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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%) an 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. These findings suggest (a) the majority of children with AG warts do not acquire these sexually, (b) vertical transmission is an important means by which young children acquire AG warts, (c) household members of children with AG warts should be routinely screened for NG and AG warts, CIN lesions (mothers only) and other AG infections or STDs (adults only), (d) HPV typing of AG warts in children may help to clarify their mode of transmission, (e) spontaneous resolution of AG warts in children does occur, (f) scissor excision combined with electrocautery is a safe and efficacious treatment for AG warts in children.