title: Anogenital human papillomavirus in sexually abused and nonabused children: a multicenter study.
abstract: OBJECTIVE
  To characterize the epidemiology of genital human papillomavirus (HPV) infection in children without previous consensual sexual activity, comparing HPV prevalence by certainty of child sexual abuse (CSA).
  
  
  METHODS
  Patients presenting for evaluation of CSA in 8 sites in Atlanta, Houston, Harrisburg, and New York City were recruited along with patients presenting for unrelated health visits. CSA certainty was classified as definite, probable, possible, or no evidence following published guidelines and the results of history, physical examination, and laboratory tests. Urine and swabs of external genitalia were tested for HPV using L1 consensus polymerase chain reaction.
  
  
  RESULTS
  The study included 576 participants (89.9% female) aged 6 months to 13 years (mean: 7.9); 534 of whom were evaluated for CSA and 42 for unrelated reasons. Of those evaluated for CSA, 14 had genital warts. One or more HPV types were detected in 11.8% (61 of 517) of participants with adequate samples. HPV detection was more likely among abused participants (definite, probable, or possible) than among participants without evidence of CSA (13.7% and 1.3%, respectively; P < .0001) and increased with certainty of abuse (8.4%, 15.6%, and 14.5% in participants with possible, probable, and definite CSA, respectively; P < .0001). Participants aged 10 years or older had a higher prevalence of HPV (20.6%) than others (5.6%) (P < .0001). CSA, anogenital warts, and age were independently associated with HPV detection.
  
  
  CONCLUSIONS
  HPV detection was associated with CSA and increased with CSA certainty. In this population, genital HPV seemed to behave as a sexually transmitted infection.
authors.affiliation: Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. eunger@cdc.gov
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Unger
authors.forename: Nancy N
authors.initials: NN
authors.lastname: Fajman
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Maloney
authors.forename: Juanita
authors.initials: J
authors.lastname: Onyekwuluje
authors.forename: David C
authors.initials: DC
authors.lastname: Swan
authors.forename: Laurie
authors.initials: L
authors.lastname: Howard
authors.forename: Consuelo M
authors.initials: CM
authors.lastname: Beck-Sague
authors.forename: Mary K
authors.initials: MK
authors.lastname: Sawyer
authors.forename: Rebecca G
authors.initials: RG
authors.lastname: Girardet
authors.forename: Robert L
authors.initials: RL
authors.lastname: Sautter
authors.forename: Margaret R
authors.initials: MR
authors.lastname: Hammerschlag
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Black
mesh_terms: D000293:Adolescent; D001003:Anal Canal / Q000821:virology; D002648:Child; D002650:Child Abuse, Sexual / Q000175:diagnosis* / Q000706:statistics & numerical data*; D002675:Child, Preschool; D015897:Comorbidity; D003218:Condylomata Acuminata / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D030361:Papillomavirus Infections / Q000453:epidemiology*