Anogenital warts in children

Fourteen cases of anogenital warts in children are reported. Girls were more frequently affected than boys (9/5). Three children had been infected during birth; two had autoinfection from non-anogenital warts; two girls had apparently been sexually abused. In the remaining 7 cases the origin of the warts was unknown. The authors discuss the epidemiological, therapeutic and social implications of this little known but important paediatric pathology, pointing to the possibility of sexual transmission in cases of "apparently" unknown origin.     

Anogenital warts in children: Analysis of a cohort of 34 prepubertal children

Anogenital warts are caused by infection with the human papillomavirus. We reviewed the clinical data of 34 children younger than 13 with anogenital warts referred to the department of dermatovenereology of a tertiary care hospital. Suspicion of sexual abuse was raised in 11 (32.4%). Human papilloma virus testing and genotyping was performed in 19 (55.9%) children, and human papilloma virus type 16 was found in 4, which raises the question regarding what type of follow‐up is required for children infected with high‐risk oncogenic HPV types. Although the diagnosis of anogenital warts in children raises concerns regarding sexual abuse, our study supports that pediatric anogenital warts can be associated with nonsexual transmission.     

Anogenital warts of the condyloma acuminatum type in HIV-positive patients

Anogenital warts of the condyloma acuminatum type seem to occur quite often during HIV infection. These warts--according to our study--are not commonly caused by malignancy-associated human papilloma virus types, but by types 6 and 11 as seen in the nonimmune-compromised population. Widespread condylomata acuminata may appear in rather early stages of HIV infection and they may therefore represent early warning signs of HIV infection.     

Anogenital warts and condom use--a survey of information giving.

OBJECTIVE: To examine information giving by genitourinary medicine (GUM) consultants about the use of condoms for patients with anogenital warts (AGW). METHOD: 228 GUM consultants in the UK and Ireland were sent a questionnaire concerning the information about condom use which they usually discuss with patients with AGW. The survey was carried out in 1994. RESULTS: There was a 46% response rate. Most consultants indicated giving information specifically with regard to the prevention of transmission of human papilloma virus (HPV), and not only in the context of safe sex. With regard to current AGW, consultants were more likely to discuss, than not to discuss, use of condoms with patients with regular sexual partners in terms of benefit, uncertain benefit, or no benefit. However, no significant difference in the likelihood of discussing, or not discussing, these issues was found for current AGW for patients without regular partners. For both groups, benefit of using condoms for current AGW was more likely to be discussed than no benefit. The majority of consultants indicated that they would discuss condom use after disappearance of AGW as being of uncertain benefit. However, many consultants also indicated discussing use of condoms for a specific period or an indefinite period of time, including many of those who specific discussing uncertain beneficial use of condoms after disappearance of AGW. The most common duration of condom use chosen for discussion was until 3 months after disappearance of AGW. CONCLUSION: GUM consultants vary in the information they give about condom use specifically to prevent transmission of HPV. This survey suggests a need for evaluation by GUM physicians of management guidelines relating to information given about condom use for AGW, including utilising the available scientific evidence as well as dealing with issues of uncertainty.     

Anogenital warts knowledge and counseling practices of US clinicians: results from a national survey

OBJECTIVES: To examine messages US clinicians use when counseling patients diagnosed with anogenital warts. STUDY DESIGN: In mid-2004, we conducted a confidential mail survey of nationally representative samples of physicians practicing internal and adolescent medicine, family/general practice, obstetrics/gynecology, urology, or dermatology; nurse midwives; physician assistants; and nurse practitioners. The survey assessed knowledge and counseling practices of clinicians who had diagnosed anogenital warts. RESULTS: After adjusting for survey eligibility, 81% responded. Most (89%) were aware that human papillomavirus (HPV) causes anogenital warts, but only 48% were aware that oncogenic and wart-related HPV genotypes usually differ. Most (>95%) clinicians reported telling patients with warts that warts are an STD, are caused by a virus, or that their sex partners may have or may acquire warts. Many clinicians (>/=85%) also reported discussing STD prevention or assessing STD risk with such patients. Most reported addressing ways to prevent HPV (89%), including using condoms; limiting sex partners or practicing monogamy; or abstinence. Many also reported recommending prompt (82%) or more frequent (52%) Pap testing to female patients with anogenital warts. Potential barriers to counseling included providing definitive answers on how HPV infection was acquired, dealing with patients' psychosocial issues, and inadequate reimbursement. CONCLUSIONS: Most surveyed clinicians appropriately counseled patients about the cause and prevention of anogenital warts. However, many clinicians were unaware that oncogenic and wart-related HPV types usually differ, and this may explain why many reported recommending more aggressive cervical cancer screening for female patients with warts.     

Carbon dioxide laser therapy for anogenital warts in children

BACKGROUND: Management of anogenital condylomas in children can be delicate especially in the event of profuse lesions and raises the issue of identification of the mode of contamination. PATIENTS AND METHODS: The dossiers of all children referred to the laser unit of "La Conception" University Teaching Hospital in Marseille between 1995 and 2005 for treatment of profuse anogenital condylomas were studied retrospectively. The main objective was to evaluate the efficacy and tolerability of CO2 laser treatment for anogenital condylomas. The secondary objective was to invstigate the mode of contamination. RESULTS: Seventeen children aged 2-11 years were treated. All were examined in routine fashion, as were their parents and siblings, for signs of PVH infection and sexual abuse. Laser was performed by the same operator under general anaesthesia. For all of these children, healing was rapid and without complication or functional sequelae. Two children were lost to follow-up. Ten children (66.7% of the treated children) presented no recurrence after only one session of CO2 laser. Vertical transmission was diagnosed for 6 children and horizontal transmission for 7 children. For 4 children, the mode of contamination remained unknown. No cases of sexual abuse were proven. CONCLUSION: Due to its painless nature, rapid healing, low rate of complications and recurrence, and minimal risk of scarring, CO2 laser is an effective treatment for the management of profuse anogenital condylomas in children. Vertical transmission is the most frequent mode of contamination and sexual abuse remains rare, although clinicians must keep this possibility in mind.