Article Text

How to manage warts
  1. C J HOBBS,
  2. J WYNNE
  1. Department of Community Paediatrics
  2. Belmont House, Clarendon Wing
  3. Leeds General Infirmary, Leeds LS2 9NJ, UK

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    Editor,—We wish to enlarge on the association between anogenital warts (AGW) and child sexual abuse, which Verbov alluded to in his paper on the management of warts.1 The population prevalence of AGW is not known, and in adults the warts are transmitted predominately through sexual intercourse after an incubation period of several months.2 How often child sexual abuse is found in children with AGW depends on how thoroughly they and their families are investigated,2 3 and figures quoted range from 31–63%. In a Leeds study of child sexual abuse the prevalence of AGW was 1.5% and the prevalence of sexually transmitted disease (STD) was 2.7%.4 A similar UK study found no AGW but a prevalence of STD of 3.7%.5

    Current literature suggests that:

    • AGW in adults are predominately sexually transmitted, the incubation period is several months

    • the virus (human papillomavirus) may be transmitted in utero or during birth and may not be manifest until the child is 2 years old (but all children who have warts require investigation for other STD and the possibility of child sexual abuse).2 6

    Suggested investigations and management include:

    • a paediatric assessment

    • behavioural indicators

    • tests for other STD in the child and carers

    • typing of warts is expensive and may be misleading as non-genital wart types may be sexually transmitted—for example, digital and genital wart types transmitted in utero

    • a social worker with or without police investigation

    • follow up appointments for adolescents are recommended, joint clinics with genitourinary physicians are ideal5

    • follow up of prepubescent children is more difficult and currently we refer back to the general practitioner for assessment, possibly at the first family planning clinic

    • locally, treatment of AGW is surgical.

    Early recognition of AGW as a marker for child sexual abuse may allow early cessation of the abuse, giving the child an improved chance of developing into a mature adult with the ability to form lasting relationships.