Human papilloma virus (HPV) infection in children and adolescents

  • Ioannis N. Mammas
  • George Sourvinos
  • Demetrios A. Spandidos


Human papilloma viruses (HPV) are common pathogens associated with a wide range of cutaneous and mucosal infections in childhood. Different HPV types can cause common warts, genital warts, low-grade as well as high-grade squamous intraepithelial lesions. Anogenital warts represent an issue with legal and clinical implications and evaluation of children for the possibility of sexual abuse should be considered in all cases. Recurrent respiratory papillomatosis has also been associated with HPV infection in a variety of studies. The recently introduced HPV vaccination is expected to prevent HPV-related cervical cancer in adulthood; however, HPV infection will continue to affect children.


HPV infection Children Warts Recurrent papillomatosis Cervical neoplasia HPV vaccine 



human papilloma virus


squamous intraepithelial lesion


recurrent respiratory papillomatosis


  1. 1.
    Allen AL, Siegfried EC (1998) The natural history of condyloma in children. J Am Acad Dermatol 39:951–955. doi:10.1016/S0190-9622(98)70268-3 PubMedCrossRefGoogle Scholar
  2. 2.
    American Academy of Pediatrics (1995) Recommendations for preventive pediatric health care. Pediatrics 96:712Google Scholar
  3. 3.
    Antonsson A, Karanfilovska S, Lindqvist PG, Hansson BG (2003) General acquisition of human papillomavirus infections of skin occurs in early infancy. J Clin Microbiol 41:2509–2514. doi:10.1128/JCM.41.6.2509-2514.2003 PubMedCrossRefGoogle Scholar
  4. 4.
    Armstrong DK, Handley JM (1997) Anogenital warts in prepubertal children: pathogenesis, HPV typing and management. Int J STD AIDS 8:78–81. doi:10.1258/0956462971919598 PubMedCrossRefGoogle Scholar
  5. 5.
    Bacelieri R, Johnson SM (2005) Cutaneous warts: an evidence-based approach to therapy. Am Fam Physician 72:647–652PubMedGoogle Scholar
  6. 6.
    Barr E, Tamms G (2007) Quadrivalent human papillomavirus vaccine. Clin Infect Dis 45:609–607. doi:10.1086/520654 PubMedCrossRefGoogle Scholar
  7. 7.
    Bosch FX, Munoz N (2002) The viral etiology of cervical cancer. Virus Res 89:183–190. doi:10.1016/S0168-1702(02)00187-9 PubMedCrossRefGoogle Scholar
  8. 8.
    Cason J, Mant C (2005) High-risk mucosal human papillomavirus infections during infancy & childhood. J Clin Virol 32:S52–S58. doi:10.1016/j.jcv.2004.12.007 PubMedCrossRefGoogle Scholar
  9. 9.
    Chen R, Sehr P, Waterboer T et al (2005) Presence of DNA of human papillomavirus 16 but no other types in tumor-free tonsillar tissue. J Clin Microbiol 43:1408–1410. doi:10.1128/JCM.43.3.1408-1410.2005 PubMedCrossRefGoogle Scholar
  10. 10.
    Chen SL, Tsao YP, Lee JW et al (1993) Characterization and analysis of human papillomaviruses of skin warts. Arch Dermatol Res 285:460–465. doi:10.1007/BF00376818 PubMedCrossRefGoogle Scholar
  11. 11.
    Clifford GM, Smith JS, Plummer M et al (2003) Human papillomavirus types in invasive cervical cancer worldwide: a meta-analysis. Br J Cancer 88:63–73. doi:10.1038/sj.bjc.6600688 PubMedCrossRefGoogle Scholar
  12. 12.
    Cohen BA (1997) Warts and children: can they be separated. Contemp Pediatr 14:128–149Google Scholar
  13. 13.
