Condylomata acuminata (anogenital warts) in children
- Latanya T Benjamin, MD
Latanya T Benjamin, MD
- Pediatric Dermatologist
- Joe DiMaggio Children's Hospital
Condylomata acuminata (also known as anogenital warts or venereal warts) are manifestations of human papillomavirus (HPV) infection that typically appear as flesh-colored or hyperpigmented verrucous papules or plaques in the perianal or genital region. Condyloma acuminatum may develop as a result of the acquisition of HPV infection via sexual or nonsexual means. In very young children, transmission of HPV via nonsexual contact may be the most common precipitator of these lesions.
The transmission, diagnosis, and management of condyloma acuminatum in children will be discussed here. Condyloma acuminatum in adults and cutaneous warts are reviewed separately. (See "Condylomata acuminata (anogenital warts) in adults: Epidemiology, pathogenesis, clinical features, and diagnosis" and "Treatment of vulvar and vaginal warts" and "Condylomata acuminata (anogenital warts): Management of external condylomata acuminata in men" and "Cutaneous warts (common, plantar, and flat warts)".)
Epidemiologic data on condyloma acuminatum in children are limited, and the prevalence of this condition in infants and children is unknown. Estimates of the average age at which children present with condyloma acuminatum range between 2.8 and 5.6 years . A female predominance is suggested by several studies [2-4].
Condyloma acuminatum is caused by infection with human papillomavirus (HPV), a double-stranded DNA virus with more than 100 serotypes . Although condyloma acuminatum in adults is commonly caused by HPV 6 and 11, the HPV types detected in lesions from children are more variable. HPV types associated with cutaneous warts (eg, HPV 1 to 4 and others) are frequently detected in anogenital lesions from children [2,5]. In one review of approximately 200 pediatric cases of condylomata acuminata in which HPV DNA was detected, HPV 6 or 11 was detected in 56 percent, HPV 1 to 4 in 12 percent, and HPV 16 or 18 in 4 percent . A separate series in which 40 children under the age of 12 with condyloma acuminatum underwent wart excision and HPV testing found that HPV types 6, 11, and/or 16 were present in only one-third of cases . (See "Human papillomavirus infections: Epidemiology and disease associations".)
The possibility of sexual abuse is a major concern in the evaluation of children with condyloma acuminatum. However, other modes of viral transmission may account for the majority of pediatric cases . The potential methods for human papillomavirus (HPV) acquisition in children are described below:To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Sinclair KA, Woods CR, Sinal SH. Venereal warts in children. Pediatr Rev 2011; 32:115.
- Marcoux D, Nadeau K, McCuaig C, et al. Pediatric anogenital warts: a 7-year review of children referred to a tertiary-care hospital in Montreal, Canada. Pediatr Dermatol 2006; 23:199.
- Allen AL, Siegfried EC. The natural history of condyloma in children. J Am Acad Dermatol 1998; 39:951.
- Stefanaki C, Barkas G, Valari M, et al. Condylomata acuminata in children. Pediatr Infect Dis J 2012; 31:422.
- Syrjänen S. Current concepts on human papillomavirus infections in children. APMIS 2010; 118:494.
- Sinclair KA, Woods CR, Kirse DJ, Sinal SH. Anogenital and respiratory tract human papillomavirus infections among children: age, gender, and potential transmission through sexual abuse. Pediatrics 2005; 116:815.
- Unger ER, Fajman NN, Maloney EM, et al. Anogenital human papillomavirus in sexually abused and nonabused children: a multicenter study. Pediatrics 2011; 128:e658.
- Armbruster-Moraes E, Ioshimoto LM, Leão E, Zugaib M. Presence of human papillomavirus DNA in amniotic fluids of pregnant women with cervical lesions. Gynecol Oncol 1994; 54:152.
- Syrjänen S, Puranen M. Human papillomavirus infections in children: the potential role of maternal transmission. Crit Rev Oral Biol Med 2000; 11:259.
- Tang CK, Shermeta DW, Wood C. Congenital condylomata acuminata. Am J Obstet Gynecol 1978; 131:912.
- Jayasinghe Y, Garland SM. Genital warts in children: what do they mean? Arch Dis Child 2006; 91:696.
- Chatterjee R, Bhattacharyya S, Biswas R, Das S. Giant condyloma acuminata in pediatric HIV. Indian Pediatr 2011; 48:62.
- Weedon D. Viral diseases. In: Weedon's Skin Pathology, 3rd ed, Elsevier Limited, Edinburgh 2010. p.515.
- Paller AS, Mancini AJ. Viral diseases of the skin. In: Hurwitz Clinical Pediatric Dermatology: A Textbook of Skin Disorders of Childhood and Adolescence, Third edition, Elsevier Saunders, Philadelphia 2006. p.405.
