The Human Papillomavirus (HPV) is one of the most prevalent viral infections worldwide, primarily affecting the surface cells of the skin and mucous membranes. For individuals concerned about family planning, the answer is reassuring: yes, you can generally get pregnant if you have HPV. The virus itself does not prevent conception or interfere with a healthy pregnancy, but it requires unique considerations for monitoring and management during the reproductive years.
HPV and the Ability to Conceive
HPV does not prevent conception because it is a localized infection affecting the epithelial cells of the skin and cervix, not the reproductive organs. The infection does not interfere with hormonal cycles or obstruct the fallopian tubes, meaning it is not a direct cause of female infertility. The Centers for Disease Control and Prevention does not classify HPV as a major factor hindering pregnancy or carrying a pregnancy to term.
The main concern regarding female fertility arises from the treatment of HPV-related precancerous lesions, not the virus itself. Procedures like the Loop Electrosurgical Excision Procedure (LEEP) or cold-knife conization remove a portion of the cervix to eliminate high-grade dysplasia. While life-saving, these excisional treatments can shorten the cervix, potentially leading to cervical insufficiency or increasing the risk of preterm birth in later pregnancies.
Research suggests a possible, though inconclusive, link between HPV and male fertility. Studies indicate the virus can bind to the surface of sperm, potentially decreasing motility or increasing sperm DNA fragmentation. This viral presence may impair fertilization or implantation, possibly contributing to early miscarriage. However, these effects are transient for many, and HPV is not a major cause of male infertility or a contraindication for pursuing conception.
Managing Cervical Abnormalities During Pregnancy
When a woman with HPV becomes pregnant, the focus shifts to monitoring cervical abnormalities to ensure they do not progress. Pregnancy hormones, such as increased estrogen, can sometimes cause cervical tissue changes that mimic dysplasia on a Pap test. A pregnant patient with an abnormal Pap test is often referred for a colposcopy, a procedure considered safe during all trimesters of pregnancy.
During the colposcopy, a specialized microscope is used to examine the cervix, and targeted biopsies may be taken if a high-grade lesion is suspected. Endocervical sampling (taking cells from inside the cervical canal) is avoided due to the risk of bleeding or pregnancy complications. The standard protocol is “watchful waiting,” as high-grade cervical intraepithelial neoplasia (CIN 2 or CIN 3) often spontaneously regresses after delivery.
Invasive treatments, such as LEEP or cold-knife conization, are generally deferred until after delivery. Excisional procedures carry risks of hemorrhage, miscarriage, or premature labor during gestation. Intervention during pregnancy is reserved only for rare cases where invasive cancer is strongly suspected based on biopsy results. Close surveillance via repeat colposcopy every 12 to 24 weeks is the preferred method to balance maternal safety with fetal well-being.
Risks of Transmission to the Infant
The risk of a mother transmitting HPV to her infant is relatively low and usually does not affect the baby’s health. Transmission most commonly occurs during vaginal delivery as the baby passes through an infected birth canal. Studies report HPV DNA detection in newborns of infected mothers in the low single digits (1% to 5%). The presence of HPV DNA at birth often represents a temporary inoculation, with the virus clearing from the infant’s system within a few months.
An extremely rare, but serious, complication of vertical transmission is Recurrent Respiratory Papillomatosis (RRP). RRP involves the growth of benign, wart-like tumors, most often in the infant’s voice box. This can cause chronic hoarseness and potentially lead to life-threatening airway obstruction. RRP is primarily associated with low-risk HPV types 6 and 11, the same types that cause genital warts, and often requires repeated surgical procedures throughout childhood.
The presence of maternal genital warts does not automatically mandate a Cesarean section. The American College of Obstetricians and Gynecologists (ACOG) guidelines indicate C-sections are only necessary if the warts are massive, widespread, or physically obstruct the birth canal, or if their passage would cause excessive bleeding. For the vast majority of HPV-positive mothers, a vaginal delivery is safe and recommended.