMed databases. Children aged 12 years or younger were
included. The ethical and legal aspects were consulted in the Declaration and
Convention on the Rights of Children and in the World Health Organization.
Non-sexual and sexual transmission events of human papillomavirus in children
have been well documented. The possibility of sexual transmission appears to be
greater in children older than 4 years. In the case of anogenital warts in
children younger than 4 years of age, the possibility of non-sexual transmission
should be strongly considered in the absence of another sexually transmitted
infection, clinical indicators, or history of sexual abuse. The importance of
human papillomavirus genotyping in the evaluation of sexual abuse is
controversial. A detailed medical history and physical examination of both the
child and caregivers are critical during the course of the investigation. The
likelihood of an association between human papillomavirus infection and sexual
abuse increases directly with age. A multidisciplinary clinical approach
improves the ability to identify sexual abuse in children with anogenital
warts.
Nearly half of the patients analysed had at least one cutaneous extraintestinal manifestation. The fact that certain lesions tend to be more common among patients with defined characteristics should alert the physicians and allow an early diagnosis and, when pertinent, a reference to dermatology.
Anogenital warts are caused by infection with the human papillomavirus. We reviewed the clinical data of 34 children younger than 13 with anogenital warts referred to the department of dermatovenereology of a tertiary care hospital. Suspicion of sexual abuse was raised in 11 (32.4%). Human papilloma virus testing and genotyping was performed in 19 (55.9%) children, and human papilloma virus type 16 was found in 4, which raises the question regarding what type of follow-up is required for children infected with high-risk oncogenic HPV types. Although the diagnosis of anogenital warts in children raises concerns regarding sexual abuse, our study supports that pediatric anogenital warts can be associated with nonsexual transmission.
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