Indian Journal of Paediatric Dermatology

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

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


Alia Abbas Rizvi, Amrinder Jit Kanwar, Shitij Goel 
 Department of Dermatology, School of Medical Sciences and Research, Sharda Hospital, Greater Noida, Uttar Pradesh, India

Correspondence Address:
Amrinder Jit Kanwar
Flat 301, Lincoln C Omaxe Grand Sector 93B, Noida - 201 301, Uttar Pradesh
India

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.



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;17:221-222


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 2020 Jan 18 ];17:221-222
Available from: http://www.ijpd.in/text.asp?2016/17/3/221/179498


Full Text

 Introduction



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



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}{Figure 2}

 Discussion



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



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.

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