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© 2007 American Public Health Association
DOI: 10.2105/AJPH.2007.119594
LETTER |
Susan B. Brogly is with the Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Mass. Eduardo L. Franco is with the Department of Epidemiology and Biostatistics, and the Department of Oncology, McGill University, Montreal, Quebec. D. Heather Watts is with the Pediatric, Adolescent, and Maternal AIDS Branch, National Institute of Child Health and Development, Rockville, Md. Russell Van Dyke is with the Department of Pediatrics, Tulane University Health Science Center, New Orleans, La.
Correspondence: Requests for reprints should be sent to Susan B. Brogly, Harvard School of Public Health, 651 Huntington Ave, FXB-607, Boston, MA 02115-6017 (sbrogly{at}sdac.harvard.edu).
We would like to thank Woo and Sterling1 for their suggestion of alternative or complementary modes of transmission for the genital condylomata that we observed in young girls enrolled in the Pediatric AIDS Clinical Trials Group protocol 219C who had been perinatally infected with human immunodeficiency virus.2 We speculated that these cases of genital condylomata might have occurred through perinatal transmission of the human papilloma virus (HPV), transmission of HPV through sexual activity, or through sexual abuse, the latter of which was identified as the likely cause of HPV infection in 31% of 55 children following a retrospective review of clinical data.3 We did not discuss the possibility of nonsexual, postnatal transmission of HPV as raised by Woo and Sterling. Indeed, close nonsexual contact and self-inoculation are possible modes of HPV transmission, and should have been included.
Unfortunately, HPV typing was not collected in protocol 219C, and we were unable to include these findings as discussed in our paper.2 However, we were able to correlate the presence of genital condylomata at a young age with the occurrence of abnormal cervical cytology during adolescence. A total of 4 of 23 girls with genital condylomata documented before 13 years of age had subsequent cervical Papanicolaou smears recorded in protocol 219C. All 4 of these girls had abnormal cervical cytology, 3 had low-grade squamous intraepithelial lesions, and 1 had abnormal cells of undetermined significance.
The multiple potential modes of HPV transmission and frequency of childhood genital condylomata cases documented in this and other studies3,4 underscore the need for additional research in this area.
Accepted for publication June 8, 2007.
References
1. Woo YL, Sterling JC. Reproductive health of adolescent girls perinatally infected with HIV. Am J Public Health. 2007;97:1929–1930.
2. Brogly SB, Watts H, Ylitalo N, et al. Reproductive health of perinatally HIV-infected adolescent girls. Am J Public Health. 2007;97:1047–1052.
3. Sinclair KA, Woods CR, Kirse DJ, Sinal SH. Anogenital and respiratory tract human papillomavirus infections among children: age, gender, and potential transmission through sexual abuse. Pediatrics. 2005; 116:815–825.
4. Marcoux D, Nadeau K, McCuaig C, Powell J, Oligny LL. Pediatric anogenital warts: a 7-year review of children referred to a tertiary-care hospital in Montreal, Canada. Pediatr Dermatol. 2006;23:199–207.[CrossRef][Web of Science][Medline]
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