Anogenital Warts in Prepubertal Children; Sexual Abuse or Not?

Abstract

Forty-two prepubertal children presenting with anogenital (AG) warts (15 boys and 27 girls) were prospectively followed up (mean 15.9 months, SD 12.24). Most (73.8%) of these children had perianal condylomatous-type warts and 11 (26.2%) had concurrent non-genital (NG) warts. None had any other AG infections or sexually transmitted disease (STD). Twelve (28.6%) children acquired their AG warts by vertical transmission from an infected maternal birth canal, 3 (7.1%) by autoinoculation from common hand warts and 2 children (4.8%) through sexual abuse. In the remaining 25 children (59.5%) mode of acquisition of AG warts was uncertain but not thought to be sexual. Human papilloma virus (HPV) DNA (types 6/11, 16/18 or 31,33,35-31+) was detected in 10/32 (31.3%) of AG warts biopsied from these children, types 6/11 in the majority of positive biopsies (9/10). Detection of HPV DNA (types 6/11, 16/18 or 31+) in a child's AG warts was significantly associated with either vertical or sexual transmission (P < 0.02). Thirty-one children had their warts treated with a combination of scissor excision and electrocautery under general anaesthesia. Warts recurred in 10 (31.4%) of these children all within 4 months following treatment. Spontaneous resolution of AG warts was seen in 9 (21.4%) children. Of 42 children with AG warts 10 (23.8%) had at least one adult family member with AG warts, 13 (36.9%) on adult family member with another AG infection or STD, and 23 (62.2%) had a mother with cervical intraepithelial neoplasia (CIN). Twenty (47.6%) of these children had a family member with NG warts.(ABSTRACT TRUNCATED AT 250 WORDS)

Cutaneous mimickers of child abuse: a primer for pediatricians

“…Anogenital warts Anogenital warts (AGW) are benign growths caused by more than 25 types of human papilloma virus (HPV), most frequently types 6, 11, 16, and 18, and are one of the most controversial issues in child sexual abuse literature [6,17,30,36,45,55]. They are considered to be the commonest sexually transmitted disease in adults [24].…”

Transmissão de verrugas anogenitais em crianças e associação com abuso sexual

“…Study with 42 prepuberal children with anogenital warts found that 28.6% acquired HPV by vertical transmission, 7.1% resulted from self inoculation of warts located on the hands, and only 4.8% were associated with sexual abuse. The mode of transmission of HPV was considered inconclusive in 59.5% of the studied children, being not possible to relate the infection to sexual abuse 20 . The maternal history of vulvar condyloma or cervical squamous intraepithelial lesion at time of delivery was observed in 50.3% of children under nine years who presented different clinical forms of the disease 30 .…”

“…Rogo KOet al 18 Obalek S et al 19 Handley J et al 20 Cason J et al 21 Smith EM et al 22 Puranen M et al 23 Frazier L 24 Kui LL et al 25 Myhre AK et al 26 Cheung PC et al 27 Simmons KJ et al 28 Marcoux D et al 29 Jones V et al Derksen DJ 31 Slaughter L et al 32 Handley J et al 20 Gutman LT et al 33 Siegfried E et al 10 Stevens-Simon et al 34 0Jesus LE et al 35 Kui LL et al 25 Sinclair KA et al 36 Jones Vet al 30 Wingood GM et al…”

“…Although DNA-HPV 16 or 18 was found in 55% of warts located in the oral cavity of children, pairing between mother and son do not necessarily show consistent, avoiding to associate these cases with the vertical transmission 25 . Study with 42 children detecting HPV DNA was associated both with the possibility of vertical transmission, such as through sexual contact 20 . In another study of 72 children under 12, patients with anogenital warts, was not possible to establish the mode of warts transmission based only on the identified HPV subtype 29 .…”

Anogenital Warts in Children and Sexual Abuse

“…Başka bir çalışmada anoogenital siğili olan 42 prepubertal çocuğun ailesinde en az bir fertte % 23.8 oranında anogenital siğil, % 47 oranında ekstragenital siğil ve % 36.9 oranında baş-ka anogenital lezyon ya da cinsel yolla bulaşan hastalıklar (STD) saptanmıştır. Ayrıca % 62.2 oranında çocukların annesinde servikal intraepitelyal neoplazi (CIN) tespit edilmiştir [23]. Bizim çalışmamızda AGS'si bulunan 10 çocuğun annelerinden birinde AGS saptandı.…”