Genital warts and pregnancy

Genital warts may increase in number, size, or recur during pregnancy (1,2)

• the relative state of immunosuppression in pregnancy may result in the inability of the host immune system to suppress already present, latent virus
  
  
• genital warts can proliferate during pregnancy, and some specialists advocate treatment. However, risks are low and information and reassurance is appropriate for the majority of women affected
  
  
• in many cases, clinically obvious lesions regress after delivery
  
  
• benefit of caesarean section for prevention of HPV transmission is not known, however, this may be indicated in rare cases where bulky warts obstruct the pelvic outlet
  
  
• no known association of HPV with pregnancy complications including miscarriage or premature labour
  
  
• treatment
  • if therapy is undertaken during pregnancy, cryotherapy is a safe, simple, cheap and effective method of treatment
  • other possible methods are trichloracetic acid or excision during the pregnancy, although 'no treatment' is a reasonable option as warts usually spontaneously regress after delivery
  • podophyllin or podophyllotoxin is contra-indicated during pregnancy or conception due to potential teratogenic effects
    
    
• transmission of HPV during pregnancy and morbidity in neonate (2)
  • vertical transmission in utero is extremely rare, and the mechanism is unclear
  • passing virus on to the neonate via vaginal delivery
    • transmission has been estimated to be between 1:80 and 1:1500
  • most important manifestation of mother-to-child transmission of wart virus is juvenile laryngeal papillomatosis
    • appears to be associated with maternal genital warts at the time of delivery
    • although an important disease with significant morbidity (patients may require multiple operative treatments to manage their disease), the lesions are histologically benign but can occasionally progress in the presence of other environmental factors (such as smoking) to malignancy
    • "... is therefore important to stress that vertical transmission is rare and almost always occurs via vaginal delivery with obvious maternal warts at that time. Although the patient may wish to discuss the option of a caesarean section, this is not generally recommended, unless warts obstruct the vagina or cause extensive cervical disease.. "

Reference:

• Ooi C, Dayan L.STIs in pregnancy. An update for GPs. Aust Fam Physician. 2004 Sep;33(9):723-6.
• Goon P, Sonnex C.Frequently asked questions about genital warts in the genitourinary medicine clinic: an update and review of recent literature. Sex Transm Infect. 2008 Feb;84(1):3-7