WINSTON-SALEM, N.C. -- Children who come to a pediatrician's officewith genital or anal warts may not be the victims of child abuse asonce thought, according to pediatricians at Brenner Children'sHospital, part of Wake Forest University Baptist Medical Center.
Most pediatricians have been trained to call social services if theydiscover a child with genital or anal warts to report a possibleallegation that child abuse may have taken place. However, new researchpublished in the October issue of Pediatrics, shows that this symptomalone may not indicate that a child has been abused.
"We have seen over the past few years an increase in the number ofHuman papillomavirus (HPV) cases (the virus which causes anal andgenital warts) in adults and in children," said Sara Sinal, M.D., apediatrician at Brenner Children's Hospital and expert in child abusecases. "However, we were seeing younger children with this virus andmany times had no other signs that abuse was taking place. Thesechildren seemed different in many ways from the children we were seeingfor suspected sexual abuse who did not have warts."
Sinal and her colleagues also noticed that a child would often go to anear, nose and throat physician to be treated for oral or laryngealwarts (warts found in the mouth or throat), however the physiciantreating the child never suspected or reported child abuse.
"This is the same virus in a different location in the body and childabuse was never considered," Sinal said. "It made us look at these analand genital warts so we could determine whether a child could contractthe diseases from nonsexual contact. We did not want to call socialservices to report a child if there was no suspicion of abuse. Havingbeen involved in many child abuse reports, I know how traumatic areport can be for a family."
HPV is a virus which can affect mucous membranes, causing warts to growin the anal, genital, oral cavities or respiratory locations of thebody. It is the most common sexually-transmitted disease in NorthAmerica. However, it can be spread from mother to child in the birthcanal. A person can get warts in their mouth and throat after havingoral sex with someone who is infected. It is possible that warts can betransmitted by contact with a hand or contaminated object. The viruscan lay dormant for many months and perhaps years before warts appearand some infected patients have no symptoms. Since the virus is asexually-transmitted disease, many pediatricians often suspect sexualabuse when a child has symptoms.
"We are not ruling child abuse out as a possible cause for theinfection in children under the age of four," Sinal said. "Every childwith warts needs a thorough evaluation for possible abuse. However,when there are no other signs a child is being abused, we no longerfeel it is necessary to report the family to the department of socialservices for suspected abuse. We are encouraging our colleagues to keepan open mind when they discover HPV in a child."
Treatment for HPV can take months and require surgery. Despite treatment, the warts often reoccur, Sinal said.
"There is a vaccine that is being developed to prevent this virus,"Sinal said. "Once it is approved then many of these cases can beprevented."
Sinal and her colleagues analyzed 124 children over an 18-year periodand compared them to children who were known to have suffered abuse forthe study. Sinal worked with the following specialists at BrennerChildren's Hospital to complete the research: Charles Woods, M.D., aninfectious disease specialist; Dan Kirse, M.D., a pediatricotolaryngologist; and Kelly Sinclair, M.D., a former pediatric residentat Brenner Children's Hospital.
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