Pediatric anogenital warts: A multicenter retrospective study of clinical features, modes of transmission, and treatment patterns

Anogenital warts are benign HPV-related lesions that are uncommon in children, with controversial modes of transmission and limited evidence regarding their management. We conducted a multicenter retrospective study of 63 children diagnosed with anogenital warts across 14 French hospital dermatology departments to describe their clinical characteristics, presumed modes of transmission, and treatment patterns. Anogenital warts predominantly affected young girls (43 girls [68.3%], median age at diagnosis: 4.0 years) and the perianal area; no cases of sexual abuse were identified, while hetero-inoculation was considered the most likely mode of transmission in nearly half of evaluable cases. Imiquimod was the most frequently prescribed first-line treatment (45/63, 71.4%), with a median treatment duration of 8 weeks; among 45 evaluable children, 22 (48.9%) achieved complete clearance within 8 weeks. As second-line treatment, podophyllotoxin was the most frequently prescribed therapy (n = 6), followed by imiquimod (n = 4) and cryotherapy (n = 2). Overall, treatments were well tolerated, with no serious adverse events reported. Among the 45 children who received imiquimod with evaluable safety data, local adverse events occurred in 21 (46.7%). The frequent off-label use of imiquimod underscores the need for dedicated pediatric studies and evidence-based treatment recommendations.