    Committee on Infectious Diseases (2007) Prevention of human papillomavirus infection: provisional recommendations for immunization of girls and women with quatrivalent human papillomavirus vaccine. Paediatrics 120:666–668. doi:10.1542/peds.2007-1735 CrossRefGoogle Scholar
  14. 14.
    de Jesus LE, Cirne Neto OL, Monteiro do Nascimento LM et al (2001) Anogenital warts in children: sexual abuse or unintentional contamination. Cad Saude Publica 7:1383–1391Google Scholar
  15. 15.
    Derkay CS, Wiatrak B (2008) Recurrent respiratory papillomatosis: a review. Laryngoscope 118:1236–1247PubMedGoogle Scholar
  16. 16.
    Farrell RM, Rome ES (2007) Adolescents’ access and consent to the human papillomavirus vaccine: a critical aspect for immunization success. Pediatrics 120:434–437. doi:10.1542/peds.2006-1692 PubMedCrossRefGoogle Scholar
  17. 17.
    Freed GL, Derkay CS (2006) Prevention of recurrent respiratory papillomatosis: role of HPV vaccination. Int J Pediatr Otorhinolaryngol 70:1799–1803. doi:10.1016/j.ijporl.2006.06.006 PubMedCrossRefGoogle Scholar
  18. 18.
    Gerein V, Schmandt S, Babkina N et al (2007) Human papilloma virus (HPV)-associated gynecological alteration in mothers of children with recurrent respiratory papillomatosis during long-term observation. Cancer Detect Prev 31:276–281. doi:10.1016/j.cdp.2007.07.004 PubMedCrossRefGoogle Scholar
  19. 19.
    Hartley C, Hamilton J, Birzgalis AR, Farrington WT (1994) Recurrent respiratory papillomatosis—the Manchester experience, 1974–1992. J Laryngol Otol 108:226–229PubMedGoogle Scholar
  20. 20.
    Hawkes M, Campisi P, Zafar R et al (2008) Time course of juvenile onset recurrent respiratory papillomatosis caused by human papillomavirus. Pediatr Infect Dis J 27:149–154PubMedCrossRefGoogle Scholar
  21. 21.
    Hazard K, Karlsson A, Andersson K et al (2007) Cutaneous Human papillomaviruses persist on healthy skin. J Invest Dermatol 127:116–119. doi:10.1038/sj.jid.5700570 PubMedCrossRefGoogle Scholar
  22. 22.
    Hernandez PA, Gorlin RJ, Lukens JN et al (2003) Mutations in the chemokine receptor gene CXCR4 are associated with WHIM syndrome, a combined immunodeficiency disease. Nat Genet 34:70–74. doi:10.1038/ng1149 PubMedCrossRefGoogle Scholar
  23. 23.
    Hornor G (2004) Ano-genital warts in children: sexual abuse or not. J Pediatr Health Care 18:165–170PubMedGoogle Scholar
  24. 24.
    Jayasinghe Y, Garland SM (2006) Genital warts in children: what do they mean. Arch Dis Child 91:696–700. doi:10.1136/adc.2005.092080 PubMedCrossRefGoogle Scholar
  25. 25.
    Jones V, Smith SJ, Omar HA (2007) Nonsexual transmission of anogenital warts in children: a retrospective analysis. ScientificWorldJournal 7:1896–1899PubMedGoogle Scholar
  26. 26.
    Koch A, Hansen SV, Nielsen NM et al (1997) HPV detection in children prior to sexual debut. Int J Cancer 73:621–624. doi:10.1002/(SICI)1097-0215(19971127)73:5<621::AID-IJC1>3.0.CO;2-Z PubMedCrossRefGoogle Scholar
  27. 27.
    Kojima A, Maeda H, Kurahashi N et al (2003) Human papillomaviruses in the normal oral cavity of children in Japan. Oral Oncol 39:821–828. doi:10.1016/S1368-8375(03)00100-3 PubMedCrossRefGoogle Scholar
  28. 28.
