Anogenital condylomata acuminata in young children: not always result of sexual transmission

Abstract

Condylomata acuminata lesions, commonly known as anogenital warts, are caused by human papillomavirus and manifest as flesh-coloured or hyperpigmented papules or plaques in the anogenital region. We report the case of a previously healthy young child that presented with anal condyloma lesions without other accompanying symptoms. His mother had similar lesions in the genital area. After careful investigation, no evidence of sexual abuse was found. Gradual clinical improvement was observed without treatment. This case highlights a disease that, when diagnosed in children, should alert the physician to the possibility of sexual abuse. However, other transmission routes, such as vertical transmission or autoinoculation and heteroinoculation during non-sexual contact, should also be considered.

Treatment of Pediatric Anogenital Warts in the Era of HPV-Vaccine: A Literature Review

“…Remarkably, anogenital HPV infection is mainly transmitted sexually in adults, occurring in more than 40% of sexually active women and representing the most common STI [ 1 , 67 , 71 ]. Conversely, the association of HPV infection with sexual activity varies greatly with age, and in young children, association is less frequent than previously thought [ 76 ]. In any case, approaches to treating pediatric AWs need to be chosen with care and address both the child and the family, starting with a fundamental detailed history of the child and the caregivers, giving specific relevance to genital and non-genital warts presented by caregivers and to possible genital HPV infection of the mother [ 1 ].…”

“…Indeed, in children with STIs, clinical findings are mostly unremarkable or non-specific during anogenital examination [ 2 ]. Therefore, a global psychological evaluation and an evaluation of social risk factors are needed as well as the exclusion of other possible STIs with serological testing for HIV, syphilis, hepatitis B and C and analysis of any anogenital exudate [ 20 , 76 ].…”

“…Although the identification of pediatric anogenital warts should always alert physicians to the possibility of sexual abuse, it must not be considered pathognomonic. Indeed, in young children (<4 years) with no other STI and no evidence of anogenital trauma or clinical indicators of physical abuse, HPV is most likely non-sexually acquired [ 76 ]. Girls are three times more frequently affected by AWs than boys and, though the perianal distribution of AWs might seem suspicious, it is actually the most common localization of AWs in young (<2 years) children, as in the case presented above, even in the absence of sexual abuse, while the penile shaft, urethra, and vulva are usually unaffected [ 2 , 76 ].…”

“…Indeed, in young children (<4 years) with no other STI and no evidence of anogenital trauma or clinical indicators of physical abuse, HPV is most likely non-sexually acquired [ 76 ]. Girls are three times more frequently affected by AWs than boys and, though the perianal distribution of AWs might seem suspicious, it is actually the most common localization of AWs in young (<2 years) children, as in the case presented above, even in the absence of sexual abuse, while the penile shaft, urethra, and vulva are usually unaffected [ 2 , 76 ]. The latter become preferred sites of AWs, together with perianal localization, only from later childhood and adolescence [ 2 , 76 ].…”

“…HPV transmission in young children is hypothesized to occur either “vertically” or, more predominantly, “horizontally” [ 2 , 76 ]. Vertical “periconceptive” transmission, through infected spermatozoa or oocytes, has been only theorized, as well as “prenatal” transmission in utero, possibly occurring through fetal membranes, amniotic fluid, and umbilical cord blood [ 1 , 76 , 77 ]. Principally, vertical transmission occurs “perinatally” during childbirth by direct contact with an infected maternal genital tract.…”