Association of coexisting vaginal infections and multiple abusers in female children with genital warts.

All 11 girls less than 12 years of age presenting to the pediatric clinic between 1980 and 1986 with genital warts were evaluated by the Child Protection Team for possible sexual abuse. Nine of the 11 girls had condylomata acuminata, and two had verruca vulgaris. Ten of the 11 had historical and/or physical evidence other than the warts that confirmed sexual abuse. Six girls had coexisting vaginal infections such as bacterial vaginosis and infections due to various pathogens including Neisseria gonorrhoeae, Trichomonas vaginalis, Ureaplasma urealyticum, and Mycoplasma hominis. These six girls were known (three) or suspected (three) of being abused by multiple perpetrators. None of the five girls with a known or suspected single abuser had coexisting vaginal infections (P = less than 0.02, Fisher's exact test). We conclude that almost all genital warts in girls are sexually transmitted and that girls presenting with anogenital warts should be evaluated for other genito-vaginal infections and sexual abuse. Multiple vaginal infections in childhood, with organisms that are sexually transmitted or associated with sexual activity, may be a marker for abuse by multiple perpetrators.