Pediatric condyloma acuminata.

BACKGROUND: Condyloma acuminata are caused by human papilloma virus (HPV) 6 and 11 and most commonly present in the anogenital region. Most transmission among adults is via sexual transmission, but HPV and resulting anogenital warts in pediatric populations may be a result of perinatal vertical transmission, indirect transmission through contaminated objects or surfaces, autoinoculation, or sexual transmission.

CASE: A 9-year-old premenarchal female presented with multiple perianal warts. She had no significant medical history, and denied history of any sexual contact, including sexual abuse. The external examination revealed multiple warts in the perianal region, but no lesions, discharge, inflammation, or external signs of trauma were visible. Tests for sexually transmitted infections were all negative. The warts were diagnosed as condyloma acuminata, and were subsequently treated with trichloroacetic acid 80% (TCA) in the provider's office. TCA was applied on 3 separate occasions 2 weeks apart, showing marked improvement at each visit.

SUMMARY/DISCUSSION: While both sexual and nonsexual means of transmission are possible, sexual abuse must always be considered in pediatric cases. It is recommended that investigators proceed delicately, because the investigation can be psychologically damaging for patients and their families. Treatment methods are a unique consideration for pediatric patients, as most options are painful and require multiple office visits. The benefits of self-administration at home must be weighed with the likelihood of patient compliance and need for ongoing evaluation by the provider.