Anogenital Warts in Children-Reply

In Reply.—  The primary goal in reporting our experience with anogenital warts in children was to change the way in which practitioners approach these patients and their families. Until recently, the presence of warts in the anogenital area of prepubertal children was a sine qua non of sexual abuse.¹ This assumption was based on anecdotal reports and a few small series. Our data and that of Obalek et al² support the nonsexual transmission of anogenital human papillomavirus (HPV) infection in children.² Moreover, both series suggest that nonsexual transmission may be the most common source of these lesions.Children in our study were categorized as unequivocably abused when the perpetrators were identified. These cases were usually referred to us directly from social services. Most patients, however, were identified for study when anogenital warts were noted incidentally on a routine primary care examination or on a visit to the