Pediatric anogenital warts: A multicenter retrospective study of clinical features, modes of transmission, and treatment patterns

Abstract Anogenital warts are benign HPV-related lesions that are uncommon in children, with controversial modes of transmission and limited evidence regarding their management. We conducted a multicenter retrospective study of 63 children diagnosed with anogenital warts across 14 French hospital dermatology departments to describe their clinical characteristics, presumed modes of transmission, and treatment patterns. Anogenital warts predominantly affected young girls (43 girls [68.3%], median age at diagnosis: 4.0 years) and the perianal area; no cases of sexual abuse were identified, while hetero-inoculation was considered the most likely mode of transmission in nearly half of evaluable cases. Imiquimod was the most frequently prescribed first-line treatment (45/63, 71.4%), with a median treatment duration of 8 weeks; among 45 evaluable children, 22 (48.9%) achieved complete clearance within 8 weeks. As second-line treatment, podophyllotoxin was the most frequently prescribed therapy (n = 6), followed by imiquimod (n = 4) and cryotherapy (n = 2). Overall, treatments were well tolerated, with no serious adverse events reported. Among the 45 children who received imiquimod with evaluable safety data, local adverse events occurred in 21 (46.7%). The frequent off-label use of imiquimod underscores the need for dedicated pediatric studies and evidence-based treatment recommendations.

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Publication Details

Journal
Research Square
Published
2026-11-01
DOI
https://doi.org/10.21203/rs.3.rs-11242588/v1
Primary Topic
Cervical Cancer and HPV Research
Type
preprint
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preprint

Pediatric anogenital warts: A multicenter retrospective study of clinical features, modes of transmission, and treatment patterns

S. Mallet, Emmanuel Mahé, C. Chiavérini, Laura Poujade et al.
Research Square
Cervical Cancer and HPV Research
preprint

Pediatric anogenital warts: A multicenter retrospective study of clinical features, modes of transmission, and treatment patterns

S. Mallet, Emmanuel Mahé, C. Chiavérini, Laura Poujade, Thomas Hubiche, Alice Phan, Marie Bachelerie, Valentine Heidelberger, Jasmine Flament, Eve Puzenat, Maella Severino‐Freire, A. Maruani, M. Steff, Juliette Miquel, I. Kupfer‐Bessaguet, Christine Labrèze, Ruxanda Moschoi, Patricia Le Nouail, Simon Benkimoun, Malorie Veyrieres, Marie Chinazzo
preprint en

Abstract

Abstract Anogenital warts are benign HPV-related lesions that are uncommon in children, with controversial modes of transmission and limited evidence regarding their management. We conducted a multicenter retrospective study of 63 children diagnosed with anogenital warts across 14 French hospital dermatology departments to describe their clinical characteristics, presumed modes of transmission, and treatment patterns. Anogenital warts predominantly affected young girls (43 girls [68.3%], median age at diagnosis: 4.0 years) and the perianal area; no cases of sexual abuse were identified, while hetero-inoculation was considered the most likely mode of transmission in nearly half of evaluable cases. Imiquimod was the most frequently prescribed first-line treatment (45/63, 71.4%), with a median treatment duration of 8 weeks; among 45 evaluable children, 22 (48.9%) achieved complete clearance within 8 weeks. As second-line treatment, podophyllotoxin was the most frequently prescribed therapy (n = 6), followed by imiquimod (n = 4) and cryotherapy (n = 2). Overall, treatments were well tolerated, with no serious adverse events reported. Among the 45 children who received imiquimod with evaluable safety data, local adverse events occurred in 21 (46.7%). The frequent off-label use of imiquimod underscores the need for dedicated pediatric studies and evidence-based treatment recommendations.

Research Square
Centre Hospitalier Universitaire de Bordeaux (FR), Centre Hospitalier Universitaire de Nice (FR), Centre Hospitalier Universitaire de Toulouse (FR), Hôpital Femme Mère Enfant (FR), Assistance Publique Hôpitaux de Marseille (FR), Centre Hospitalier Universitaire de La Réunion (RE), Centre Hospitalier Universitaire de Besançon (FR), Centre Hospitalier Universitaire de Tours (FR), Centre Hospitalier Universitaire de Clermont-Ferrand (FR), Centre Hospitalier Victor Dupouy (FR), Centre hospitalier Robert-Ballanger (FR), Centre Hospitalier Universitaire de Rouen (FR), Hôpital de la Timone (FR)
Good health and well-being
Cervical Cancer and HPV Research
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