G86(P) Protocols for the management of anogenital warts in primary care

Abstract

Aims While sexual abuse needs to be considered in cases of anogenital warts (AGW) in children, Human Papilloma Virus (HPV) may be transmitted in other ways. The upper age limit of presentation with warts following perinatal infection is uncertain and accepted to extend into early childhood, with older children being more likely to acquire warts by sexual transmission. Autoinoculation is also possible. To our knowledge there are no protocols routinely used for management of AGW in children in Primary Care. We conducted a survey to see if children with AGW were being assessed in the context of their age and family/social history. Method Surveys were distributed to GP Safeguarding Children’s Leads asking: how many children had been seen with AGW in their practice in the last two years; whether they had a policy within their practice regarding AGW; whether they would be more or less concerned about AGW based on the child’s age/social history. Finally, participants were asked to rate their response (from strongly disagree to strongly agree) to the statement ‘all children presenting with AGW should be referred to Social Care’. Results 20 responses: 80% said no children with AGW had been seen in the past two years 85% did not have a policy pertaining to AGW; none had a written policy None stated they would be ‘less concerned’ by AGW in a child 45% said they would be less concerned if a parent/sibling had finger warts 45% said they would be less concerned about AGW in a teenager but would want to know if consensually sexually active 60% agreed/strongly agreed with the statement that ‘all children presenting with AGW should be referred to Social Care’. Conclusion The presence of AGW raises the possibility of sexual abuse, but is not diagnostic. GPs had little experience of AGW in children and none had a written management policy. GPs were just as concerned by AGW in children above or below 2 years, age not influencing their decision to refer to child protection services. These results will be used to inform content of GP teaching sessions and protocol development.