Anogenital Warts in Children Always Means Sexual Abuse?

Previously healthy 8-year-old female patient with multiple anogenital lesions with “cauliflower appearance”, which were increasing in size, and causing some pain (Figure 1). After assessment, the diagnosis of condyloma acuminatum was made and treatment with imiquimod was started. The child lived with her mother and older sister, and neither of them had condylomatosis. Facing the positivity of HPV infection, analytical study to exclude other sexually transmitted diseases was made (negative). Psychologic and forensic evaluation concluded that the child was stable at a behavioral and emotional level, with no signs of sexual abuse. Due to persistence of lesions under imiquimod, cryotherapy was started with a subsequent improvement (Figure 2).