2025 Volume 61 Issue 2 Pages 214-220
Anogenital warts (AWs) are usually caused by mucosal human papillomavirus (HPV) types 6 and 11 infection and are described as a papule/crown-like wart at the perineum lesion known as a sexually transmitted infection (STI). In this report, we present a case of pediatric AWs that are unrelated to typical mucosal HPV infection. An 11-year-old girl visited us complaining that horn-shaped protrusions repeatedly appeared from the perineum, and the tip became keratinized and fell off naturally. A biopsy showed typical findings of HPV infection and a diagnosis of AWs. Topical imiquimod therapy was initiated but discontinued owing to the development of dermatitis. To rule out the possibility of sexual abuse, we decided to perform resection under general anesthesia. There were no lesions in the vagina or cervix, and the possibility of sexual contact was extremely low. PCR analysis for mucosal HPV including types 6 and 11 showed negative results. No recurrence was observed at six months postoperatively. In addition to vertical–horizontal infection and STIs, there are many iatrogenic and unknown infection routes in children, and cutaneous HPV, which causes vulgaris warts, can be detected. In pediatric cases, as it is not always an STI, we should be careful about estimating the route of infection. This patient was born by cesarean section, and the HPV test taken voluntarily by the parents showed negative results. The route of infection is still unknown, but cutaneous HPV infection should be considered in the case of AWs that are histologically shown to be an HPV infection but negative for mucosal HPV.
