Anogenital warts can be solitary or multiple and are found on the perineum, genitalia, crural folds, and anus. Warts may extend into the vagina, urethra, and peri-rectal epithelium. They can be associated with itching, bleeding, tenderness, or be asymptomatic. The finding of anogenital warts in children requires health care providers to always consider possible sexual abuse. However, it is possible that these lesions are acquired nonsexually as well.

In children, introduction of human papillomavirus (HPV) into the anogenital area can be from several modes of transmission. Vertical transmission has been reported to be responsible for at least 20% of lesions. It can occur as the newborn descends the birth canal, by viral ascent, or hematogenous route. Horizontal transmission by caregivers in the first days of life is another modality of HPV contamination in newborns. Though rare, contaminated fomites, such as underwear, swimwear, bath towels, etc, have also been implicated in acquired HPV infections. There is also heteroinoculation by affected family members with common warts (verruca vulgaris) and autoinoculation from children who have cutaneous or oral infection.

In children, anogenital warts can be caused by HPV serotypes typically associated with cutaneous warts. There is no relationship between HPV types and modes of transmission (vertical or horizontal).