Clinical cases
WAYS OF TRANSMISSION OF ANOGENITAL HPV INFECTION IN CHILDREN

Human papillomavirus (HPV) is a pathogen commonly associated with a variety of mucocutaneous infections: oral, respiratory, conjunctival and ano-genitourinary.


The incidence of infection in the genital and perigenital areas in children is much lower than in adults, and is most commonly caused by the serotypes HPV 6 and 11. Although it was considered that HPV sub-classification in skin and mucosal types identifies the specific topography of lesions, recent studies have shown HPV types in various locations, in both children and adults. Given the theoretically long latency period of the virus (from 3 weeks to 8 months), it is difficult to identify the modality of infection, as there are multiple possible routes of transmission: vertical (perinatal), self- or heteroinoculation.
Diagnosis of condyloma acuminatum in a child must exclude a possible sexual abuse every time.


We show the cases of four children who came for the occurrence of soft, non-keratotic papules, some looking like a cauliflower, localized in the genital, perigenital and perianal areas. The general and local clinical examination revealed no direct or indirect signs of sexual abuse, the usual tests were within normal limits and we did not identify other sexually transmitted infections.


A combined treatment was administered: cryotherapy with liquid nitrogen (-196°C) or podophyllotoxin (sol. 0.5%) in association with systemic immunomodulatory therapy with Isoprinosine 50 mg/kg/day given the extent of lesions and high risk of relapse.

The age of these patients was another challenge. Checks conducted periodically over 12 months revealed no relapse or the appearance of new lesions in the genital or perigenital areas. A long-term follow is recommended for these children/patients, even if there are no studies to clarify their risk of developing carcinoma as adults.