Condylomata acuminata in children and sexual abuse.

Sir, The paper by Baruah et al on condylomata acuminata in a male child gives a misleading impression of the occurrence and transmission of venereal warts in childhood.1 Reports may be difficult to find because of the diversity of specialties to which such children may be referred, such as dermatology, paediatrics, and infectious diseases, but reports do exist. Several reports had been published before 1983, including four since 1976, in which sexual abuse was recognised as the cause of condylomata acuminata.2-5 Histological confirmation was specifically mentioned by Mininberg and Rudick4 and DeJong et al.5 These studies reported on a total of 12 children, eight of whom had been sexually abused. Five of the 12 were boys, of whom two had urethral condylomata acuminata and three had perianal lesions. More recently, White et al reported three cases of condylomata acuminata in boys aged two, 10, and 12, all of whom were victims of sexual abuse.6 Since 1979 four girls, aged 2, 4, 5, and 7 have presented at our clinic with condylomata acuminata, all of whom were found to have been sexually abused. With the possible exception of young infants, the presence of condylomata acuminata in a prepubertal child should be considered to be an indication of sexual abuse until proved otherwise. Parental denial of abuse in no way rules it out. The probability of obtaining an accurate history depends a great deal on the skill and techniques of the interviewer and subsequent investigation by the social services. The best efforts may not obtain a history of abuse, even when it is highly suspected. Young boys are not exempt from sexual abuse. About 20/o of our sexually abused children were boys. Our youngest such patient was a six month old male infant who sustained severe rectal and anal tears from sexual abuse. We have found that the perpetrators are almost always known to the children. In our population about 80% of the abusers have been the child's father, stepfather, or a boyfriend living with a woman relative. It must be recognised that sexually transmitted diseases of adults are sexually transmitted in children as well. To fail to make this diagnosis leaves children open to further abuse. Yours faithfully, Marcia Herman-Giddens Child Protection Team, Department of Pediatrics, Box 2998 Durham University Medical Center, Durham, North Carolina 27710, USA