Evaluation of sexually abused and nonabused young girls for intravaginal human papillomavirus infection
L. T. Gutman, K. St Claire, M. E. Herman-Giddens, W. W. Johnston and W. C. Phelps
Department of Pediatrics, Duke University Medical Center, Durham, NC 27710.
OBJECTIVE--The objective of this study was to compare the prevalence of
intravaginal human papillomavirus-associated disease in two groups of girls
to develop information regarding the means of transmission of anal-genital
human papillomavirus disease. DESIGN--A pair of parallel studies of
prevalence of human papillomavirus infections in two populations of
prospectively enrolled girls. PATIENTS--Index patients consisted of 15
consecutive girls aged 11 years or younger who were confirmed to have been
sexually abused, had signs or symptoms of vaginal disease, and required
generalized anesthesia for evaluation. Selection of nonabused control
patients was based on negative findings from screening evaluations and
physical examinations. MAIN OUTCOME MEASURES--Prevalences of
cervical-vaginal human papillomavirus infections in the two populations
were compared. Vaginal wash samples from index and control patients were
assayed for human papillomavirus 1, 2, 4, 6, 11, and 16 by reverse-blot and
Southern transfer hybridization methods. Papanicolaou smears were examined
from index patients. RESULTS--Vaginal wash samples from five (33%) of 15
index patients were positive for human papillomavirus 6, 11, or 16,
compared with none of 17 controls. The presence or absence of external
anal-genital warts was not correlated with results from the assay of
intravaginal samples. Blinded readings of vaginal exfoliative cytologic
findings of the index patients showed koilocytosis, atypia, or inflammatory
reactions in four of five human papillomavirus-positive girls, and normal
cytologic findings in one human papillomavirus-positive girl.
CONCLUSION--These findings support other studies that indicate that sexual
contact is a major route in the transmission of anal-genital human
papillomavirus-related disease in children. Evaluation of intravaginal
specimens was required to identify human papillomavirus-infected girls
since the results of the wash samples were not correlated with the presence
or absence of external anal-genital warts.
