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Implication of human papillomavirus (HPV) infection in the paediatric population
  1. Daniel Guerendiain1,
  2. Kirsten Healy2,
  3. Ingolfur Johannessen1,3,
  4. Kate Cuschieri1
  1. 1Scottish Human Papillomavirus Reference Laboratory, Royal Infirmary of Edinburgh NHS Lothian, Edinburgh, UK
  2. 2Paediatrics, NHS Fife, Kirkcaldy, UK
  3. 3Division of Laboratory Medicine, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
  1. Correspondence to Mr Daniel Guerendiain, Scottish Human Papillomavirus Reference Laboratory, Division of Laboratory Medicine, Microbiology Department, Royal Infirmary of Edinburgh, NHS Lothian, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK; daniel.guerendiain{at}nhslothian.scot.nhs.uk

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Key messages

  • While genital human papillomavirus (HPV) infection is often acquired through intimate sexual contact, other non-sexual transmission routes are possible including autoinoculation.

  • Comprehensive evaluation of every case of anogenital warts in a child is necessary to determine if child sexual abuse (CSA) may have occurred.

  • Molecular HPV genotyping is not currently informative for determining/confirming whether CSA has occurred.

Why undertake this review?

At the Scottish Human Papillomavirus Reference Laboratory we deliver human papillomavirus (HPV) testing for epidemiological, clinical and research workstreams. We also serve as a hub for enquiries relating to HPV, HPV testing and the consequences of infection. Enquiries are varied but have included those around the detection and implications of HPV infection in childhood and the rationale/justification for HPV testing in cases of suspected child sexual abuse (CSA). Given these enquiries, the sensitive nature of the issues and the associated legal implications, we took the opportunity to review the evidence on the origins and implications of HPV infection in children and to highlight any key knowledge gaps. To this end we provide a summary document that will hopefully be of use to clinicians.

How can children acquire HPV?

HPV is a common epitheliotropic virus that can be transmitted via skin-to-skin contact. One of the more common clinical manifestations of anogenital HPV infection is genital warts, which has a peak prevalence in young adults aged 20–25 years.1 However, anogenital warts can also arise in children, which raises questions and concerns around potential sexual abuse.

As genital HPV infection is often …

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