HPV in children may point to sexual abuse, or not

NEW YORK (Reuters Health) – HPV, the virus that causes
genital warts, is usually thought of as a sexually transmitted
disease, but it can also be spread in other ways. Therefore,
when a child is found to be infected, the possibility of sexual
abuse has to be considered.

Although most cases of HPV, or human papillomavirus, in
very young children are the result of non-sexual transmission,
a medical evaluation should be conducted, researchers say in
the medical journal Pediatrics.

There is disagreement regarding the origin of HPV in
children, senior investigator Dr. Sara H. Sinal told Reuters
Health.

So Sinal and her colleagues at Wake Forest University in
Winston-Salem, North Carolina, examined the records of children
younger than 13 years old who were found to have HPV infections
between 1985 and 2003, as well as records of 1565 children
younger than 13 years old who were examined in the child sex
abuse clinic between 1993 and 2002.

Dr. Sinal’s group identified 124 children with HPV. The
possibility of sexual abuse was considered in 71 (57 percent)
HPV cases, and 55 (44 percent) were referred to the child sex
abuse clinic for evaluation. Of these, 17 were considered
likely to have been sexually abused.

“I think that for every child who has HPV, even in the
larynx, you probably at least need to do some screening for sex
abuse,” Sinal said.

In her study, abused children were older than those who had
not been abused.

“If the child is under 4 years of age and there are no
other findings of abuse — parents aren’t suspicious, there are
no behaviors to suggest abuse, physical exam is normal, the
patient is negative for all other STDs — if all of that is
negative, then I’m not inclined to report them to social
services,” Sinal added.

It is possible that some cases are transmitted through the
birth canal or from warts on the parents’ hands, she noted.
“But the older they are, the more likely it is to have occurred
as a result of sexual abuse,” the researcher added.

“We also have to raise the sensitivity of parents to the
possibility” of sexual abuse, she added. “So we tell parents
that we see no evidence of sexual abuse now, but as the child
gets older if there are other symptoms or disclosure then we
need to re-evaluate that child.”

SOURCE: Pediatrics, October 2005.