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:
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- 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