Sexually transmitted diseases in sexually abused children.

Over a 4-year period, 409 cases of suspected sexual abuse of children were reviewed to study sexually transmitted disease (STD). Sexually transmitted disease was identified in 54 (13%) of the 409 children: 46 cases of gonorrhea, six cases of syphilis, four cases of trichomoniasis, and three cases of condyloma acuminata. Nine of the 46 children with cultures positive for gonorrhea did not have a history of discharge. Four of the six children with syphilis also had a gonococcal infection. One child with syphilis had condyloma. Only one child had clinical features of syphilis. Sexually transmitted disease was more likely to be transmitted by an extended family member or a nonfamily member than by a father/stepfather (P less than .001). Laboratory tests that identify sexually transmitted disease may aid in the diagnosis of sexual abuse.

Nonsexual transmission of sexually transmitted diseases: an infrequent occurrence.

Sexually transmitted diseases occur in epidemic numbers in the United States today. Nonsexual transmission of these diseases is rarely an issue in adults. However, when the same diseases are found in children, the tendency of pediatricians and other health care practitioners has been to believe the mode of transmission is asexual. A review of gonorrhea, Chlamydia trachomatis, herpes genitalis, condyloma acuminata, Trichomonas vaginalis, syphilis, chancroid, and granuloma inguinale infections has been made to address the issue of nonsexual transmission of sexually transmitted diseases. Nonsexual transmission of these infections is an infrequent occurrence and when they affect the prepubertal child, sexual abuse must be highly suspected.

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.

Evaluation of male consorts of women with genital human papilloma virus infection.

Ninety male partners of women with genital condylomata were evaluated for evidence of condylomata by visual examination of the genitalia with the colposcope, urethroscopy, and biopsy. Fifty-three men (59%) were found initially to have condylomata and nine other cases were found on reevaluation for a total prevalence of 69%. Thorough evaluation with the use of acetic acid, magnification and liberal use of biopsy is stressed. Urethroscopy may not be a necessary part of the routine screening evaluation.

Cervical papillomavirus infection and intraepithelial neoplasia: a study of male sexual partners.

The male sexual partners of 34 women with cervical condyloma or cervical intraepithelial neoplasia (CIN) were examined for penile condylomata and/or urinary tract lesions. External lesions were detected in 18 (53%) of the male consorts of women with cervical lesions including 14 of 22 whose consorts had cervical condyloma or low grade CIN, one of six whose consorts had CIN 2, and three of six whose consorts had CIN 3. The majority of lesions were present either on the glands or the penile shaft, and one patient had a lesion in the urethral meatus. The urinary cytology specimens from the men with and without penile lesions contained nonspecific abnormalities consisting of squamous metaplasia with mild degrees of cytologic atypia. Koilocytotic atypia characteristic of condyloma was not found except in cases with documented distal urethral condylomata. Hence, at present the diagnosis of human papillomavirus infection in the man is best made by careful clinical examination. Whether or not papillomavirus resides deep in the urinary tract of these patients remains to be determined.

Magnified penile surface scanning in diagnosis of penile condyloma.

To determine the incidence of penile condyloma in a group of high risk males, we have performed magnified penile surface scanning and biopsy of suspicious lesions in 51 men. All men were partners of women with proven condyloma. Of these men, 45 were found to have histologic evidence of condyloma, only 8 of which were grossly visible.

Genital tract papillomavirus infection in children.

Genital tract papillomas in five children were examined for the presence of human papillomavirus (HPV) DNA by molecular hybridization. Papillomavirus DNA was detected in each sample and was identified as HPV-6 (three cases), HPV-6 or HPV-11 (one case), or HPV-16 (one case). These viruses are the same as are responsible for genital papillomas (condylomata) of adults. The transmission of adult genital tract viruses to children occurs primarily by a venereal route but may occur by a nonvenereal route.

Enteric diseases of homosexual men.

Certain enteric ailments are particularly common among homosexual men. They are primarily infectious diseases and include not only such common venereal diseases as gonorrhea and syphilis but also infections not usually regarded as being sexually transmitted. Among the latter are shigellosis, salmonellosis, giardiasis, and amebiasis. Patients' symptoms are non-specific and seldom helpful in diagnosing particular diseases. The practitioner must be prepared to identify a number of infections with similar presentations that may occur singly or together in gay men. Gonorrhea is probably the most common bacterial infection in gay men. Carriage rates as high as 50% have been reported, and extra-genital carriage is common; this necessitates culturing the urethra, rectum, and pharynx. Procaine penicillin G is the treatment of choice for most patients; spectinomycin is probably the drug of choice in penicillin-sensitive patients. In contrast to other venereal diseases, syphilis may have a characteristic protoscopic presentation. Benzathine penicillin G is the treatment of choice for most patients. Lymphogranuloma venereum causes penile lesions and inguinal lymphadenitis in heterosexual men, whereas homosexual men are more prone to proctitis. The disease may mimic Crohn's disease. Recommended treatment includes tetracycline or sulfamethoxazole-trimethoprim. Shigellosis usually presents as an acute diarrheal illness. Patients generally require only supportive treatment with fluids. Herpes simplex viral infection is difficult to diagnose and has several different presentations, including lumbosacral radiculomyelopathy. Symptomatic treatment with sitz baths, anesthetic ointment, and analgesics is recommended. Venereal warts are believed to be caused by the same virus that causes verrucous warts; they are usually found in the anal canal or around the anal orifice. They are commonly treated with 25% podophyllin solution. Parasitic infections include giardiasis, amebiasis, and pinworm infections. Metronidazole may be used in the treatment of symptomatic giardiasis and amebiasis, but it is not approved for the former indication; quinacrine is approved for giardiasis. Pinworm infestation may be treated with pyrantel pamoate or mebendazole. Cure of enteric diseases in homosexual men must be documented.

Condyloma acuminata in children.

Condyloma Acuminata (venereal warts) are sexually transmitted involving the human papilloma virus. It has become commoner in adults in the last decade. While infection is most often by sexual intercourse, it can be transmitted at birth and with close contact with infected individuals. It is common in marked sexual promiscuity. Condyloma acuminata in children should alert the physician to the possibility of sexual abuse or early sexual activity. We report 14 cases of condyloma acuminata in children; from 6 months to 17 years. Sex incidence was equal. All had social and family problems in common, except for one who developed perianal condyloma after repeated rectal dilatations because of a pull through procedure for Hirschsprung's Disease. Two cases of sexual abuse were documented. Treatment methods included podophyllin, liquid nitrogen, 5 fluorouracil cream, fulguration and laser therapy. An adequate social history was available only in six cases. Investigations should include VDRL and cultures for Gonococcus, careful medical and social history for neglect or abuse.

Analysis of plume emissions after papovavirus irradiation with the carbon dioxide laser.

This study was undertaken to evaluate potential inhalation hazards to operating room personnel after irradiation of tumors with the carbon dioxide laser. Cellular debris was analyzed for viability using labeled nucleotides and labeled glucose. In this way the plume was investigated for the presence of material with oncogenic potential. Most surgeons who have ablated venereal warts or certain tumors with the carbon dioxide laser have worried about possible hazards of inhaling the vapor that is produced as a result of their work. We utilized three methods to determine whether viable particles exist in the laser plume. Fortunately, it is most comforting that the metabolic studies, DNA and RNA studies and cytologic studies seem to indicate that the plume is biologically inactive.

Warts--a clinical's view.

We do have more modalities for treating warts than ever before, but the very plurality of approaches bespeaks the fact that no single method is adequate. We await the development of a safe and effective wart vaccine with keen anticipation.

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.

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.

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!

[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.