What Are the Risks of HPV During Pregnancy?

Human papillomavirus (HPV) is a type of sexually transmitted infection (STI). Most types of HPV are transmitted through oral, vaginal, or anal sex. HPV is very common. In fact, it’s the most common STI in the United States, according to the Centers for Disease Control and Prevention (CDC). About 80 percent of people will get HPV at some point in their lives. This is because there are over 150 different varieties of HPV. Many of them typically don’t cause any problems and will go away without treatment. Few people even find out they have it. About 40 HPV strains can infect the genital tract. This may cause genital warts and cancer of these areas of the body:

• cervix
• vagina
• vulva
• penis
• anus

To reduce the risk for cervical cancer due to HPV, an HPV vaccine was created to target specific HPV strains that are linked to cervical cancer. This vaccine isn’t recommended during pregnancy, however. HPV usually doesn’t cause any issues in pregnancy. However, you should know about a few rare complications if you’re pregnant and have HPV.

With HPV, you may show no symptoms at all. The most common symptom is warts. Warts are flesh-colored bumps on the skin that grow alone or form into clusters that look like cauliflower. The type of HPV you have will determine where on your body the warts grow:

• Genital warts grow on the vagina, vulva, cervix, or anus in females, and on the penis, scrotum, or anus in males.
• Common warts form on the hands or elbows.
• Plantar warts appear on the balls or heels of the feet.
• Flat warts usually occur on the face in children and males, and on the legs in females.

You probably won’t feel the warts, but sometimes they can itch or burn.

How might pregnancy affect HPV symptoms? During pregnancy, changing hormone levels can make warts grow faster than usual. A pregnant woman’s body also produces an increased amount of vaginal discharge, which gives warts a warm, moist place to thrive.

Having certain types of HPV can also increase your risk for cervical cancer. This kind of cancer often doesn’t produce symptoms until it starts to spread. Once the cancer spreads, it can cause symptoms such as:

• abnormal bleeding from the vagina, or bleeding that isn’t due to your menstrual period
• vaginal discharge, which may contain blood
• pain during sex

Most OB-GYNs don’t normally test for HPV during pregnancy unless they have a reason to. Diagnosing HPV usually occurs if your doctor finds warts or during a routine Pap test. During a Pap test, your doctor uses a swab to remove a small number of cells from your cervix. They send this sample to a lab and test it for precancerous cells. The presence of precancerous cells may indicate that you have HPV. If you’re over the age of 30, your OB-GYN can now also give you an HPV DNA test, along with the Pap test. This test can detect whether you have a type of HPV that can cause cervical cancer.

Currently, there isn’t a cure for HPV, but most women won’t need any treatment during pregnancy. No drug is available to treat the virus itself. Instead, treatment focuses on managing any symptoms. HPV shouldn’t pose a risk to your baby. Warts also don’t need to be treated unless they’re especially large or bothersome. If this is the case, your doctor can safely remove them by:

• freezing them off with liquid nitrogen (cryotherapy)
• laser therapy
• using a heated needle (electrocauterization)
• performing surgery or a small excision

Will HPV warts affect my delivery?

Having genital warts shouldn’t affect your delivery. Sometimes, large warts may cause bleeding during delivery. Rarely, genital warts can grow large enough during pregnancy to block the birth canal or make childbirth more difficult. If this happens, your doctor will likely recommend having a cesarean delivery.

How is HPV treated after delivery?

If a Pap test shows that you have precancerous cells in your cervix, your doctor may wait to treat you until after your delivery. Once your baby is born, you’ll likely have another Pap test. HPV often clears up without treatment. If you still have abnormal cells after delivery, your doctor may treat you by removing the abnormal tissue with one of these procedures:

• cryosurgery, which involves using extreme cold to freeze off the abnormal cells
• cone biopsy, or conization, which involves using a knife to remove a cone-shaped wedge of tissue
• loop electrosurgical excision procedure (LEEP), which involves removing your abnormal tissues with an electrically heated loop

Having HPV during pregnancy shouldn’t affect your baby’s health. You may pass HPV to your unborn baby during pregnancy or delivery, but it’s unlikely. Studies have differed on the rate of HPV transmission from mother to baby. In a 2016 study, researchers found that about 11 percent of newborns born to HPV-positive mothers also had the virus. However, this research needs to be expanded. Most babies who do develop HPV in the womb will clear the virus on their own without having any long-term problems. In rare cases, genital warts may be passed on to the baby. Warts might develop on the newborn’s larynx or vocal cords. When warts develop here, it’s called recurrent respiratory papillomatosis. Treatment involves surgery to remove the growths.

What about breastfeeding? Having HPV shouldn’t stop you from breastfeeding. Although the virus can pass from mother to child in breast milk, this kind of transmission is very rare.

The two best ways to avoid getting HPV are by practicing safe sex and getting vaccinated. Older guidelines recommend the HPV vaccine Gardasil for females between the ages of 11 and 26, and for males through age 21. The current guidelines now state that both men and women between the ages of 27 and 45 who have not been previously vaccinated for HPV are now eligible for Gardasil 9. The complete vaccination series involves two or three doses.

• Two doses. Two doses of the vaccine are recommended for most people before their 15th birthday. The second dose should be given between 6 to 12 months after the first dose.
• Three doses. Three doses are recommended for anyone who gets their first dose between 15 and 26 years old, or for anyone with a compromised immune system.

You need to get the complete series of vaccinations to be fully protected. If you didn’t get vaccinated before becoming pregnant, or you started the vaccine series but didn’t finish it, you’ll need to wait until after giving birth to get or complete the vaccine. The guidelines don’t recommend the HPV vaccine for pregnant women.

Why isn’t the HPV vaccine recommended for pregnant women? According to the CDC, the HPV vaccine hasn’t been shown to have negative effects during pregnancy. However, data is limited on vaccination during pregnancy. Therefore, they recommend postponing vaccination until after pregnancy.

If you’re over 30, see your OB-GYN to get HPV tests alongside your routine Pap test. That way, you can talk with your doctor about any special monitoring you might need during pregnancy if you discover you have HPV. Remember that nearly all sexually active adults will get HPV at some point in their lives. Consistently practicing safe sex and getting tested will help prevent STIs.