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How to manage children with anogenital warts
  1. Margaret Kingston1,
  2. Denise Smurthwaite2,
  3. Sarah Dixon3,
  4. Catherine White4
  1. 1The Hathersage Integrated Contraception, Sexual Health & HIV Service, Manchester Royal Infirmary, Central Manchester Foundation Trust, Manchester, UK
  2. 2St Mary's Sexual Assault Referral Centre, Central Manchester Foundation Trust, Manchester, UK
  3. 3Paediatrics, Royal Manchester Children's Hospital, Central Manchester Foundation Trust, Manchester, UK
  4. 4St Mary's Sexual Assault Referral Centre, Central Manchester Foundation Trust, Manchester, UK
  1. Correspondence to Dr Margaret Kingston, Manchester Royal Infirmary, Central Manchester Foundation Trust, Manchester Centre for Sexual Health, The Hathersage Centre, Manchester M13 OFH, UK; margaret.kingston{at}

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Children found to have anogenital warts (AGW) are usually brought in the first instance to their general practitioners (GPs), who may assess and manage the children themselves or refer them onto a specialist from one of several disciplines including paediatricians, dermatologists, paediatric surgeons or genitourinary medicine (GUM) physicians. In addition, if child sexual abuse (CSA) is considered advice may be sought from a sexual assault referral centre (SARC), and if so referral to children's social care and police would be advised.

The authors have all been contacted for advice regarding the management of these children and we have noted:

  • Variable degrees of competence in the diagnosis of AGW.

  • Unfamiliarity with paediatric genital examination.

  • Unfamiliarity with the need to test for coexisting sexually transmitted infections (STIs) in children in whom CSA is suspected.

  • Lack of up-to-date knowledge regarding appropriate tests including those for other STIs.

  • Variable levels of concern about possible CSA and in some cases lack of awareness that this diagnosis requires consideration and what action is then required.

To streamline this process, provide a framework for safeguarding evaluation and to ensure that all children are appropriately assessed, we developed a clinical algorithm for clinicians in any field supported by an appendix on sampling for STI screening for those less familiar with this.


  1. We reviewed the relevant specialty guidance on the management of STIs in children from:

    1. The British Association for Sexual Health and HIV (BASHH)1

    2. The physical signs of CSA publication from the Royal College of Paediatric and Child Health2

  2. We canvassed the opinion of other doctors in our specialties of GUM, paediatrics and forensic medicine, including the lead authors of the BASHH guideline, by face-to-face meetings, email and telephone conversations.

  3. The initial draft of the clinical algorithm evolved empirically with …

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  • Handling editor Jackie A Cassell

  • Contributors All authors have given relevant advice and themselves managed children with anogenital warts and at risk of child sexual abuse, and as a consequence of their clinical experiences worked collaboratively to develop this clinical management algorithm. All have contributed to writing this article.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

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