Overview

Genital warts are a common sexually transmitted infection (STI) caused by the human papillomavirus (HPV). They present as small growths that appear on the skin of the genital or anal area. They are caused by specific strains of HPV, primarily types 6 and 11, which are considered low-risk because they do not cause cancer. HPV is transmitted through sexual contact and genital warts are one of the most common manifestations of the virus.

While not all individuals infected with HPV will develop warts, those who do may experience physical discomfort and emotional stress. HPV is highly prevalent, and many people may carry the virus without knowing it, as it often remains dormant in the body for months or even years before causing visible symptoms. Genital warts usually appear as single or multiple bumps that can vary in size and appearance. Some may be small, flesh-coloured, and smooth, while others can be larger, cauliflower-like, and more prominent.¹

Genital warts during pregnancy

The relationship between genital warts and pregnancy is a topic of concern for many expectant mothers. Understanding how genital warts affect pregnancy, the risk to the baby, and the treatment options available is crucial for ensuring the health and well-being of both mother and child.

During pregnancy, the immune system undergoes changes that can affect how the body responds to infections, including HPV. As a result, genital warts may grow more rapidly or increase in number during pregnancy. The hormonal changes, increased blood flow to the pelvic region, and changes in skin elasticity may contribute to the accelerated growth of warts.³

Impact on the mother

For pregnant women, genital warts can be a source of physical discomfort, particularly if they grow large or are located in areas prone to friction, such as the vagina or anus. In some cases, the warts may cause pain, bleeding or itching. However, genital warts themselves do not usually pose a direct threat to the pregnancy or the mother’s overall health.

Pregnancy is a time when the body undergoes numerous changes, and the presence of genital warts can complicate some aspects of care. For example, if the warts become too big, they may block part of the birth canal, potentially complicating a vaginal delivery. In such cases, a caesarean section (C-section) may be recommended to prevent trauma to the warts and to avoid potential transmission of HPV to the baby.⁴

Risk to the baby

One of the primary concerns for pregnant women with genital warts is the potential risk of transmitting HPV to their babies during childbirth. While the likelihood of this happening is relatively low, there is a possibility that the baby could contract a condition called laryngeal papillomatosis, or recurrent respiratory papillomatosis (RRP). This rare condition occurs when the baby develops warts in the throat or voice box, which can cause breathing difficulties.

However, it is important to note that RRP is extremely uncommon, and most babies born to mothers with genital warts do not develop any complications related to HPV. The virus is typically not transmitted to the baby through the placenta or amniotic fluid, and the risk of transmission occurs primarily during vaginal delivery.⁴

Diagnosis of genital warts in pregnant women

The diagnosis of genital warts during pregnancy is typically made through a physical examination by a doctor. In some cases, a biopsy may be performed to confirm the diagnosis, especially if the warts are unusual in appearance or if there is a concern about other types of growth.

It is important for pregnant women to inform their healthcare providers if they have a history of HPV or genital warts, as this can influence decisions regarding prenatal care and delivery. Regular prenatal check-ups provide an opportunity to monitor the condition and discuss any potential concerns.^3,4

Treatment of genital warts during pregnancy

The management of genital warts during pregnancy can be challenging, as some of the treatments typically used to remove warts may not be safe for use during pregnancy. Many wart-removal methods, such as certain topical medications, are contraindicated for pregnant women because they could pose risks to the developing foetus.

Treatment options

• Monitoring: In many cases, healthcare providers may recommend a conservative approach, particularly if the warts are not causing significant discomfort or complications. Genital warts often regress on their own after pregnancy when the immune system returns to its pre-pregnancy state
• Cryotherapy: Cryotherapy, which involves freezing the warts with liquid nitrogen, is considered a safe option during pregnancy. This treatment can be performed in a healthcare provider’s office and may be repeated over several sessions to fully remove the warts
• Trichloroacetic Acid (TCA): TCA is a topical chemical solution that can be applied to the warts to cause them to slough off. This treatment is safe for use during pregnancy and can be administered by a healthcare provider
• Surgical Removal: In cases where the warts are large or obstructing the birth canal, surgical removal may be necessary. This can be done through excision, using laser, or electrosurgery by a dermatologist. These procedures are usually only used as a last resource⁵

Treatments to avoid

Pregnant women should avoid over-the-counter wart treatments and certain prescription medications, such as podophyllin, podofilox, and imiquimod, as these are not recommended during pregnancy due to potential risks to the foetus.

Impact on delivery

For most women with genital warts, a normal vaginal delivery is still possible. However, if the warts are extensive or located in a way that could interfere with delivery, a C-section may be recommended. The decision to perform a C-section is typically based on the size and location of the warts, as well as the overall health of the mother and baby.

Healthcare providers will weigh the risks and benefits of vaginal delivery versus C-section and make a recommendation based on the individual circumstances. In cases where there is a concern about the risk of HPV transmission to the baby, a C-section may be considered, although this is not commonly needed.⁵

Postpartum considerations

After pregnancy, many women find that their genital warts regress or disappear as their immune system returns to normal. However, in some cases, the warts may persist or recur. Women who have had genital warts during pregnancy should continue to monitor their condition and follow up with their healthcare provider for any necessary treatment after delivery.

It is safe for a mother who has genital warts to breastfeed as HPV is not passed on to the baby via breast milk. However, women with warts on their breasts or nipples should take precautions to avoid direct contact with the baby’s mouth during feeding.⁵

Preventing genital warts during pregnancy

Preventing genital warts and HPV infection is important for sexually active individuals, especially those planning to become pregnant. The most effective method to prevent HPV transmission is vaccination. While it is recommended for boys and girls starting at ages 12 to 13, it can also be administered to individuals up to age 45. The vaccine can protect against up to nine strains of the virus, including those responsible for causing genital warts and certain types of cancer (cervical, anal, vulval, vaginal, penile and mouth). It is safe to have it while breastfeeding and generally also safe if you are pregnant, although your doctor may prefer to wait until the baby is born. For those who are already sexually active, using condoms or other barrier methods can help reduce the risk of HPV transmission, although they do not provide complete protection, as HPV can be transmitted through skin-to-skin contact.⁶

Summary

• If genital warts are properly managed during pregnancy, most women can have a healthy pregnancy and delivery
• While the warts themselves are not typically harmful to the mother or baby, they can cause discomfort and may complicate delivery in some cases
• Treatment options include cryotherapy, chemical and surgical procedures
• Breastfeeding is usually safe when the mother has genital warts only
• Understanding the risks, treatment options, and preventative measures related to genital warts and HPV can help expectant mothers make informed decisions about their health during pregnancy