Anogenital warts in childhood

Fifteen children with anogenital warts are presented. Twelve cases were referred for assessment of sexual abuse which was established in six cases, strongly suspected in one, and excluded in three. In two, the source was unclear. Papillomavirus typing was carried out by HPV DNA dot and Southern blot hybridization using mixed HPV 6/11, 16/18, and 2/3 DNA probes on 15 specimens from 12 of the children. Seven biopsy specimens were positive for HPV 6 or 11 and one hybridized with both HPV 6/11 and 16/18 mixed sets of probes. Two specimens were positive for HPV 2, and a further two hybridized with both HPV 18 and 2. Three wart specimens could not be typed with the available genital or skin probes. The viruses causing genital tract papillomata are the same for children and adults. The identification of HPV 16/18 raises the concern of potential oncogenicity and stresses the need for long-term assessment. The diagnosis of sexual abuse was made on history rather than examination, as only two cases showed additional physical signs of sexual abuse. It is advocated that the presence of anogenital warts alone be sufficient grounds to pursue the possibility of sexual abuse. Nonsexual transmission, although possible, is far less likely.