Genital wart in Child
See also in: AnogenitalAlerts and Notices
Synopsis
In children, HPV infections can present as common skin warts, anogenital warts, oral and laryngeal papillomas, and subclinical infections. HPV types 1, 2, 3, 4, 7, and 10 cause skin warts in children, with incidence peaking at ages 12-16 years. HPV types 6 and 11 account for most genital and oral warts, while types 16 and 18 cause both genital warts and genital malignancies. HPV infection causes oropharyngeal and anal cancers in patients of any sex: cervical, vaginal, and vulvar cancer in women and penile cancer in men.
Note: Childhood sexual abuse is a problem of epidemic proportions affecting children of all ages and of all economic and cultural backgrounds. A critical consideration for assessing condyloma acuminata in children is the determination of whether inoculation occurred as a result of sexual abuse. However, anogenital warts from HPV can also occur secondary to perinatal exposure, heteroinoculation (eg, from caregiver a changing diapers), autoinoculation (eg, from a wart on the hand of child), and indirect fomite transfer (eg, from shared towels). Large case series have found that about 3%-10% of anogenital warts in children are due to child sexual abuse.
Related topic: oral mucosal wart
Codes
ICD10CM:A63.0 – Anogenital (venereal) warts
SNOMEDCT:
240542006 – Condyloma acuminatum
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
There are many verrucous-looking lesions of the genitals:- Pearly penile papules – May be seen as early as the second decade of life.
- Acrochordons
- Lichen planus
- Lichen nitidus
- Molluscum contagiosum – Shiny papules with central umbilication; giant molluscum in the anogenital area of children have been mistaken for condyloma acuminatum.
- Seborrheic keratoses
- Melanocytic nevi
- Fordyce spots
- Psoriasis
- Nodules of scabies
- Epidermal nevus
- Pseudoverrucous papules and nodules in association with chronic fecal incontinence.
- Condyloma lata (secondary syphilis) – Lesions tend to be flatter and smoother than condyloma acuminata.
- Hymenal remnants
- Vestibular papillae (also known as vulvar papillomatosis, a normal variant of female external genitalia) – Softer than condyloma, and symmetrically or linearly distributed compared to irregular distribution of condyloma; base of individual lesions remains separate compared to coalescing of superficial projections seen in condyloma.
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Management Pearls
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Therapy
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References
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Last Reviewed:09/23/2021
Last Updated:09/23/2021
Last Updated:09/23/2021
Patient Information for Genital wart in Child
Overview
Condyloma acuminatum is the medical term for genital warts, which are an infection spread through skin-to-skin contact during sexual activity. The warts are caused by a virus called the human papillomavirus (HPV). There are more than 30 strains of HPV that cause warts, and some of the strains are serious and can cause some cancers, including cervical cancer. There is no cure for HPV, but there is a vaccine that is available through a doctor to prevent the strains of HPV that cause cancer. However, a person who has had the vaccine can still get genital warts.Warts often go away on their own, but if they do not, a doctor can remove the warts one by one. Removing the warts does not cure the affected person of HPV, and the warts can come back at any time. Because the warts are spread through skin-to-skin contact, condoms are not always protective against warts, though condoms are a good idea to use to prevent many other sexually transmitted diseases.
The HPV vaccine protects against cancers caused by HPV. A 2-dose schedule is recommended for boys and girls who start the vaccine between the ages of 9 and 14, while a 3-dose schedule is recommended for those who initiate the vaccine series between the ages of 15 and 45 and for patients with HIV infection or other immunocompromising conditions regardless of age. If you are over the age of 26, discuss the possibility of vaccination with your doctor.
Who’s At Risk
Genital warts are the most common sexually transmitted disease and affect millions of people. At least one-half of sexually active men and women are infected with HPV at some point. A person can be infected without any visible signs of infection. In women, persistence of the infection can lead to cervical cancer. Men who have perianal and penile warts have a small chance of developing squamous cell skin cancer, but this risk is higher if the person is immunosuppressed with HIV, anti-rejection drugs (organ transplant), or chemotherapy.Genital warts can recur, either from the same original infection or from re-infection with a different HPV type. It is almost impossible to tell the source of the virus, as warts may appear weeks to months after infection occurs.
Signs & Symptoms
Genital warts appear as small 1- to 2-mm smooth bumps or larger warty, cauliflower-like lesions. They can be white, gray, or skin colored. They appear on the labia, vagina, penis, scrotum, anus, skin around the anus, and groin folds. They do not cause any symptoms.Self-Care Guidelines
Genital warts can be prevented by abstaining from sexual activity and having as few sexual partners as possible. Since HPV is so prevalent, every new partner increases your chances of becoming infected with HPV. Because there are no symptoms, there is no way of being certain that your partner is not infected. Using condoms cannot completely protect you from HPV, since vaginal or anal penetration does not need to occur to contract the virus.When to Seek Medical Care
You do not need to have visible warts to be contagious, as the virus may be in a latent or "resting" phase. However, when warts are visible, the infection is considered active and is definitely contagious. A healthy immune system usually clears the infection on its own, but if you are sexually active, you should seek treatment to reduce the chance of passing the virus to other partners.If your partner has been diagnosed with warts, you should be checked for infection. For women, a Pap smear is done to look for any signs of abnormal cervical cells, which can be the first sign of cervical cancer. This should be done annually if you previously had an abnormal Pap smear and every few years as a routine health check-up. For men, the genital area is visually inspected. Even if that check is normal, you may still get warts or cervical cancer in the future.
Treatments
Genital warts cannot be cured. The individual lesions can be treated, but the virus is virulent and exists beyond the visible borders of the lesions. Lesions can recur frequently.Destructive therapies include the following: freezing with liquid nitrogen (cryosurgery), burning (electrocautery or laser), application of topical therapies such as podophyllin solution, imiquimod 3.75% or 5% cream, or cidofovir gel, and injection of alpha-interferon, an antiviral drug.
Wait to have sex for at least 2 weeks, after the areas are well healed and you can see no warts.
In immunosuppressed patients, spontaneous resolution may occur when the immunosuppression is reversed. Therefore, conservative strategies should be used.
Make sure to tell the doctor if you could be pregnant.
References
Bolognia, Jean L., ed. Dermatology, pp.1224-1228, 1698-1699. New York: Mosby, 2003.
Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed., pp.1086, 2121, 2440, 2460. New York: McGraw-Hill, 2003.
Genital wart in Child
See also in: Anogenital