HPV is the most common sexually transmitted infection globally. Genital warts are a visible manifestation of infection with certain types. Many people diagnosed with HPV or genital warts worry about the impact on their ability to conceive. Genital warts, caused by low-risk HPV types, do not physically obstruct conception. The concern surrounding HPV and reproductive capacity lies primarily with the underlying viral infection, particularly high-risk strains, and the treatments required for related cell changes. This article addresses how HPV may affect fertility in both men and women.
Understanding Genital Warts and HPV
Genital warts are benign growths caused by low-risk types of HPV, most commonly types 6 and 11. They do not directly cause infertility, nor do these physical lesions prevent sperm from reaching the egg or interfere with implantation. Reproductive health concerns focus on the HPV infection itself, which is categorized into low-risk and high-risk types.
Low-risk HPV types cause warts, while high-risk types, such as HPV 16 and 18, are associated with precancerous and cancerous cell changes, particularly in the cervix. The majority of HPV infections are cleared by the body’s immune system, often within one to two years. When high-risk HPV persists, it can lead to cell abnormalities requiring medical intervention, which introduces an indirect link to reproductive issues.
HPV Effects on Female Reproductive Capacity
The HPV virus itself does not usually cause female infertility. However, treatments for persistent high-risk HPV infections can have secondary effects on the cervix. High-risk types can cause abnormal cervical cell growth, known as dysplasia, which must be removed to prevent cancer progression. The surgical procedures used to excise these abnormal cells are the primary factor linking HPV management to potential reproductive challenges.
Procedures like the Loop Electrosurgical Excision Procedure (LEEP) or a cold knife cone biopsy remove a cone-shaped wedge of tissue from the cervix. Removing a large amount of tissue can potentially weaken the structural integrity of the cervix, causing cervical insufficiency. This weakening is a risk factor for premature birth or late-term miscarriage in subsequent pregnancies.
In rare cases, scarring from these excisional treatments can cause the cervical opening to narrow or close, known as cervical stenosis. Cervical stenosis may make it more difficult for sperm to pass through the cervix to fertilize an egg, impacting conception. Most women who undergo these procedures are still able to conceive and carry a pregnancy to term without complications.
HPV Effects on Male Reproductive Capacity
For men, the presence of HPV in semen has been linked to markers of reduced sperm quality, though the risk of absolute male infertility remains low. High-risk HPV genotypes are particularly associated with impaired sperm function. Studies show that HPV infection in semen can negatively affect sperm parameters, including reduced motility and altered morphology.
A significant finding is the association between HPV and increased sperm DNA fragmentation (SDF). High SDF indicates damage to the genetic material within the sperm head, which can lead to reduced fertilization rates and impact embryo development. The virus may attach directly to the sperm surface, triggering the production of anti-sperm antibodies that impair movement. While these factors contribute to subfertility, they do not automatically cause total infertility for most men.
Monitoring and Treatment During Conception
Couples planning to conceive should be aware that HPV does not require delaying attempts to get pregnant. Women with a history of abnormal Pap smears or excisional procedures should discuss their cervical health with their obstetrician for appropriate monitoring during pregnancy. Regular screening, including Pap smears and HPV testing, is recommended to manage high-risk infections and prevent the need for extensive procedures in the future.
If genital warts are present during pregnancy, they may grow larger due to hormonal changes and increased blood flow. However, they rarely pose a risk to the baby or necessitate a Cesarean section. Treatments for warts are often postponed until after delivery unless they cause an obstruction. The HPV vaccine is a highly effective preventative measure against the most common high-risk types and should be considered for both partners for future reproductive health.