Consultation with the Specialist

Abstract

1. Melanie A. Wellington, MD, PhD* 2. William Bonnez, MD† 1. *Assistant Professor of Pediatrics, Division of Infectious Diseases, University of Rochester School of Medicine & Dentistry, Rochester, NY 2. †Associate Professor of Medicine, Division of Infectious Diseases, University of Rochester School of Medicine & Dentistry, Rochester, NY After completing this article, readers should be able to: 1. Recognize the clinical syndrome of anogenital warts. 2. Describe how human papillomavirus (HPV) is transmitted in children. 3. Identify the risks associated with HPV infection in adolescents. 4. Review treatments for anogenital warts in children. Readers are used to the term “sexually transmitted disease” (STD). This article uses the term “sexually transmitted infection” (STI), which is becoming accepted more widely as appropriate usage. Not all sexually transmitted infections result in disease. -LFN A 22-month-old girl is brought to her pediatrician by her parents for “bumps” in her diaper area. They initially noted the lesions during a diaper change earlier in the week. The patient has not complained about the lesions, and her parents do not believe that they bother her. Physical examination reveals three perianal flesh-colored, hyperkeratotic papules, 3 to 6 mm in diameter, with the largest lesion being pedunculated. The patient attends a local accredited child care center and otherwise is cared for by her parents. Anogenital warts (also called venereal warts or condyloma acuminatum [plural: condyloma ta acuminat a ]) can be solitary or multiple and are exophytic, flesh- to gray-brown-colored papillomatous lesions that are hyperkeratotic on keratinized epithelia. They may be sessile or pedunculated and can range in size from several millimeters to many centimeters. In girls, they occur most often in the perianal area and the labia minorae, but can occur anywhere on the perineum. In boys, perianal warts are most common, but lesions may involve the penis. In adolescent women, the posterior introitus is the most common site; adolescent men typically have involvement of the penile shaft and preputial cavity (in uncircumcised patients). Occasionally, anogenital warts on keratinized skin may be pigmented. The likelihood of perianal lesions in sexually active adolescents varies with sexual practice. Anogenital warts usually are …