Brenner Children's Hospital pediatrician says one symptom no longer a clear sign of child abuse

October 03, 2005

WINSTON-SALEM, N.C. - Children who come to a pediatrician's office with genital or anal warts may not be the victims of child abuse as once thought, according to pediatricians at Brenner Children's Hospital, part of Wake Forest University Baptist Medical Center.

Most pediatricians have been trained to call social services if they discover a child with genital or anal warts to report a possible allegation that child abuse may have taken place. However, new research published in the October issue of Pediatrics, shows that this symptom alone may not indicate that a child has been abused.

"We have seen over the past few years an increase in the number of Human papillomavirus (HPV) cases (the virus which causes anal and genital warts) in adults and in children," said Sara Sinal, M.D., a pediatrician at Brenner Children's Hospital and expert in child abuse cases. "However, we were seeing younger children with this virus and many times had no other signs that abuse was taking place. These children seemed different in many ways from the children we were seeing for suspected sexual abuse who did not have warts."

Sinal and her colleagues also noticed that a child would often go to an ear, nose and throat physician to be treated for oral or laryngeal warts (warts found in the mouth or throat), however the physician treating the child never suspected or reported child abuse.

"This is the same virus in a different location in the body and child abuse was never considered," Sinal said. "It made us look at these anal and genital warts so we could determine whether a child could contract the diseases from nonsexual contact. We did not want to call social services to report a child if there was no suspicion of abuse. Having been involved in many child abuse reports, I know how traumatic a report can be for a family."

HPV is a virus which can affect mucous membranes, causing warts to grow in the anal, genital, oral cavities or respiratory locations of the body. It is the most common sexually-transmitted disease in North America. However, it can be spread from mother to child in the birth canal. A person can get warts in their mouth and throat after having oral sex with someone who is infected. It is possible that warts can be transmitted by contact with a hand or contaminated object. The virus can lay dormant for many months and perhaps years before warts appear and some infected patients have no symptoms. Since the virus is a sexually-transmitted disease, many pediatricians often suspect sexual abuse when a child has symptoms.

"We are not ruling child abuse out as a possible cause for the infection in children under the age of four," Sinal said. "Every child with warts needs a thorough evaluation for possible abuse. However, when there are no other signs a child is being abused, we no longer feel it is necessary to report the family to the department of social services for suspected abuse. We are encouraging our colleagues to keep an open mind when they discover HPV in a child."

Treatment for HPV can take months and require surgery. Despite treatment, the warts often reoccur, Sinal said.

"There is a vaccine that is being developed to prevent this virus," Sinal said. "Once it is approved then many of these cases can be prevented."
Sinal and her colleagues analyzed 124 children over an 18-year period and compared them to children who were known to have suffered abuse for the study. Sinal worked with the following specialists at Brenner Children's Hospital to complete the research: Charles Woods, M.D., an infectious disease specialist; Dan Kirse, M.D., a pediatric otolaryngologist; and Kelly Sinclair, M.D., a former pediatric resident at Brenner Children's Hospital.

Media Contacts: Rae Bush,, or Ann Hopkins,, at 336-716-4587.

Wake Forest University Baptist Medical Center is an academic health system comprised of North Carolina Baptist Hospital, Wake Forest University Health Sciences and Brenner Children's Hospital. The system comprises 1,187 acute care, rehabilitation, psychiatry and long-term care beds and is consistently ranked as one of "America's Best Hospitals" by U.S. News & World Report. Brenner Children's was named one of the top children's hospitals in the nation by Child magazine.

Wake Forest Baptist Medical Center

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