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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 17  |  Issue : 3  |  Page : 221-222

Condyloma acuminata in a 3-year-old female: Sexual abuse or not?


Department of Dermatology, School of Medical Sciences and Research, Sharda Hospital, Greater Noida, Uttar Pradesh, India

Date of Web Publication5-Jul-2016

Correspondence Address:
Amrinder Jit Kanwar
Flat 301, Lincoln C Omaxe Grand Sector 93B, Noida - 201 301, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-7250.179498

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  Abstract 

Condyloma acuminata (also known as anogenital warts or venereal warts) a sexually transmitted disease (STD) is usually seen in younger adults. However, genital warts have been reported in all age groups of children including infants. The possibility of sexual abuse is a major concern in the evaluation of children with genital warts. We hereby report a case of genital warts in a three year old female child.

Keywords: Condyloma acuminata, female child, sexual abuse


How to cite this article:
Rizvi AA, Kanwar AJ, Goel S. Condyloma acuminata in a 3-year-old female: Sexual abuse or not?. Indian J Paediatr Dermatol 2016;17:221-2

How to cite this URL:
Rizvi AA, Kanwar AJ, Goel S. Condyloma acuminata in a 3-year-old female: Sexual abuse or not?. Indian J Paediatr Dermatol [serial online] 2016 [cited 2019 Dec 8];17:221-2. Available from: http://www.ijpd.in/text.asp?2016/17/3/221/179498


  Introduction Top


Anogenital warts or condyloma acuminata are caused by the human papillomavirus (HPV).[1] Besides sexual abuse, perinatal and nonsexual contact through kissing, fondling, etc., should also be considered causes of genital warts in infants and toddlers.[2] The presence of anogenital warts in children outside the perinatal period is highly suspicious of sexual abuse.[3] However, mode of transmission of HPV in the pediatric population often remains untraced.[4] Further, the verification of sexually transmitted genital warts is made more difficult by the long latency period before clinical presentation. Henceforth, the presence of warts or HPV DNA alone without supporting social and clinical information is not diagnostic of sexual abuse.[4]


  Case Report Top


A mother brought her 3-year-old female child with multiple asymptomatic papular lesions over the genital area from the past 1 month. Clinical examination revealed multiple flesh-colored, soft, papular lesions with filiform-like projections, on the inner aspect of labia consistent with condyloma acuminata [Figure 1]. Genital inspection was normal. There were no such lesions elsewhere on her body. Examination of the parents did not reveal any similar lesions. On further questioning, the parents denied any knowledge of possible sexual abuse. The child was treated successfully with topical imiquimod 5% cream thrice a week and oral levamisole 150 mg pulse for 4 weeks [Figure 2].
Figure 1: Multiple condyloma acuminata present over the inner aspect of labia

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Figure 2: Regression of the genital warts after 4 weeks of treatment

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  Discussion Top


HPVs are probably the most common viral sexually transmitted pathogens.[3] Among HPV DNA, subtypes 6 and 11 have been reported more frequently than subtypes 2 and 3 in sexually abused children.[3]

Condyloma acuminata are usually seen in younger adults.[5] In a study of 126 patients suffering from skin and genital warts, the maximum incidence was reported in the age group of 16–20 year.[6] However, we report a case of genital warts in a 3-year-old female child. Although there was no history of sexual assault, the same cannot be ruled out altogether.

The average incubation period from sexual HPV exposure to development of genital warts in adolescents and adults is about 3 months (range 3 weeks to 8 months),[7] but is unknown in children.

In children with anogenital warts, reports of sexual abuse have varied from 0% to 80%.[5],[6] Of sexually abused children, HPV DNA and/or abnormal Pap cytology has been reported in 3.4–33% and anogenital warts only in 0.3–2%.[6],[8] Evaluation is complex as most children who have been sexually abused will neither show carriage of the virus nor have evidence of physical trauma.[9],[10]

Whether HPV infection was a consequence of perinatal transmission or by family or environmental contact would need to be determined. At this time, the data on the epidemiology of the acquisition of clinically apparent HPV disease in children are inconclusive.[3]


  Conclusion Top


Sexual abuse in children is not an uncommon problem. It is associated with high degree of adverse physical and psychological consequences; some of which can be life-threatening. The incidences of sexual abuse in children are difficult to estimate, mainly because much of the sexual abuse in childhood escapes detection. Thereby, it is important to improve awareness among children, parents, adolescents, and general population.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.

 
  References Top

1.
Marcoux D, Nadeau K, McCuaig C, Powell J, Oligny LL. Pediatric anogenital warts: A 7-year review of children referred to a tertiary-care hospital in Montreal, Canada. Pediatr Dermatol 2006;23:199-207.  Back to cited text no. 1
    
2.
Dhawan J, Gupta S, Kumar B. Sexually transmitted diseases in children in India. Indian J Dermatol Venereol Leprol 2010;76:489-93.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.
Kumaran MS, Dogra S, Handa S, Kanwar AJ. Anogenital warts in an infant. J Eur Acad Dermatol Venereol 2005;19:782-3.  Back to cited text no. 3
    
4.
Jayasinghe Y, Garland SM. Genital warts in children: What do they mean? Arch Dis Child 2006;91:696-700.  Back to cited text no. 4
    
5.
Armstrong DK, Handley JM. Anogenital warts in prepubertal children: Pathogenesis, HPV typing and management. Int J STD AIDS 1997;8:78-81.  Back to cited text no. 5
    
6.
Moscicki AB. Genital infections with human papillomavirus (HPV). Pediatr Infect Dis J 1998;17:651-2.  Back to cited text no. 6
    
7.
Oriel JD. Natural history of genital warts. Br J Vener Dis 1971;47:1-13.  Back to cited text no. 7
    
8.
Gibbs NF. Anogenital papillomavirus infections in children. Curr Opin Pediatr 1998;10:393-7.  Back to cited text no. 8
    
9.
Atabaki S, Paradise JE. The medical evaluation of the sexually abused child: Lessons from a decade of research. Pediatrics 1999;104(1 Pt 2):178-86.  Back to cited text no. 9
    
10.
Berenson AB, Chacko MR, Wiemann CM, Mishaw CO, Friedrich WN, Grady JJ. A case-control study of anatomic changes resulting from sexual abuse. Am J Obstet Gynecol 2000;182:820-31.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2]



 

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