    Majewski S, Jablonska S (1995) Epidermodysplasia verruciformis as a model of human papillomavirus induced genetic cancer of the skin. Arch Dermatol 131:1312–1318. doi:10.1001/archderm.131.11.1312 PubMedCrossRefGoogle Scholar
  29. 29.
    Maloney EM, Unger ER, Tucker RA et al (2006) Longitudinal measures of human papillomavirus 6 and 11 viral loads and antibody response in children with recurrent respiratory papillomatosis. Arch Otolaryngol Head Neck Surg 132:711–715. doi:10.1001/archotol.132.7.711 PubMedCrossRefGoogle Scholar
  30. 30.
    Mammas I, Sourvinos G, Michael C, Spandidos DA (2006) Human papilloma virus in hyperplastic tonsillar and adenoid tissues in children. Pediatr Infect Dis J 25:1158–1162. doi:10.1097/01.inf.0000245094.15643.8c PubMedCrossRefGoogle Scholar
  31. 31.
    Mammas I, Sourvinos G, Michael C, Spandidos DA (2008a) ‘High-risk’ human papilloma viruses (HPVs) were not detected in the benign skin lesions of a small number of children. Acta Paediatr 97:1669–1671PubMedCrossRefGoogle Scholar
  32. 32.
    Mammas I, Sourvinos G, Giannoudis A, Spandidos DA (2008b) Human papilloma virus (HPV) and host cellular interactions. Pathol Oncol Res; Epub ahead of printGoogle Scholar
  33. 33.
    Mant C, Kell B, Rice P et al (2003) Buccal exposure to human papillomavirus type 16 is a common yet transitory event of childhood. J Med Virol 71:593–598. doi:10.1002/jmv.10529 PubMedCrossRefGoogle Scholar
  34. 34.
    Marcoux D, Nadeau K, McCuaig C et al (2006) Pediatric anogenital warts: a 7-year review of children referred to a tertiary-care hospital in Montreal, Canada. Pediatr Dermatol 23:199–207. doi:10.1111/j.1525-1470.2006.00218.x PubMedCrossRefGoogle Scholar
  35. 35.
    Moscicki AB (1996) Genital HPV infections in children and adolescents. Obstet Gynecol Clin North Am 23:675–697PubMedGoogle Scholar
  36. 36.
    Mount S, Papillo J (1999) A study of 10 296 pediatric and adolescent Papanicolaou smear diagnoses in Northern New England. Pediatrics 103:539–545. doi:10.1542/peds.103.3.539 PubMedCrossRefGoogle Scholar
  37. 37.
    Munoz N, Bosch FX, de Sanjose S et al (2003) Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med 348:518–527. doi:10.1056/NEJMoa021641 PubMedCrossRefGoogle Scholar
  38. 38.
    Myhre AK, Dalen A, Berntzen K, Bratlid D (2003) Anogenital human papillomavirus in non-abused preschool children. Acta Paediatr 92:1445–1452. doi:10.1080/08035250310007015 PubMedCrossRefGoogle Scholar
  39. 39.
    Obalek S, Misiewicz J, Jablonska S et al (1993) Chilhood condyloma acuminatum: association with genital and cutaneous human papillomaviruses. Pediatr Dermatol 10:101–106. doi:10.1111/j.1525-1470.1993.tb00031.x PubMedCrossRefGoogle Scholar
  40. 40.
    Padel AF, Venning VA, Evans MF et al (1990) Human papillomaviruses in anogenital warts in children: typing by in situ hydridisation. BMJ 300:1491–1494PubMedGoogle Scholar
  41. 41.
    Peto J, Gilham C, Deacon J et al (2004) Cervical HPV infection and neoplasia in a large population-based prospective study: the Manchester cohort. Br J Cancer 91:942–953PubMedGoogle Scholar
  42. 42.
