The mode of transmission of HPV in the pediatric population often remains untraced. Sexual abuse should be considered in  cases of condyloma acuminata in children, particularly on older than 2 years of age [1]. In children with anogenital warts, the reports of sexual abuse are too broad, ranging from 0 to 80%. Forms of transmission of HPV in children other than sexual transmission include vertical (periconception, prenatal, and perinatal) and horizontal (autoinoculation and heteroinoculation) transmission [3].

Management of condyloma acuminata presents a therapeutic challenge in pediatric patients. In most cases, condyloma acuminata is asymptomatic and resolves in a few years [4]. When the involvement is extensive, and the patient is symptomatic, other treatment options are considered. Many treatments involve immunotherapy or destructive modalities that can lead to unpredictable responses and can have significant pain or side effects. Immunotherapy with Candida antigen and oral cimetidine are two treatment examples that have been shown to be safe and effective as primary and adjuvant treatment for condyloma in children [5, 6]. These treatments avoid local irritation, but treatment response is often slow. For more extensive cases, surgery that potentially has more risks can be considered.

Topical treatments for condyloma are usually preferred when possible. Common topical agents such as imiquimod and podophyllotoxin have limited data on their efficacy and safety in pediatric patients. However, there have been a few case reports of topical cidofovir used in children with moderate success and few side effects, including local irritation and numbing of the skin [7,8,9]. Cidofovir is a nucleoside analog antiviral agent that competitively inhibits DNA polymerase and is labeled for use intravenously to treat CMV retinitis in immunocompromised patients. While intravenous cidofovir carries risk of serious side effects, topical cidofovir has been used in the treatment of HPV warts in adults with moderate efficacy and a good safety profile,  with the most common adverse events being pain, pruritus, and rash at the application site [10].

This patient is being presented to show that compounded cidofovir 3% gel can be considered to treat extensive or large condyloma acuminata prior to or instead of surgical removal. Studies are needed to understand better the safety and efficacy profile of cidofovir in treating condyloma acuminatum in pediatric populations.