Three-year-old boy develops facial warts, suspected shared towel use

A three-year-old boy developed warts on his face, with a urologist suspecting the human papillomavirus (HPV) was transmitted from his grandfather, who previously had warts, through the family's habit of sharing towels.

Doctor Gu Fangyu, Director of Gu Fangyu Urology Clinic in Taiwan, shared this case on his personal page. The boy, aged three to four years old, presented with wart-like lesions caused by human papillomavirus (HPV) on his face.

After investigating the family history, the doctor noted that the boy's grandfather had previously visited entertainment venues and contracted warts. Given that family members regularly shared a single towel, Doctor Gu Fangyu clinically assessed that this was likely a case of indirect transmission through contact.

The primary transmission route for HPV is direct skin-to-skin and mucosal contact. However, studies indicate that personal items like towels or clothing can serve as non-sexual intermediaries for transmission. Precisely identifying the exact timing and method of infection in each case is often challenging. Some review studies have shown that HPV can transmit through non-sexual routes, including self-inoculation on the body, contact with others, or via contaminated objects.

Clinical lesions of warts often appear rough, growing in clusters resembling cauliflower. Photo: Koppert

According to Doctor Gu Fangyu, young children can still receive treatment even if warts appear early. However, HPV warts may recur after treatment, making regular follow-up visits essential.

"When boys reach nine years old, families can consult a doctor about HPV vaccination", he stated. The 9-valent HPV vaccine is approved for use in Taiwan for both males and females aged nine to 45. Children aged nine to 14 require a two-dose regimen, while individuals aged 15 to 45 receive three doses.

Warts, caused by HPV, typically appear in the genital and anal regions. In the initial stage, the warts are small, causing no pain or itching, making them difficult to detect. Doctor Gu Fangyu noted that even if visible warts are removed through treatment, it does not mean the virus has been completely eliminated from the body. The virus can persist in a latent form, leading to a risk of recurrence.

The US Centers for Disease Control and Prevention (CDC) states that if left untreated, warts may disappear on their own, maintain their size, or grow. Current treatments primarily remove the warts and alleviate symptoms, but cannot guarantee complete eradication of HPV. Therefore, the condition still carries a risk of recurrence after treatment.

Doctors recommend vaccination as one of the most important solutions for preventing HPV infection. The 9-valent vaccine protects against HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58. Among these, types 6 and 11 cause approximately 90% of wart cases.