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Evaluation of Sexually Abused and Nonabused Young Girls for Intravaginal Human Papillomavirus Infection
Laura T. Gutman, MD;
Karen St. Claire, MD;
Marcia E. Herman-Giddens, PA, MPH;
William W. Johnston, MD;
William C. Phelps, PhD
Am J Dis Child. 1992;146(6):694-699.
Abstract
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• 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 prevalences 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.
(AJDC. 1992;146:694-699)
Author Affiliations
From the Departments of Pediatrics (Drs Gutman and St. Claire and Ms Herman-Giddens) and Pathology (Dr Johnston), Duke University Medical Center, Durham, NC, and the Burroughs-Wellcome Research Laboratories, Research Triangle Park, NC (Drs Gutman and Phelps).
Footnotes
Accepted for publication March 25, 1992.
Presented in part at the 1991 Papillomavirus Workshop, Seattle, Wash, July 23,1991, and at the joint plenary session for the 31st Interscience Conference on Antimicrobial Agents and Chemotherapy and the Infectious Diseases Society of America, Chicago, Ill, September 30, 1991.
Reprint requests to Box 3971, Duke University Medical Center, Durham, NC 27710 (Dr Gutman).
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