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Anogenital warts

Professor Stephan Strobel and colleagues advise on child anogenital warts and how to establish whether abuse has occurred

Anogenital warts are relatively uncommon in children.

They are caused by human papilloma virus (HPV), types 6 and 11 being common. In children, they cause alarm because they may reflect sexual abuse. Transmission of HPV to children may occur by two main routes:

•Intra-partum (the child is infected from the mother's genital tract at delivery; the virus may be latent for over three years).•In the post-natal period, when transmission from adults with genital warts may occur non-sexually (such as by sharing a bath with an infected person) or sexually.

The long and variable incubation period, the possibility of latent or subclinical infection in the source, and the problems in eliciting an accurate account of sexual contact can make it difficult to decide which applies in the individual case.

Clinical presentation

Anogenital warts are often asymptomatic, but may cause discomfort, discharge or bleeding. Typically, lesions are soft, pink and elongated. They may be filiform or pedunculated; a few are flat. They are often multiple, especially on moist surfaces.

Diagnosis

Typing of the causative HPV may be useful in investigating cases in which sexual abuse is suspected.

Identifying the same HPV type present in a suspected abuser does not provide proof of sexual abuse; however, a different HPV type would be strong evidence against the possibility.

Treatment

Viral warts can be expected to resolve spontaneously and without trace in the great majority of cases. Therefore, unless they are causing substantial discomfort, they should probably not be treated. Treatments that can be considered include topical podophyllin, cryotherapy and excision.

Prognosis

The duration of anogenital warts varies from a few weeks to several years. The main long-term concern is the risk of cervical dysplasia and neoplasia in females, but the risk when infection occurs in early childhood has never been quantified. It is clearly important, for this reason, to identify active infections in the mother so that she can be treated and followed up appropriately.

Stephan Strobel is honorary professor of paediatrics and clinical immunology at University of College London Institute of Child HealthStephan Marks is consultant paediatric nephrologist, Great Ormond Street HospitalPete Smith is consultant paediatric allergist, Bond University, QueenslandMagdi El Habbal is consultant in paediatrics and cardiology, Hull Royal Infirmary Lewis Apitz is Nuffield Professor of Paediatric Surgery, Great Ormond Street HospitalThis article is an adapted extract from The Great Ormond Street Colour Handbook of Paediatrics and Child Health by Stephan Strobel, Stephen Marks, Peter Smith, Magdi El Habbal and Lewis Spitz, Manson Publishing, ISBN 978-1-874545-27-9 www.mansonpublishing.com

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