Difficulties in Diagnosing Sexual Abuse in Children with Condyloma Acuminata in Turkey

Abstract

Human papillomavirus is responsible for anogenital warts and could be regarded as an indicator of possible sexual abuse in children. A genital wart was detected during an investigation of anti-hepatitis C virus positivity in a four-year-old male patient. No pathological findings of another sexually transmitted disease were found except complete cleft palate and circumferential lesions in the perianal region. No family member was anti-hepatitis C virus positive, but the patient's uncle and his wife had genital condylomata. Although detailed physical examination uncovered no other findings indicative of sexual abuse, suspicion of abuse could not be eliminated. Therefore, we wanted to draw the attention of health professionals to the association of anogenital warts and sexual abuse.

Giant condyloma acuminate due human papilloma virus type 16 in an infant successfully treated with topical imiquimod therapy

“…The transmission routes of HPV infection in children are not as clear as in adults. 3 Proposed mechanisms of perinatal and postnatal transmission include vertical transmission, horizontal transmission (autoinoculation, heteroinoculation), and fomite transmission 5-8 , 13 Condyloma acuminata in children may be, but is not always, an indicator of sexual abuse. 7 Anogenital lesions that are noticed in a child before its first birthday are generally acquired perinatally (vertical transmission), either in utero or during vaginal delivery.…”

“… 4 Therefore, it is difficult to define whether the transmission route in these cases is sexual or not. 3 , 4 Although most small children acquire their anogenital warts in innocuous ways, the possibility of sexual abuse must be seriously considered. 2 A careful medical and social history must be taken to exclude any sign of neglect or abuse, and referral to child protective services is indicated if necessary.…”

“… 2 The prevalence of anogenital warts in childhood is 1.5%, and they are observed in girls two times more commonly than in boys. 3 There is limited data about the incidence of anogenital condyloma acuminate in childhood. 4 The overall prevalence of infection with specific human papilloma virus types and the true incubation period for children is not well known; however, it is important to define the transmission mode, the therapy, and the follow-up for long term potential complications.…”

Vulval Warts in the Paediatric Age Group: A Report of Three Cases

“…When seen, it may be associated with sexual abuse, vertical transmission, immune-suppression, or poor hygiene [7,8]. In Case 1, sexual abuse was likely due to the absence of the hymen, while in Case 2, there was poor hygiene; there was a possibility of autoinoculation in Case 3 as has been shown in some studies [1,9].…”