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Human Papillomaviruses

PEDIATRICS Vol. 106 No. 4 October 2000, pp. 645-649

The Prevalence of Genital Human Papillomavirus Infections in Abused and Nonabused Preadolescent Girls

Received Jul 26, 1999; accepted Jan 3, 2000.

Catherine Stevens-Simon*, Donna Nelligan*, Paula Breese, Carole Jenny§, and John M. Douglas Jr.parallel

From the * Department of Pediatrics, University of Colorado Health Sciences Center, Denver, Colorado; Dagger  Denver Department of Public Health, University of Colorado Health Sciences Center, Denver, Colorado; § Department of Pediatrics, Director, Child Protection Program, Brown University School of Medicine, Providence, Rhode Island; and parallel  Department of Medicine, Denver Department of Public Health, University of Colorado Health Sciences Center, Denver, Colorado.

Objective.  To compare the prevalence of genital human papillomavirus (HPV) infections in sexually abused and nonabused preadolescent girls and assess the feasibility of conducting a longitudinal study of the natural history of HPV infection in this population.

Method.  Consecutively referred, 5- to 12-year-old girls who were evaluated for sexual abuse by a Child Advocacy and Protection Team were invited to participate in the study. During a standard forensic medical examination, 2 specimens for HPV testing were obtained (one by rubbing a Dacron swab over the perineum and the other by lavaging the vagina with phosphate-buffered saline). The specimens were evaluated for HPV DNA by polymerase chain reaction using MY09/11 consensus primers and high-risk (16,18,31,33,35,39,45,51,52, 56,58) and low-risk (6,11,42,43,44) types were detected with a solution hybridization assay, the SHARP Signal System (Digene Diagnostics). The genital area was examined for warts and subclinical, colposcopic evidence of HPV. Participants were invited to return for longitudinal evaluation at 4-month intervals for 2 years.

Results.  Sexual abuse was confirmed in 29 (72.5%) of the 40 study participants, suspected in 2 (5%), and ruled out in 9 (22.5%). None of the girls had genital warts or abnormal colposcopic findings. HPV DNA was detected in 5 (16%) of the 31 girls with confirmed or suspected sexual abuse (1 with high-risk and 4 with low-risk types) and none of the nonabused girls (Fisher's exact test). Girls who tested positive and negative for HPV did not differ significantly in age or type of abuse. Despite close telephone follow-up and numerous attempts to schedule appointments, none of the participants returned for follow-up.

Conclusions.  Genital HPV infection is more common among sexually abused than nonsexually abused girls, with the majority of infections not clinically apparent. Because it is so difficult to study the natural history of these infections in abused children, it may be necessary to draw inferences about the long-term sequelae of pediatric HPV infections from longitudinal studies of girls who voluntarily initiate sexual activity soon after menarche.  Key words:  human papillomavirus, sexual abuse, colposcopy.




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