[Venereal diseases in children and sexual abuse]. / Veneriske sygdomme hos børn og seksuelt misbrug.

Sexual abuse in children is reported increasingly frequently. The abuse frequently comes to the attention of the authorities when the children present symptoms which raise the suspicion of sexual abuse. One of these symptoms may be sexually transmitted disease in the child. Previously, there was a tendency to accept the possibility that sexually transmitted disease in children could be transmitted by other means than sexual contact, eg indirectly by infected bedclothes and toilet articles. Where gonorrhoea is concerned, no documentation exists in the literature for non-sexual infection in children. Condylomata acuminata are caused by infection with the human papilloma virus and may possibly infect children by non-sexual contact in rare instances but, in the majority of cases, meticulous investigation of the surroundings of the children will raise the suspicion of sexual abuse as the cause of the infection. The case history of gonococcal vulvo-vaginitis in a girl aged 23 months were the source of infection could not be successfully proved is mentioned. Two case histories are reported concerning anal condylomata acuminata in a girl aged nine years who had been sexually abused and a girl aged 25 months where there was a strong suspicion of sexual abuse but where the source of infection remained unknown. On the basis of literature from recent years and the case histories reported here, it is concluded that all gonococcal infections in children must be regarded as being sexually transmitted and these should, therefore, be reported to the social authorities. In addition, all children with ano-genital condylomata acuminata should be investigated meticulously for sexual abuse and be reported to the social authorities, if the suspicion is well founded.

Human papillomavirus infection: a potentially carcinogenic sexually transmitted disease (condylomata acuminata, genital warts).

Human papillomavirus is a sexually transmitted virus that has been associated with intraepithelial neoplasia. The incidence and prevalence of the disease has risen dramatically, to epidemic proportions, within the last two decades. Risk factors for HPV are similar to those for intraepithelial neoplasia: early onset of sexual activity, multiple sexual partners, high-risk sexual practices, and poor hygiene. Health care workers need to screen all patients for HPV through the use of a comprehensive history, including sexual history, a thorough physical examination, and appropriate laboratory methods. Pregnant women must be thoroughly screened because they are at increased risk for HPV, plus there has been an association between genital warts at the time of delivery and subsequent laryngeal papillomas in their infants. Treatment is aimed at the elimination of the lesions. Although in some cases lesions spontaneously resolve without treatment, in other cases there is a significant incidence of recurrence, even with treatment. Cell-mediated immunity seems to play a role in recurrence and regression as well as transformation to atypical cells. Transformation of HPV to neoplasia also seems to be related to co-factors that act synergistically in the oncogenic process. Public education, identification of high risk groups, and prevention are mandatory if the spread of HPV is to be contained. Equally essential is to remain cognizant of the fact that HPV is an STD with potentially carcinogenic properties; thus, screening and treatment of sexual partners are mandatory!

A solitary cauliflower-like nodule on the mucosal surface of the lower lip.

The incidence of oral condylomata acuminata and simultaneous genital condylomata is not known. A review of the literature implies that the disease is rare, but it is more likely that it is only rarely reported. As the virus is autoinoculable and transmissible, the etiologic factor in this case of oral condylomata acuminatum is most likely orogenital contact. This case report serves as a reminder also that oroanogenital contact expands the anatomic range of sexually transmitted diseases.

Value of acetic acid screening for flat genital condylomata in men.

Application of acetic acid solution to the genital skin followed by magnified examination permits the detection of grossly inapparent flat condylomata acuminata. To evaluate the accuracy of this screening method, the male sexual partners of 36 women with genital condylomata were examined by this method and biopsies were obtained when results were positive. Of 47 biopsies of acetowhite (the whitish change that occurs when an epithelial surface is stained with acetic acid) lesions there were 26 cases of histologically confirmed condylomata, 9 of koilocytotic atypia and 12 with false positive results. There were 25 men whose sexual partners had cervical condylomata and cervical dysplasia. In this subgroup, considered to be at higher risk for flat condylomata, the screening method revealed 15 cases of condylomata, 6 of koilocytotic atypia and 4 in which no changes by acetic acid could be found. The extensive involvement of genital skin with flat condylomata in this subgroup raises doubts as to the practicality of treatment. Nevertheless, before treatment is rendered a punch biopsy for confirmation of the screening test is advised.

[Condyloma acuminatum in children]. / Condiloma acuminado en niños.