    Plasencia JM (2000) Cutaneous warts: diagnosis and treatment. Prim Care 27:423–434. doi:10.1016/S0095-4543(05)70204-9 PubMedGoogle Scholar
  43. 43.
    Poro AM, Alchorne MM, Mota GR et al (2003) Detection and typing of human papillomavirus in cutaneous warts of patients infected with human immunodeficiency virus type 1. Br J Dermatol 149:1192–1199. doi:10.1111/j.1365-2133.2003.05650.x CrossRefGoogle Scholar
  44. 44.
    Powell J, Strauss S, Gray J, Wojnarowska F (2003) Genital carriage of human papilloma virus (HPV) DNA in prepubertal girls with and without vulval disease. Pediatr Dermatol 20:191–194. doi:10.1046/j.1525-1470.2003.20301.x PubMedCrossRefGoogle Scholar
  45. 45.
    Raffle AE (2007) Challenges of implementing human papillomavirus (HPV) vaccination policy. BMJ 335:375–377. doi:10.1136/bmj.39273.458322.BE PubMedCrossRefGoogle Scholar
  46. 46.
    Rice PS, Mant C, Cason J et al (2000) High prevalence of human papillomavirus type 16 infection in children. J Med Virol 61:70–75. doi:10.1002/(SICI)1096-9071(200005)61:1<70::AID-JMV11>3.0.CO;2-Y PubMedCrossRefGoogle Scholar
  47. 47.
    Rimell FL, Shoemaker DL, Pou AM et al (1997) Pediatric respiratory papillomatosis: prognostic role of viral typing and cofactors. Laryngoscope 107:915–918. doi:10.1097/00005537-199707000-00015 PubMedCrossRefGoogle Scholar
  48. 48.
    Rintana M, Grenman S, Jarvenkyla ME et al (2005) High-risk types of human papillomavirus (HPV) DNA in oral and genital mucosa of infants during their first 3 years of life: experience from the Finnish HPV Family Study. Clin Infect Dis 41:1728–1733. doi:10.1086/498114 CrossRefGoogle Scholar
  49. 49.
    Robinson AJ, Watkeys JE (1999) Genital warts in children: problems of management. J Clin Forensic Med 6:151–155. doi:10.1016/S1353-1131(99)90062-7 PubMedCrossRefGoogle Scholar
  50. 50.
    Sanclemente G, Gill DK (2002) Human papillomavirus molecular biology and pathogenesis. J Eur Acad Dermatol Venereol 16:231–240. doi:10.1046/j.1473-2165.2002.00419.x PubMedCrossRefGoogle Scholar
  51. 51.
    Sharma G, DeHart J, Nuovo GJ (2005) Correlation of histology, human papillomavirus, and viral load in laryngeal papillomas of childhood. Diagn Mol Pathol 14:230–236. doi:10.1097/ PubMedCrossRefGoogle Scholar
  52. 52.
    Shehata B, Otto K, Sobol S et al (2008) E6 and E7 oncogene expression by human papilloma virus (HPV) and the aggressive behavior of recurrent laryngeal papillomatosis (RLP). Pediatr Dev Pathol 11(2):118–121PubMedCrossRefGoogle Scholar
  53. 53.
    Sidbury R (2004) What’s new in pediatric dermatology: update for the pediatrician. Curr Opin Pediatr 16:410–414. doi:10.1097/01.mop.0000133081.24760.08 PubMedCrossRefGoogle Scholar
  54. 54.
    Sinal SH, Woods CR (2005) Human papillomavirus infections of the genital and respiratory tracts in young children. Semin Pediatr Infect Dis 16:306–316. doi:10.1053/j.spid.2005.06.010 PubMedCrossRefGoogle Scholar
  55. 55.
    Sinclair KA, Woods CR, Kirse DJ, Sinal SH (2005) Anogenital and respiratory tract human papillomavirus infections among children: age, gender, and potential transmission through sexual abuse. Pediatrics 116:815–825. doi:10.1542/peds.2005-0652 PubMedCrossRefGoogle Scholar
  56. 56.
