title: Anogenital warts in children: sexual abuse or unintentional contamination?
abstract: Anogenital warts (AGW) were recently recognized in children, and their significance as an index of childhood sexual abuse is controversial. We report our transdisciplinary approach (including a pediatric surgeon, psychologist, social worker, ethics expert, and occasionally law enforcement agents) and its results in a group of 17 children with AGW treated at the public pediatric referral hospital in Rio de Janeiro, Brazil, during a 3-year period (1996-1999). All children were treated by electrocauterization of the warts, tested for other STDs, and submitted to perineal examination under anesthesia. Families received psycho-social counseling as necessary and cases were referred to child protection and law enforcement agents when indicated according to Brazilian legislation. We identified a high incidence of sexual abuse (8 children, 5/7 > 5 years old), with 3 patients inconclusive as to sexual abuse and 7 cases of perinatal transmission (5/8 < 4 years old). We conclude that AGW are indeed a strong sign of suspicion for sexual abuse in children, especially but not exclusively > 5 years of age. However, strong support and a transdisciplinary approach to the children and their families is necessary to identify it.
authors.affiliation: Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, RJ, 24033-900, Brasil.
authors.forename: L E
authors.initials: LE
authors.lastname: de Jesus
authors.forename: O L
authors.initials: OL
authors.lastname: Cirne Neto
authors.forename: L M
authors.initials: LM
authors.lastname: Monteiro do Nascimento
authors.forename: R
authors.initials: R
authors.lastname: Costa Araújo
authors.forename: A
authors.initials: A
authors.lastname: Agostinho Baptista
mesh_terms: D002648:Child; D002650:Child Abuse, Sexual / Q000175:diagnosis*; D002675:Child, Preschool; D003218:Condylomata Acuminata / Q000209:etiology*; D004564:Electrocoagulation; D005260:Female; D005500:Follow-Up Studies; D005831:Genital Diseases, Female / Q000209:etiology*; D005832:Genital Diseases, Male / Q000209:etiology*; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D027383:Papillomaviridae; D010290:Parents; D010808:Physical Examination; D012725:Sexual Behavior