Condilomatosis en sospecha de abuso sexual en niños: interrogantes médico-legales

Abstract

Human Papillomavirus (HPV) infection in the pediatric population represents a significant challenge in medico-legal practice due to the coexistence of multiple routes of transmission and the clinical variability of its manifestations. Scientific evidence demonstrates that HPV can be acquired through both sexual and non-sexual mechanisms, including intrauterine, perinatal, or early postnatal vertical transmission, as well as autoinoculation and close contact with infected caregivers. Consequently, the presence of HPV infection in childhood cannot be automatically attributed to sexual transmission.

This article presents the clinical case of a four-year-old girl with perianal lesions consistent with HPV-related condylomas, with early onset and progressive evolution, and no genital findings suggestive of sexual abuse. The biological behavior of the virus, characterized by variable incubation periods and prolonged phases of latency, limits the ability to accurately determine the timing of infection acquisition based solely on clinical findings.

From a medico-legal perspective, this case highlights that clinical, molecular, or histopathological confirmation of HPV infection in children does not allow for the determination of the specific mode of transmission and, by itself, does not constitute conclusive evidence of sexual abuse. Therefore, forensic assessment must rely on a comprehensive analysis that integrates clinical history, family and social context, lesion evolution, and current scientific evidence, in order to avoid automatic inferences with potential legal and judicial implications.