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What can cause genital warts in young children?
I’m looking for information about genital warts in children. My friend’s 4-year-old daughter was diagnosed with genital warts on her thighs and buttocks. The pediatrician brought up the possibility of sexual abuse. The parents don’t have any evidence of this, but the wart coincided with their daughter starting preschool. One day, the girl came home with different underwear provided by the school because she wet her pants. Could the underpants have transmitted the warts? The doctor gave them a cream to put on the warts but they are not going away and one is growing like cauliflower. Should the warts be removed? Should the mother be worried about getting warts on her hands when she applies the cream to her daughter? They also have three other young children who share the same bathroom...can genital warts spread to the other children via the toilet seat or towels? Any information you can provide would be very helpful!
Ruthann M. Cunningham, MD on September 20, 2011
Thank you for your excellent questions about a very sensitive issue. I’ll do my best to help.
Sadly, the pediatrician was right to bring up the possibility of sexual abuse. Genital warts are caused by specific types of human papillomavirus (HPV). In adults, the virus is most often passed through sexual contact. In kids, the story is different...and the research is still inconclusive.
Most research indicates that if a child develops genital warts before the age of two, she probably got the disease from her mother ⎼ possibly during childbirth. If the child develops the disease when she’s a little older, there is a possibility she got the disease from a different source including sexual abuse...but also including other possibilities that researchers are still learning about. In any case, I strongly encourage the child’s parents to talk to a professional who can examine their daughter and, if necessary, help her talk about any trauma she may have experienced.
Regarding your other questions, it’s unlikely that the HPV that causes genital warts can be passed on underwear, toilet seats, or towels. Some research suggests that HPV might be transferred via “fomites” (a contaminated object, including clothing)...but the chances of that are low. However, mom and dad should watch their daughter and her siblings to make sure she doesn’t touch her genital warts and then touch her siblings...doing so could spread the disease.
Also, mom doesn’t need to worry too much about getting warts on her hands when she applies the treatment cream. The strains of HPV that cause genital warts generally won’t infect hands or other areas of the body. However, there’s always a small chance so if she wishes, she can take the precaution of wearing a latex glove when she applies the cream; she should also wash her hands thoroughly after applying the cream.
In terms of the treatment and removal of the warts, a cauliflower-like wart doesn’t mean that the wart needs to be removed immediately. I recommend that the family talk to their doctor about treatment options...if the warts aren’t causing the girl discomfort, then the cream is a good first step. If the warts are making the girl uncomfortable, then the warts can be surgically removed. You can learn more about HPV treatment, risks and prevention in our HPV Overview.
Thanks again for you questions. I’m sure this must be a confusing time for your friend’s family. I wish them all the best in treating their daughter’s physical, and perhaps emotional, conditions.
Dr. Cunningham is a member of the Analyte Physicans Group. She's also a member of the American College of Emergency Physicians, practicing at both Northwestern Lake Forest Hospital in Illinois and at Wheaton Franciscan All Saints Medical Center in Wisconsin. An ER physician since 2000, she regularly treats patients with STDs. Dr. Cunningham was educated at Wayne State University School of Medicine and completed her Emergency Medicine residency at Cook County Hospital in Chicago, IL.