    Smith EM, Swarnavel S, Ritchie JM et al (2007) Prevalence of human papillomavirus in the oral cavity/oropharynx in a large population of children and adolescents. Pediatr Infect Dis J 26:836–840. doi:10.1097/INF.0b013e318124a4ae PubMedCrossRefGoogle Scholar
  57. 57.
    Smolinski KN, Yan AC (2005) How and when to treat molluscum contagiosum and warts in children. Pediatr Ann 34:211–221PubMedGoogle Scholar
  58. 58.
    Steben M, Duarte-Franco E (2007) Human papillomavirus infection: epidemiology and pathophysiology. Gynecol Oncol 107:S2–S5. doi:10.1016/j.ygyno.2007.07.067 PubMedCrossRefGoogle Scholar
  59. 59.
    Sterling JC, Handfield-Lones S, Hudson PM (2001) Guidelines for the management of cutaneous warts. Br J Dermatol 144:4–11. doi:10.1046/j.1365-2133.2001.04066.x PubMedCrossRefGoogle Scholar
  60. 60.
    Stevens-Simon C, Nelligan D, Breese P et al (2000) The prevalence of genital human papillomavirus infections in abused and nonabused preadolescents girls. Pediatrics 106:645–649. doi:10.1542/peds.106.4.645 PubMedCrossRefGoogle Scholar
  61. 61.
    Summergill KF, Smith EM, Levy BT et al (2001) Human papillomavirus in the oral cavities of children and adolescents. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 91:62–69. doi:10.1067/moe.2001.108797 CrossRefGoogle Scholar
  62. 62.
    Swygart C (1997) Human papillomavirus: disease and laboratory diagnosis. Br J Biomed Sci 54:299–303PubMedGoogle Scholar
  63. 63.
    Syrjanen S (2004) HPV infections and tonsillar carcinoma. J Clin Pathol 57:449–455. doi:10.1136/jcp.2003.008656 PubMedCrossRefGoogle Scholar
  64. 64.
    Syrjanen S, Puranen M (2002) Human papillomavirus infections in children: the potential role of maternal transmission. Crit Rev Oral Biol Med 11:259–274CrossRefGoogle Scholar
  65. 65.
    Tasca RA, Clarke RW (2006) Recurrent respiratory papillomatosis. Arch Dis Child 91:689–691. doi:10.1136/adc.2005.090514 PubMedCrossRefGoogle Scholar
  66. 66.
    Tasca RA, McCormick M, Clarke RW (2006) British Association of Paediatric Otorhinolaryngology members experience with recurrent respiratory papillomatosis. Int J Pediatr Otorhinolaryngol 70:1183–1187. doi:10.1016/j.ijporl.2005.12.003 PubMedCrossRefGoogle Scholar
  67. 67.
    The FUTURE II Study Group (2007) Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med 356:1915–1926. doi:10.1056/NEJMoa061741 CrossRefGoogle Scholar
  68. 68.
    Wiatrak B (2003) Overview of recurrent respiratory papillomatosis. Curr Opin Otolaryngol Head Neck Surg 11:433–441. doi:10.1097/00020840-200312000-00005 PubMedCrossRefGoogle Scholar
  69. 69.
    Zacharisen MC, Conley SF (2006) Recurrent respiratory papillomatosis in children: mansquerader of common respiratory diseases. Pediatrics 118:1925–1931. doi:10.1542/peds.2006-1555 PubMedCrossRefGoogle Scholar
  70. 70.
    zur Hausen H (2002) Papillomaviruses and cancer: from basic studies to clinical application. Nat Rev Cancer 2:342–350. doi:10.1038/nrc798 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Ioannis N. Mammas
    • 1
  • George Sourvinos
    • 1
  • Demetrios A. Spandidos
    • 1
  1. 1.Department of Virology, School of MedicineUniversity of CreteCreteGreece

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