A retrospective study of eleven children affected of condyloma acuminatum is presented. Authors evaluated: age of presentation and consulting, sex, social history, predisposing factors, characteristic and extension of disease, previous venereal diseases, microscopic pathology, treatment and follow up. Age presentation ranged between 1.5 months and 14 years old. Two were male and nine were female. In two cases obvious sexual abuse was demonstrated; close contact without sexual goals in four; in two transmission during labor existed; early sexual activity in one and they didn't evidence mechanism of transmission in two. Predisposing factors include social problems, lack of hygiene, promiscuity, diabetes, ammoniacal erythema and others. Culture was positive for gonococcus in two children. VDRL test was negative in all cases. All of them were treated with 5% 5-fluorouracil cream. Recovery oscillated between seven and twenty-one days, without adverse reactions, except reddening of adjacent skin.

Papillomavirus. Effects upon mother and child.

Papillomaviruses are widespread, sexually transmitted agents with an increasing prevalence. They are associated with a significant risk of genital carcinoma in infected women. Because they can be transmitted to the fetus before or during birth, they are also a risk to the infant born to an infected woman. Laryngeal HPV infections, while presumably much less prevalent than genital tract infections, are associated with a high degree of morbidity and a significant degree of mortality when they cause laryngeal papillomas. Therefore, transmission of these viruses to the fetus is a major problem. Much more information regarding mode of transmission and possible cure for this infection is needed in order to reduce the risk of laryngeal papillomatosis in infants in the future.

Condiloma acuminado em crianças / Condyloma acuminata in children

No presente trabalho, é realizada uma revisäo da literatura sobre Condiloma Acuminado em crianças. A incidência da doença na infância vem aumentando. A transmissäo pode ocorrer durante o parto, por contato íntimo näo-sexual ou por contato sexual. Há grande associaçäo com maus tratos, podendo haver inclusive perigo de vida. O risco de abuso sexual chega a 25 a 50% dos casos de Condiloma Acuminado. O tratamento pode ser feito com podofilina, nitrogênio líquido, ácido tricloroacético e outros, sendo as recidivas freqüentes

Bowenoid papulosis and squamous cell carcinoma of the genitalia: suspected sexual transmission.

The human papillomavirus causes a variety of genital lesions: condyloma acuminatum, bowenoid papulosis (carcinoma in situ), and squamous cell carcinoma. Only condylomata have been documented to be sexually transmitted. We report clinical and histopathologic evidence of suspected female to male transmission of bowenoid papulosis to the penis from a woman with condylomata acuminata, squamous cell carcinoma in situ, and focally invasive squamous cell carcinoma of the vulva. These findings indicate a need for thorough clinical and histopathologic evaluation of any anogenital lesions resembling condylomata and occurring in sexual partners. Conservative yet thorough destruction of bowenoid papulosis and squamous cell carcinoma in situ appears to be the treatment of choice.

[Condylomata acuminata-associated STD infections of the urethra of the male. A comparative epidemiologic study]. / Condylomata-acuminata-assoziierte STD-Infektionen der Urethra des Mannes. Eine vergleichende epidemiologische Studie.

Urethral swabs from 322 men without urethritis, 73 of whom had venereal warts (condylomata acuminata, CA) and 249 who had none, were investigated between 1981 and 1984 by microscope and culture for the presence of Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma species, Trichomonas vaginalis, Garderella vaginalis, B streptococci, aerobic pathogenic bacteria and Candida species. The isolation frequencies in patients with and without CA were as follows: N. gonorrhoea: with CA 0%, without 0.4%; C. trachomatis: with CA 6%, without 4.4%; U. urealyticum in high CFU: with CA 15%, without 17.7%; Mycoplasma spp. in high CFU: with CA 6%, without 4%; T. vaginalis: with CA 0%, without 0.4%; G. vaginalis: with CA 4%, without 5%; B streptococci: with CA 4%, without 6%; Candida spp. only in low CFU: with CA 3%, without 2.4%.--The results indicate that as far as the isolation frequencies of sexually transmittable pathogens in the urethra are concerned, there are no significant differences between patients with CA and asymptomatic patients presenting to an STD department. However, N. gonorrhoeae was significantly less frequently isolated and C. trachomatis and U. urealyticum significantly more frequently isolated in our patients than has been reported in previous studies.