Human papillomavirus (HPV) is a common infection that primarily spreads through intimate skin-to-skin contact, most often during sexual activity. Mothers with HPV often worry whether it is safe to breastfeed their infant. Medical and public health organizations generally agree that breastfeeding is safe and highly recommended. The benefits of breast milk significantly outweigh the extremely low theoretical risk of transmission.
HPV Transmission and Breast Milk Safety
The primary concern regarding breastfeeding with HPV centers on whether the virus can be transmitted directly through the milk itself. Research has consistently shown that the risk of a clinically relevant HPV infection from ingesting breast milk is considered negligible. While HPV DNA has been detected in a small percentage of breast milk samples, this finding does not translate into a known route of infection for the infant.
Studies have found HPV DNA in anywhere from 2.5% to about 28.8% of breast milk samples from infected mothers. However, the presence of viral DNA does not confirm the existence of an infectious, live virus capable of causing disease. For example, in one study of mothers with high-risk HPV, none of the exposed infants contracted the infection.
The consensus is that there is no evidence linking the presence of HPV DNA in breast milk to an increased risk of oral HPV infection in the baby. Therefore, ingestion-based transmission of the virus is not considered a reason to avoid breastfeeding. The nutritional and immunological benefits of breast milk remain paramount.
Managing Breastfeeding with Warts or Lesions
A distinct and practical consideration is the presence of warts on the mother’s breast, nipple, or areola. Unlike the safety of the milk itself, warts in this location present a localized risk of direct skin-to-skin contact transmission to the infant’s mouth. HPV is known to spread through contact with the epithelial cells that form these lesions.
If a mother has active warts on the feeding area, she should consult with her healthcare provider for a clear management plan. The lesions can potentially transmit the virus to the infant’s mouth or respiratory tract during the feeding process. To mitigate this risk, the wart should be covered completely with a bandage or gauze during breastfeeding sessions.
In cases where the wart is located directly on the nipple or is too large to be adequately covered, temporary cessation of feeding from that specific breast may be necessary. The mother can temporarily pump milk from the affected breast and discard it if the lesion cannot be completely covered. Treatment for these external warts, such as ablative methods, is often recommended during the postpartum period to allow for safe, uninterrupted nursing.
Understanding Infant Exposure and Risk
The primary known route of HPV transmission occurs during birth, not through breastfeeding. This typically happens when the baby passes through the birth canal of a mother with active genital HPV lesions. This exposure can lead to the infant acquiring the virus, though most newborns who are exposed will clear the virus naturally without developing symptoms.
A rare but serious condition linked to vertical transmission of specific HPV types is Juvenile Recurrent Respiratory Papillomatosis (JRRP). This condition involves the development of wart-like growths in the child’s aerodigestive tract, most commonly in the larynx or voice box. JRRP is caused by the low-risk HPV types 6 and 11, which are also responsible for most genital warts.
The incidence of JRRP is low, estimated at about 4.3 cases per 100,000 children in the United States, and it is primarily associated with exposure during vaginal delivery. While the disease can be aggressive and requires repeated surgical procedures to maintain an open airway, the risk of a baby developing JRRP is not typically linked to breastfeeding. The most effective long-term strategy for prevention is the HPV vaccine, which is recommended for children and adolescents before they become sexually active.