Condyloma lata in a preschooler: The dilemma of sexual abuse versus non-abuse
A 4-year-old girl was referred to our hospital for evaluation of peri-anal lesions. About 4 weeks back, she had developed sore-throat, fever and rash involving the trunk and extremities including the palms and soles. She was prescribed syrup cephalexin for 1 week by the pediatrician after which the fever and rash improved. Subsequently, the mother noticed peri-anal lesions and informed the pediatrician who referred the child to us. She was born of a full term normal uncomplicated delivery to a 31 years old woman who received no prenatal care. As both the mother and the child were normal and healthy–no need was felt to investigate either of them after the delivery. The child lived with her parents, two brothers and a sister. The child gave no history of her genitalia being touched by anybody else than her mother. According to the parents, the child did not exhibit any behavioral changes or concerns. Physical examination, at the time of referral revealed a malnourished child with generalized lymph node enlargement. Muco-cutaneous examination revealed condyloma lata in the peri-anal area with a few ulcerated papules in the vicinity []. There was no sign of sexual abuse. Systemic examination was normal. Dark-field examination of the lesions was negative for Treponema pallidum. Serology showed positive venereal disease research laboratory (VDRL) (titre-1:64), T.pallidum particle agglutination assay (>1:80) and negative human immunodeficiency virus (HIV). Cultures for Neisseria gonorrhoeae and Chlamydia trachomatis from the vagina and rectum were negative. She was diagnosed as secondary syphilis and administered benzathine penicillin, 50,000 U/kg in a single dose and her lesions resolved.\nVDRL titers of the mother and father were also positive 1:32 and 1:16 respectively. Father gave a history of unprotected extra-marital contact with a commercial sex worker 5 months back. After 3 weeks, he developed a genital sore which improved with medicines. Subsequently, he developed fever and rash, for which he was given antibiotics and paracetamol. 1 month after this, mother also developed fever, rash and warty lesions in the genital area for which she received no treatment. Both of them did not have any lesions at the time of examination. They were also treated with benzathine penicillin.\nPediatric, dermatologic and psychiatric work-up did not show any evidence of child abuse. After ruling out sexual abuse, we considered non-sexual transmission of syphilis in the child. Contact of the girl with her infected parents was hypothesized as the mode of infection.