Anogenital human papillomavirus in non-abused preschool children

Aim: To estimate the prevalence of human papillomavirus in anogenital samples from children selected for non-abuse. Methods: A letter of invitation was sent to 2731 girls and 1042 boys, all of them five or six years old. Inclusion was based on self-selection, whereby parents who did not suspect any occurrence of sexual abuse of their child gave informed consent to participate. Several mechanisms were undertaken to exclude abused children. A complete examination was done of each child, including anogenital examination with a colposcope and microbiological sampling from the genitals and anus. The polymerase chain reaction with primers MY09 and MY11 was used to identify HPV, and sequencing was done on each positive amplicon. Results: PCR was performed on 325 adequate specimens from 211 children enrolled. Seven samples from 5 girls were HPV positive, making 2/161 (1,2%) of the anal and 5/164 (3,0%) of the genital specimens positive. None of the boys had HPV detected. In four girls strong associations with HPV6 genotypes were found, while one girl probably had a mixed infection with HPV 6 and 16. Three girls (1,8%) had clinically detectable anogenital warts. Conclusion: Since our results are comparable with a prevalence reported from allegedly abused children, and higher rates have been reported from the oral cavity in healthy children, we find detection of HPV unreliable as an indicator of sexual abuse in 5-6 year old children. The rate of anogenital warts found in our study is comparable with a rate reported in abused children.