The prevalence of genital human papillomavirus infections in abused and nonabused preadolescent girls

Objective. To compare the prevalence of genital human papillomavirus (HPV) infections in sexually abused and nonabused preadolescent girls and assess the feasibility of conducting a longitudinal study of the natural history o f HPV infection in this population. Method. Consecutively referred, 5- to 12-year-old girls who were evaluated for sexual abuse by a Child Advocacy and Protection Team were invited to pa rticipate in the study. During a standard forensic medical examination, 2 s pecimens for HPV testing were obtained (one by rubbing a Dacron swab over t he perineum and the other by lavaging the vagina with phosphate-buffered sa line). The specimens were evaluated for HPV DNA by polymerase chain reactio n using MY09/11 con sensus primers and high-risk (16,18,31,33,35,39,45,51,5 2, 56,58) and low-risk (6,11,42,43,44) types were detected with a solution hybridization assay, the SHARP Signal System (Digene Diagnostics). The geni tal area was examined for warts and subclinical, colposcopic evidence of HP V. Participants were invited to return for longitudinal evaluation at 4-mon th intervals for 2 years. Results. Sexual abuse was confirmed in 29 (72.5%) of the 40 study participa nts, suspected in 2 (5%), and ruled out in 9 (22.5%). None of the girls had genital warts or abnormal colposcopic findings. HPV DNA was detected in 5 (16%) of the 31 girls with confirmed or suspected sexual abuse (1 with high -risk and 4 with low-risk types) and none of the nonabused girls (Fisher's Exact test). Girls who tested positive and negative for HPV did not differ significantly in age or type of abuse. Despite close telephone follow-up an d numerous attempts to schedule appointments, none of the participants retu rned for follow-up. Conclusions. Genital HPV infection is more common among sexually abused tha n nonsexually abused girls, with the majority of infections not clinically apparent. Because it is so difficult to study the natural history of these infections in abused children, it may be necessary to draw inferences about the long-term sequelae of pediatric HPV infections from longitudinal studi es of girls who voluntarily initiate sexual activity soon after menarche.