- Komericki P, Akkilic-Materna M, Strimitzer T, Aberer W. Efficacy and safety of imiquimod versus podophyllotoxin in the treatment of anogenital warts. Sex Transm Dis 2011; 38:216.
- Baker DA, Ferris DG, Martens MG, et al. Imiquimod 3.75% cream applied daily to treat anogenital warts: combined results from women in two randomized, placebo-controlled studies. Infect Dis Obstet Gynecol 2011; 2011:806105.
- Beutner KR, Spruance SL, Hougham AJ, et al. Treatment of genital warts with an immune-response modifier (imiquimod). J Am Acad Dermatol 1998; 38:230.
- Edwards L, Ferenczy A, Eron L, et al. Self-administered topical 5% imiquimod cream for external anogenital warts. HPV Study Group. Human PapillomaVirus. Arch Dermatol 1998; 134:25.
- Masuko T, Fuchigami T, Inadomi T, et al. Effectiveness of imiquimod 5% cream for treatment of perianal warts in a 28-month-old child. Pediatr Int 2011; 53:764.
- Campaner AB, Santos RE, Galvão MA, et al. Effectiveness of imiquimod 5% cream for treatment of extensive anogenital warts in a seven-year-old child. Pediatr Infect Dis J 2007; 26:265.
- Gruber PC, Wilkinson J. Successful treatment of perianal warts in a child with 5% imiquimod cream. J Dermatolog Treat 2001; 12:215.
- Schaen L, Mercurio MG. Treatment of human papilloma virus in a 6-month-old infant with imiquimod 5% cream. Pediatr Dermatol 2001; 18:450.
- Majewski S, Pniewski T, Malejczyk M, Jablonska S. Imiquimod is highly effective for extensive, hyperproliferative condyloma in children. Pediatr Dermatol 2003; 20:440.
- Moresi JM, Herbert CR, Cohen BA. Treatment of anogenital warts in children with topical 0.05% podofilox gel and 5% imiquimod cream. Pediatr Dermatol 2001; 18:448.
- Theos AU, Cummins R, Silverberg NB, Paller AS. Effectiveness of imiquimod cream 5% for treating childhood molluscum contagiosum in a double-blind, randomized pilot trial. Cutis 2004; 74:134.
- Longstaff E, von Krogh G. Condyloma eradication: self-therapy with 0.15-0.5% podophyllotoxin versus 20-25% podophyllin preparations--an integrated safety assessment. Regul Toxicol Pharmacol 2001; 33:117.
- Xie FM, Zeng K, Chen ZL, et al. [Treatment of recurrent condyloma acuminatum with solid lipid nanoparticle gel containing podophyllotoxin: a randomized double-blinded, controlled clinical trial]. Nan Fang Yi Ke Da Xue Xue Bao 2007; 27:657.
- Lacey CJ, Goodall RL, Tennvall GR, et al. Randomised controlled trial and economic evaluation of podophyllotoxin solution, podophyllotoxin cream, and podophyllin in the treatment of genital warts. Sex Transm Infect 2003; 79:270.
- Yan J, Chen SL, Wang HN, Wu TX. Meta-analysis of 5% imiquimod and 0.5% podophyllotoxin in the treatment of condylomata acuminata. Dermatology 2006; 213:218.
- Syed TA, Lundin S, Ahmad SA. Topical 0.3% and 0.5% podophyllotoxin cream for self-treatment of condylomata acuminata in women. A placebo-controlled, double-blind study. Dermatology 1994; 189:142.
- Hellberg D, Svarrer T, Nilsson S, Valentin J. Self-treatment of female external genital warts with 0.5% podophyllotoxin cream (Condyline) vs weekly applications of 20% podophyllin solution. Int J STD AIDS 1995; 6:257.
- Tuncel A, Görgü M, Ayhan M, et al. Treatment of anogenital warts by pulsed dye laser. Dermatol Surg 2002; 28:350.
- Cohler M, Schaffer JV. Successful treatment of massive anogenital warts in a two-year-old boy with imiquimod and cimetidine immunotherapy. Pediatr Infect Dis J 2009; 28:1141.
- Franco I. Oral cimetidine for the management of genital and perigenital warts in children. J Urol 2000; 164:1074.
- Lee SH, McGregor DH, Kuziez MN. Malignant transformation of perianal condyloma acuminatum: a case report with review of the literature. Dis Colon Rectum 1981; 24:462.
- Ejeckam GC, Idikio HA, Nayak V, Gardiner JP. Malignant transformation in an anal condyloma acuminatum. Can J Surg 1983; 26:170.
- CLINICAL MANIFESTATIONS
- CLINICAL COURSE
- DIAGNOSIS AND EVALUATION
- Assessment for sexual abuse
- DIFFERENTIAL DIAGNOSIS
- Therapeutic options
- - Imiquimod
- - Podophyllotoxin
- - Surgical and laser therapy
- - Other
- SUMMARY AND RECOMMENDATIONS