The presence of HPV should not be a burden of concern for the pregnant woman. It is a very frequent infection, benign and without impact on pregnancy or the fetus that does not lead to reproductive complications

The lesions produced by HPV during pregnancy are exactly the same (Condyloma acuminatum, genital wart and subclinical lesion, cervical dysplasia) to those that occur outside of it. There is no distinction if the infection is acquired before, during or after pregnancy.

The presence of HPV in the female genital area does not directly affect pregnancy, does not generate complications such as premature birth or causes fetal malformations.

The presence of HPV in the female genitalia, in any of its forms, does not contraindicate pregnancy or affect the reproductive future of women.

Pregnancy limits the use of certain proposed treatment regimens for HPV infection.

There is no specific anti-viral treatment against HPV: indicating acyclovir for HPV suggests supine ignorance on the part of the doctor.

How will my pregnancy be affected?

In none of its two forms, condylomatosis or cervical dysplasia, HPV directly affects the normal progression of your pregnancy or the good health of your baby. You can be totally calm

There is no direct relationship between HPV infection and normal evolution of pregnancy and fetal health, recent data rule out maternal-fetal complications such as infertility, premature birth, fetal growth disorders or fetal malformations.

In the case of cervical pathology due to HPV it seems that the progression of the infection to premalignant stages is very infrequent, and in our experience we have never had rapid progression from simple HPV infection to dysplastic forms such as CINs and patients with CINs have not progressed to malignant changes.

In the case of condylomatous pathology of genital tract and external genitalia we have seen that the disease could be exacerbated during the first two thirds of pregnancy (in some patients) but almost invariably the lesions disappeared completely weeks before delivery. In some cases the lesions were so extensive that all types of wart-control treatment were discontinued and when we had given up the lesions disappeared spontaneously in a matter of days to a few weeks. Warts can be very annoying due to rubbing and contact with clothing, some can get infected and cause local problems with pain, suppuration and skin infection type cellulite

In the case of your baby you can rest assured that it is known that HPV does not affect the fetus

What is the management of the infection during pregnancy?

Cervical: if HPV is only present in the cervix without generating premalignant changes, all that is required is to evaluate by cytology and / or colposcopy the evolution of the infection every 3 months during pregnancy and after 3 to 4 months after the Birth. If there is dysplasia and this is of severe degree (IAS 3) an ablative procedure such as diathermic loop resection may be indicated, taking care to remember that during pregnancy the cervix bleeds abundantly so we recommend that the procedure be performed in the operating room. and with the expertise and the suitable equipment. The latter is rare and most patients infected with HPV will only require conservative surveillance

Condylomatosis: when there are vulvovaginal condylomas , the use of caustic substances that locally applied can control the number and size of lesions can be recommended. There is a lot of discussion about whether these lesions should be treated during pregnancy, but many patients so wish because of the discomfort they suffer from rubbing, bleeding from some of them or secondary infection. Particularly I treat visible injuries to lower the viral load and limit the foci of auto viral inoculation. We must remember that during pregnancy the lesions spread alarmingly in some patients (due to cellular immunosuppression typical of normal pregnancy) and that little is achieved with local therapy; It should not be forgotten that in most patients the lesions will tend to disappear spontaneously as we approach the end of pregnancy. Substances such as podophyllin, 5-fluorouracil or imiquimod can not be used. We avoid electrocautery or any other invasive procedure that could leave marks in the vulvar region; In addition, the response can be frustrating since the patient believes that the procedure will cure it and the lesions could reappear and generate more concern. The truth is that being conservative and explaining these details to the affected patients has worked very well for us. Again, we ask patience, tranquility and sanity to the affected patients.

HPV: delivery or Cesarean section?

HPV, even oncogenic genotypes, is not a contraindication for vaginal delivery. Although the baby is exposed to the virus during its passage through the birth canal, the risk of overt infection is so low that the authorities in HPV do not consider that the cesarean section should be practiced for the presence of the virus but for the appropriate obstetric reasons; it is believed that the newborn has antibodies that protect him from the virus and that would explain the low rate of neonatal complications due to HPV when we consider the large number of patients who give birth to their children vaginally in the presence of the virus

Laryngeal Condylomatosis is the most serious condition that can occur in the newborn infected with HPV. This picture presents with hoarseness, cough and difficulty feeding due to the growth of condylomas in the vocal cords that narrow the light of the respiratory tract. It is known that lesions can appear up to 3 years after vaginal birth. The reported risk of this disease is 1: 2000

If the condylomatous lesions are very extensive at the time of delivery, we prefer to perform a cesarean section due to the fear of genital bleeding due to disruption of the diseased tissue and logically to avoid the passage of the baby through a region with a high viral load.

In many cases we let the couple make the decision of a cesarean section due to the presence of HPV and the risk of laryngeal papillomatosis, a condition that, although rare, is difficult to treat and is highly recurrent and at risk of laryngeal cancer. to future. Personally, I firmly believe that babies are not statistically, so in the presence of HPV I prefer to perform a caesarean section and not expose an innocent being to a potential risk if it is preventable: the world is already hostile enough.

Management of HPV after birth

After the birth, it is expected that the changes of pregnancy and post-partum will have an effect in order to re-evaluate the patient. This is done between 6 and 12 weeks after the baby is born. The cytology is taken and a colposcopy is performed and a tissue biopsy is taken if necessary.

Diagnosis

Cervical cytology is the most economical, universal and simple cancer screening method that exists for any cancer. Papanicolaou developed and disseminated cervical cytology in the world.

There is no contraindication to perform one or more cytologies during pregnancy. The procedure does not affect the fetus or cause premature labor.

Pregnancy is not free of malignant or premalignant lesions of the cervix, so you should have a cytology as part of your prenatal care.

The HPV virus does not affect the fetus nor the normal evolution of controlled pregnancy.

The presence of HPV in the birth canal (cervix, vagina and external genitalia) could generate a laryngeal infection (laryngeal condylomatosis) in the newborn, which, although severe, is quite rare (1: 2000).