Oral condyloma acuminatum in a child: case report.

Oral condyloma acuminatum is a viral-induced lesion and usually a manifestation of infectious venereal disease. It has been stated that venereal lesions in children are pathognomonic of sexual abuse. The literature is reviewed in relation to the etiology, diagnosis, clinical and histological features, and treatment of the lesion. The third case reported in the international literature is presented and discussed. Condyloma acuminatum is a viral-induced lesion which occurs primarily in the mucous membrane of the anal/genital regions of both males and females (Eller and Eller 1951). It is well established that a virus belonging to the papova group causes this growth as well as other warts which occur on the skin and mucosa (Lever 1975). The first to describe an oral condyloma acuminatum were Knapp and Uohara (1967). Since then a total of cases appeared in the international literature, 1 suggesting an increased incidence of this lesion in the oral cavity. However, only two of these reports referred to the incidence in children (Marquard and Racey 1981; Ashiru et al. 1983). Genital warts are thought to be one of the four most common sexually transmitted diseases, second only to genital herpes among the sexually transmitted viruses (Wright and Judson 1978). Oral lesions in children have been associated with preceding or coexisting genital lesions in affected individuals or with the presence of genital warts in their mothers during pregnancy. Autoinoculation from these lesions generally accounts for the intraoral lesions. However, the last report of Ashiru et al. (1983) showed neither skin or genital lesions nor a history of sexual contact, suggesting that a nonsexual mode of viral transmission is possible. *Anneroth et ai. 1982; Ashh’u et al. 1983; Choukas and Toto 1982; Danilov 1974; Doyle et al. 1968; Doran and Capper 1980; Judson 1981; McClotchey et al. 1979; Malic et al. 1983; Markelow 1971; Marquard and Racey 1981; Seibert et aL 1969; Shaffer et al. 1980; Summers and Booth 1974; Swan et al. 1981. Clinical Report A five-year-old white female, was brought to the emergency room of Children’s Hospital of Wisconsin (CHW) by her aunt for suspected sexual abuse. The initial physical examination did not indicate evidence of physical abuse. Six months later, the patient again was seen in the CHW emergency room for pain in the outer left ear. The ear was erythematous with a yellowish crust on the ear lobe. Examination also revealed a wart-like lesion inside the lower lip, 5 mm in diameter. The genitalia were normal. Vaginal cultures proved positive for Neisseria lactamina, N. rneningitidis, and N. Gonorrhoeae. A diagnosis of impetigo of left outer ear and gonorrhea was established. The patient was treated with antibiotics (Pen VK 250 mg/5 cc) and referred to the dermatology clinic for further treatment and to a child advocacy group for followup concerning suspected sexual abuse. The dermatology department physicians diagnosed two viral warts, 5 mm and 1 mm in diameter, respectively, that were treated with liquid nitrogen (cryosurgery). According to the child advocacy report, the parents denied the presence of similar lesions on themselves as well as the possibility of sexual abuse of the child. The social worker who interviewed the child was not able to elicit any information from her. Thirty-day follow-up in the dermatology clinic revealed one additional lesion adjacent to the previous lesions which had shown no improvement. No warts were present in the genitalia and new vaginal cultures were negative for gonorrhea. The Venereal Disease Research Lab (VDRL) test was also negative. The child was last seen in the outpatient medical clinic of CHW for impetigo on the nose, lip lesions, and pain in the lower right molar area. She was treated with antibiotics for the impetigo and referred to the dental clinic. 232 ORAL CONDYLOMA CUMINATUM: EMMANOUIL AND Post