Anogenital warts in prepubertal children; sexual abuse or not?
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)
Handley
J
J
Department of Dermatology, Royal Victoria Hospital, Belfast, N. Ireland, UK.
Dinsmore
W
W
Maw
R
R
Corbett
R
R
Burrows
D
D
Bharucha
H
H
Swann
A
A
Bingham
A
A
D001004:Anus Diseases / Q000209:etiology / Q000382:microbiology / Q000601:surgery; D002648:Child; D002650:Child Abuse, Sexual; D002675:Child, Preschool; D003218:Condylomata Acuminata / Q000209:etiology* / Q000382:microbiology / Q000601:surgery; D004279:DNA, Viral / Q000032:analysis; D004564:Electrocoagulation; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D027383:Papillomaviridae / Q000302:isolation & purification; D015995:Prevalence; D011446:Prospective Studies; D012008:Recurrence; D014860:Warts / Q000150:complications / Q000453:epidemiology / Q000635:transmission*
D004279:DNA, Viral