The human papillomavirus (HPV) is the most common sexually transmitted infection, acquired through skin-to-skin contact, typically during sexual activity. Pregnancy does not cause HPV, but it can significantly influence the behavior of an existing infection. Navigating HPV during this time involves understanding how the body’s changes affect the virus and following specific medical guidelines for monitoring and delivery.
How Pregnancy Affects Existing HPV Infections
The immune system changes during pregnancy, creating an environment of relative immunosuppression. This shift can influence how a pre-existing HPV infection manifests, making physical symptoms more pronounced without increasing the inherent cancer risk.
Hormonal changes, particularly increased estrogen and progesterone, combined with greater local blood flow, can cause genital warts to grow rapidly. These lesions may become larger, multiply, or reappear if they had previously cleared. Their increased size and vascularity can sometimes lead to bleeding or irritation.
These changes are temporary, and the lesions often shrink spontaneously after delivery as hormone levels return to normal. Care focuses on managing symptoms and ensuring the lesions do not obstruct the birth canal near delivery. Treatments like cryotherapy may be considered if the warts become excessively large or bothersome.
Clinical Guidelines for HPV Screening and Diagnosis During Pregnancy
Cervical cancer screening is safe during pregnancy, and a Pap smear is performed as part of routine care. Providers use gentle tools like a cyto-broom to minimize the risk of minor bleeding, which occurs because the cervix is more vascular during gestation. Screening is typically performed at the same intervals recommended for non-pregnant individuals.
If a Pap smear indicates abnormal cells, a colposcopy may be performed to closely examine the cervix. Colposcopy is also safe in pregnancy and is recommended for those with results suggesting a higher risk of high-grade lesions or cancer. During this examination, the provider may take a small tissue sample, or biopsy, if invasive cancer is suspected.
Management of pre-cancerous lesions is generally deferred until after delivery. Treatments like a Loop Electrosurgical Excision Procedure (LEEP) are typically postponed due to the risk of complications, such as bleeding or preterm labor. Instead, pregnant patients are monitored closely with repeat colposcopies and cytology tests until after delivery, when definitive treatment can be safely administered.
Understanding Transmission Risks to the Infant
Vertical transmission of the virus from mother to child is a concern. While the risk of a baby acquiring the virus is present, the rate of transmission is relatively low. Most exposed infants naturally clear the infection without developing symptoms or long-term health problems.
In rare instances, vertical transmission of certain low-risk HPV types (typically 6 and 11) can lead to Juvenile-Onset Recurrent Respiratory Papillomatosis (JORRP). JORRP involves the growth of non-cancerous, wart-like tumors in the baby’s airway, most commonly in the larynx or vocal cords. This condition requires repeated surgical procedures to maintain a clear airway and prevent voice damage.
A C-section is generally not recommended solely to prevent HPV transmission, as the virus can be acquired through other means, and the procedure does not offer complete protection. A C-section is usually only considered when large genital warts could cause severe bleeding or physically block the birth canal. The decision about delivery method is made on an individualized basis, weighing the risk of JORRP against the risks associated with the procedure.