HPV in Pregnancy: Symptoms, Causes, and Treatments

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Genital warts are soft, fleshy growths in the genital area, on the cervix, or in the vagina. Warts can appear alone or in clusters, and resemble tiny pieces of cauliflower. These warts are caused by human papillomavirus (HPV).

According to the Centers for Disease Control and Prevention (CDC), approximately 42.5% of the United States population 18 and older has been exposed to HPV. This means that many pregnant women have HPV.

It is also very common to have HPV and not have any visible warts or other symptoms. In fact, many people (pregnant people included) with HPV have no idea they have it. Additionally, this highly contagious condition can be spread when no symptoms are present. Here is what you need to know about HPV, genital warts, and pregnancy.

Overview

More than 200 distinct types of HPV have been recognized, many of which can be spread through sexual contact. Most types of HPV cause skin warts, but about 40 types infect the mucosal epithelium and are associated with cervical cancer.

Some types of HPV can cause other types of genital cancers, as well as oral, anal, and penile cancers. Additionally, some types of HPV may increase the chances of infertility, preterm birth, and pregnancy loss.

The CDC estimates that there were 43 million HPV infections in 2018 including 13 million new infections in that same year. In fact, HPV is so common that the CDC estimates that almost every person who is sexually-active will get HPV at some time in their life if they do not get the HPV vaccine.

Causes

Genital warts can be spread through all types of skin-to-skin sexual contact including oral, anal, and genital sex. As noted above, simply not being able to see warts does not mean the other person is virus-free or that you cannot get them. It is also possible to get genital warts in the throat after oral sex with an infected partner.

Symptoms

Many times a person with the HPV infection shows no symptoms at all. When this occurs, healthcare professionals consider this an asymptomatic infection. A lack of symptoms is especially true for high-risk strains of HPV.

It also is possible to have had HPV and for your body to have cleared the infection. This type of infection occurs most commonly in sexually active younger women. For those who do have symptoms of HPV, they often manifest as genital warts.

Genital warts are usually painless growths that resemble tiny heads of cauliflower on your genitals. You might notice them in the shower or your partner might find them during sex. If you do find genital warts, it is important to be seen by a healthcare provider.

Diagnosis

There is no specific test that screens for HPV or determines a person's HPV status. However, there are HPV tests that are used to screen for cervical cancer. But these tests are only recommended for women 30 years and older.

Most people infected with HPV do not even know they are infected and never develop symptoms. Others might find out when they get an abnormal Pap test result while others may only find out they have HPV once they have developed more serious problems like certain cancers.

If you develop genital warts, these are often diagnosed during a Pap smear or a physical exam. You may also need a colposcopy, which uses a special device to look intensely and closely at the cervix and the walls of the vagina for genital warts, any changes to cervical cells caused by HPV, and any other anomalies.

Treatment

Warts themselves may disappear, or they could grow into clusters of warts. Just because warts disappear does not mean that the HPV is gone—and they can also come back. Smaller warts may be frozen off in a process called cryosurgery or burned off with a laser or cautery.

If genital warts are diagnosed prior to pregnancy, topical immunologic creams or topical trichloroacetic acid (TCA) can be used. However, if you do not have an active infection, you do not need to do anything special before getting pregnant except letting your doctor know that you have had genital warts in the past.

HPV in Pregnancy

One study found that nearly 40% of pregnant women have HPV, which can cause a number of issues in pregnancy. For instance, there is some evidence that women with HPV may experience pre-labor rupture of membranes.

As for genital warts themselves, they do not pose a problem to your pregnancy unless they grow large enough to obstruct your vaginal opening. As noted above, some research indicates that some types of HPV may be linked to miscarriage, preterm birth, and fertility issues, but results are still inconclusive.

Additionally, there is no association between having the HPV vaccine and infertility. In fact, the vaccine helps to protect the fertility of both sexes.

If you have genital warts, you and your provider may decide to wait for treatment until after you give birth, because some of the treatments are not safe to use while you are pregnant. Keep in mind that sometimes genital warts can flourish and grow more quickly while you are pregnant because of the increased blood flow and hormone levels.

If you have active genital warts at the time you give birth, it is highly unlikely to interfere with your vaginal delivery. Additionally, your baby may also be exposed to the infection even if you deliver by c-section. However, your baby is not likely to contract the virus through birth.

Prevention

The transmission of genital warts and HPV can be minimized by abstaining from sexual activity, particularly with any partner with whom you are not monogamous and/or using barrier protection (such as condoms).

Checking your partner for lesions and having frank discussions around possible prior exposure, current sexual activity, exclusivity, getting the HPV vaccine, and being screened for STIs prior to sexual contact is also recommended.

Barrier methods like the male and female condom reduce the likelihood of transmission but do not make the risk zero. Gardasil-9 is the only HPV vaccine available in the U.S. but it should not be given while you are pregnant.

HPV Vaccine

The HPV vaccine is recommended beginning at age 11 or 12 years. Additionally, the CDC's Advisory Committee on Immunization Practice (ACIP) recommends vaccination for everyone through age 26 years if not vaccinated previously.

Typically, vaccination is not recommended for people older than 26. However, according to the CDC, some adults 27 to 45 years old may decide to get the HPV vaccine based on discussions with a healthcare provider, especially if they did not get adequately vaccinated when they were younger. At this age, though, HPV vaccination provides less benefit because most people have already been exposed to HPV.

A Word From Verywell

Being pregnant and knowing (or finding out) that you have genital warts or the virus that causes it (HPV) can be scary and worrisome. However, know that many pregnant women have this infection and the vast majority go on to safely deliver healthy babies with no or few complications from HPV. The important thing is to communicate any concerns you have to your healthcare provider and get the care you need to protect your baby.

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13 Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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