Human Papillomavirus (HPV) is a highly common viral infection, transmitted primarily through skin-to-skin sexual contact, making it the most prevalent sexually transmitted infection in the United States. There are over 100 types of HPV, with about 40 strains affecting the genital area. In most people, the body’s immune system clears the virus naturally within one to two years without causing symptoms. Some strains are classified as high-risk because they can lead to precancerous cell changes, particularly on the cervix, while others are low-risk and cause genital warts.
HPV’s Relationship with Fertility and Conception
For most individuals, having an HPV infection does not affect their ability to conceive naturally. The presence of the virus does not interfere with ovulation, fallopian tube function, or the successful implantation of a fertilized egg. Even active genital warts, caused by low-risk HPV types, rarely prevent conception, unless the lesions physically obstruct the entrance to the vagina.
The primary concern regarding fertility is not the virus itself, but the treatments for high-risk HPV infections that cause abnormal cervical cell changes. Procedures designed to remove precancerous cells, such as a Loop Electrosurgical Excision Procedure (LEEP) or a cone biopsy, involve excising a portion of the cervix. Removing significant cervical tissue can potentially change the quality of cervical mucus or cause cervical stenosis, a narrowing of the cervical opening.
These changes may slightly impede the movement of sperm toward the uterus, but they do not cause infertility in most cases. For male partners, HPV DNA has been detected in semen, and some studies suggest it may negatively affect sperm quality, including reduced motility and viability. However, a definitive causal relationship between male HPV infection and conception difficulties has not been established. Overall, success rates for achieving a healthy pregnancy are similar for those with and without a current high-risk HPV diagnosis.
Monitoring and Treatment Protocols During Pregnancy
Once pregnancy is established, managing an existing HPV infection shifts toward surveillance. Routine cervical cancer screening, including a Pap smear and HPV testing, is maintained at the same intervals as for non-pregnant individuals. If an abnormal Pap smear suggests high-grade precancerous changes, a colposcopy may be performed.
During a colposcopy, a magnified visual examination of the cervix assesses the extent of cellular abnormalities. If a biopsy is necessary, it is considered safe during pregnancy. However, extensive treatments for lesions, such as LEEP or cold knife cone biopsy, are postponed until after delivery. This delay minimizes the risk of preterm birth or bleeding and accounts for the high chance that cervical lesions will regress spontaneously postpartum.
Active treatment for genital warts that develop or enlarge during pregnancy is often deferred. Removal may be necessary only if the warts cause significant discomfort, bleeding, or are large enough to obstruct the birth canal. Safe treatment options involve ablative methods, such as cryotherapy or surgical excision. Patient-applied topical treatments used outside of pregnancy are generally not recommended due to potential risks to the developing fetus.
Potential Risks to the Fetus and Newborn
Transmission of HPV from a pregnant person to the fetus or newborn is rare, but it is a concern during gestation. The virus can be transmitted in utero, but the most common route is perinatal, during passage through the infected birth canal. When a newborn contracts the virus, the infection often clears on its own without long-term consequences.
The most serious, though uncommon, complication for the infant is Recurrent Respiratory Papillomatosis (RRP). This condition involves the growth of non-cancerous tumors, or papillomas, in the respiratory tract, most often on the vocal cords or larynx. RRP is associated with the low-risk HPV types 6 and 11, the same strains that cause external genital warts.
High-risk HPV strains, linked to cervical cancer, are not typically associated with RRP development in the child. Some studies suggest an association between maternal HPV infection and adverse pregnancy outcomes, including premature rupture of membranes and preterm birth. However, the overall risk remains low, and further research is needed to solidify these connections.
The delivery method decision is important for people with active genital warts, though having warts does not automatically necessitate a Cesarean section (C-section). Physicians recommend a C-section only if the warts are very large, widespread, or positioned to cause an obstruction or severe bleeding during delivery. Studies have not shown that a C-section significantly reduces the risk of vertical transmission of HPV or RRP development in the newborn. The standard approach is vaginal delivery unless there is a clear mechanical or bleeding risk posed by the warts.