Although the HPV-associated morbidities in children are less common than seen in adults, several morbidities are seen including recurrent laryngeal papillomatosis (RLP) and genital warts (GW). Perinatal transmission has been thought the primary mode of transmission for RLP and GW.
The literature was reviewed for HPV DNA detection and disease in children.
Rates of estimated transmission varied widely. The prevalence of oral HPV in neonate ranged from 1%-85%, however, the majority of studies show little correlation between the infant’s oral HPV type with the mother’s genital type. A recent meta-analysis showed that if the mother had genital HPV, the infant had a 33% increased chance of having oral HPV DNA detected. One study of parents and their neonate observed over a 3 year period a 42% cumulative detection rate of HPV DNA in oral samples and 36% in genital samples. These findings suggest that transmission may also occur between the parent and the infant during caretaking. In a relatively large study, there was a bimodal distribution for oral HPV with 2.5% of those <1 year having a positive test for HPV, 0.15% in the 1-4 year old children and 3.9% of 16-20 year olds. As in adults, source of sample is important in that tonsillar tissue is much more likely to yield a positive HPV test than buccal samples. Studies of foreskin showed higher rates than other anogenital sites. HIV infection as seen in adults may also be a risk for children but little is known about HPV in perinatally infected children (PHIV). A recent study of non-sexually active PHIV found oral HPV in 17% of girls and 4% of boys and genital HPV in 36% and 22%, respectively. GW and HPV DNA detection in children may also be a sign of sexual abuse. Older age of the child at diagnosis is highly correlated with increased risk of sexual abuse. One study showed that HPV DNA was detected from the genital area in 14-16% of those with proven sexual abuse vs 1.3% with no evidence of abuse. In this study 100% of those referred for GW were found to have evidence of sexual abuse.
Several organizations consider GW as evidence of possible sexual abuse if the child is older than 24 months of age when referral for evaluation is warranted. HPV DNA testing is not currently recommended in evaluation. However, organizations now recommend HPV vaccination at 9 years of age in those with a history of sexual abuse. Reasons include that children with a history of abuse are more likely to engage in consensual sexual activity at earlier ages and engage in high risk sexual and substance use behaviors. Early exposure to HPV increases their risk of developing anogenital cancers.