Genital HPV infections in children and adolescents

Major differences in estrogen and progesterone levels and in vaginal/cervical cell types exist among children, adolescents, and adults, which may help explain the observed differences in the prevalence of HPV among these groups. Although sexual transmission occurs in both children and adolescents, the persistence of genital HPV in the neonate from maternal transmission is highly questionable. The discordances in HPV types between neonatal transmission studies and the studies in older children have yet to be explained. Neonatal infections seem to be predominantly types 16 and 18 and persist for short periods in the genital area. The majority of condylomatous lesions in children are HPV types 6 and 11. Acquisition of HPV during childhood and adolescence is not an immediate cause of severe morbidity. However, significant evidence suggests that early exposure not only hastens the development of anogenital cancers but may also increase the actual risk of cancer. Future studies should include large-scale longitudinal designs to test and follow neonates with careful attention to sexual abuse issues during the prospective period so that we may confidently diagnose and appropriately treat children with HPV infections. The role of age and immunity remains confusing, supporting the need for studies to examine cervical immunity more closely.