Genital wart - Suspected Child Abuse
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
A63.0 – Anogenital (venereal) warts
240542006 – Condyloma acuminatum
- Pearly penile papules – May be seen as early as the second decade of life.
- 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
- 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.