Condyloma acuminata in child end laser therapy: a case report
© Ferizi et al; licensee BioMed Central Ltd. 2009
Received: 13 October 2008
Accepted: 04 February 2009
Published: 04 February 2009
Condyloma acuminata are soft, skin colored, fleshy warts that are caused by the Human Papilloma Virus (HPV). The disease is highly contagious, can appear singly or in groups, small or large. The incubation period may be from 1–6 months. Although anogenital warts are considered to be sexually transmitted in adults, this may not be the case for children. Genital warts in children may result from several modes of transmission: from the maternal genital tract autoinoculation, from finger warts and nonsexual transmission from members/careers.
The presented case is a 13-month-old girl. She was hospitalized at the Clinic of Dermatovenerology in 2001 due to papillomatosis changes on the genital area. The changes had started to appear in the sixth month of life, light purple in color, smooth and combined in a tumorous mass, in the vulva and anal areas.
From this case we can come to the conclusion that condyloma acuminate are not only transmitted sexually but through nonsexual ways as well, such is this case, from the infected mother to the infant. Laser therapy is preferred when multiple warts are spread over a large area as though in our case.
Venereal warts are caused by the human papilloma virus (HPV) which is a small DNA virus that does not grow in tissue culture but can be identified by electron microscopy .
The incubation period may take from one to six months .
Although anogenital warts are considered to be sexually transmitted in adults, this may not be the case for children . Genital warts at children may result from several modes of transmission: from perinatal transmission of HPV, occurring in uteri and during passage of the neonate through an HPV-infected birth canal, from finger warts and nonsexual transmission from members/careers.
However, the possibility of sexual abuse must always be borne by mind .
The topical treatment of childhood condylomata acuminate includes the application of caustic or irritating agents, such as liquid nitrogen trichloroacetic acid or podophyllum resin. These agents poorly tolerated by a child who may require multiple applications. Vaporization of the warts with a carbon dioxide laser is the newest treatment method. The advantage of using the CO2 laser is the ability to treat a large area without causing a scar, stricture, or narrowing of the lumen. This method tends to eliminate the virus and promote rapid healing with very little scar formation.
The child had been born by vaginal delivery after full term normal pregnancy. From the mother's hetero-anamnesis we learned that the mother has had genital warts during her pregnancy, which have faded out right after the delivery, without previous therapy.
Serological tests for syphilis in the infant and her mother gave negative results.
Based on the heteroanamnesis from her mother, clinical presentation, laboratory and serological tests for syphilis we made a final diagnosis of condylomata acuminate. After general anesthesia our patient is treated with a carbon dioxide laser. This method is well tolerated and promotes rapid healing with very little scar formation.
Sexually transmitted diseases affect the sexually active population being in the reproductive age group and usually are being transmitted in venereal form . Many researches report on big percentage of the infections with HPV at pregnant women .
Pregnant women infected with genital warts can pass them on to their newborns .
Generally, in children less than 2 years of age, the mode of transmission is vertical from mother to child during childbirth. There is an increasing prevalence of the genital warts in the first three months of the gravidity, which considerably decreases after delivery . Beside the mental-health problems caused by traumatic experiences in the childhood, the sexual abuse can have later influence on the children's growth and development that demands an early and continuous care . It is postulated that the incubation period may be markedly prolonged in cases where sexual abuse is not suspected or found . The increasing incidence of genital warts in adults that has been observed in recent years probably provides a widespread source of infection and results in an increase in the incidence of similar lesions in children. Treatments of genital warts in children have included topical sulfisoxazole, 5% ammoniated mercury ointment and fulguration, cryotherapy and immunotherapy with auto vaccines.
Laser therapy is preferred when multiple warts are spread over a large area, also useful for treating cervical and vaginal warts, when surgical excision is not possible or would be difficult . As malignant transformation of genital warts is known to occur, it is of the utmost importance that such lesions in children be treated promptly[11, 12].
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
YB, AK and ShD was involved in drafting the manuscript or revising it critically for important intellectual content.
- Oriel JD: Genital warts: Sex. Transmit Dis. 1977, 4: 153-159.View ArticleGoogle Scholar
- Turing S: Human papillomavirus infections: Epidemiology, pathogenesis and host immune response. J Am Acad Dermatology. 2000, 43 (S): 18-26. 10.1067/mjd.2000.107807.View ArticleGoogle Scholar
- Gibson PE, Gardner SD, Best SJ: Human papillomavirus types in anogenital warts of children. J Med Virol. 1990, 30 (2): 142-145.View ArticlePubMedGoogle Scholar
- Kemp CH: Sexual abuse, another hidden pediatric problem: The 1977 C Anderson Aldrich Lecture. Pediatrics. 1978, 62: 9-382.Google Scholar
- Baggish MS: Carbon dioxide laser treatment for condylomata acuminate Venereal Infections. Obstet Gynecol. 1980, 55 (6): 711-715.PubMedGoogle Scholar
- Meisels A: Cytologic diagnosis of human papillomavirus: Influence of age and pregnancy. Acta Cytol. 1992, 36 (4): 2-480.Google Scholar
- Shelton TB, Jerkins GR, Noe HN: Condylomata acuminata in the pediatric patient. J Urol. 1986, 135 (3): 9-548.Google Scholar
- Peng TC, Searle CP, Shah KV: Prevalence of human papillomavirus Infections in pregnancy. Am J Perinatol. 1990, 7 (2): 92-189. 10.1055/s-2007-999478.Google Scholar
- McCune KK, Horbach N, Dattel BJ: Incidence and clinical correlates of human papillomavirus disease in a pediatric population referred for evaluation of sexual abuse. J Pediatric Adolescent Gynecology. 1993, 6: 20-24.View ArticleGoogle Scholar
- Duus BR, Philipsen T, Christensen JD: Refractory condylomata acuminata: a controlled clinical trial of carbon dioxide laser versus conventional surgical treatment. Genitourin Med. 1985, 61 (1): 59-61.PubMed CentralPubMedGoogle Scholar
- Lee Sh, Mc Gregor DH, Kuzier MN: Malignant transformation of perianal condyloma acuminatum. Dis Colon Rectum. 1981, 24: 7-462. 10.1007/BF02626784.View ArticleGoogle Scholar
- Ejeckam GC, Idicio HA, Nayak V, Gardiner JP: Malignant transformation in anal condyloma acuminatum. Can J Surg. 1983, 26: 3-170.Google Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.