The presence of HPV should not be a burden of concern for pregnant women.

Lesions caused by HPV:

Condylomata acuminata, genital wart: the most characteristic lesion are genital warts that look like small cauliflowers of 2-5 mm in diameter in the genitals and around the anus. Although they do not annoy much produce irritation and bleeding with the rubbing of clothing and are aesthetically quite unpleasant for the patient and his partner. This lesion is infectious for the couple but rarely generates cancer (serotypes 6 and 11 produce it). Excellent review (English) of all invented, effective treatments or not against warts caused by HPV

Subclinical lesion, cervical Dysplasia: find cytology (PAP) "changes consistent with HPV infection" begins the process of formal and thorough evaluation of the cervix. Most of these patients do not present any evidence of Verrucous lesions and the virus is found in the neck of the uterus without showing no symptoms. This type of infection, under the personal and viral features right, tends to be the trigger for the cervical cancer!

As you can see, the lesions caused by HPV during pregnancy are exactly like produced abroad. There is no distinction whatsoever if the infection is acquired before, during or after pregnancy.

How will my pregnancy for HPV affect?

In any of its two forms, condilomatosis or cervical Dysplasia, HPV directly affects the normal progression of your pregnancy or your baby's good health.

There is no direct relationship between HPV infection and the normal development of pregnancy and fetal health: recent data rule out complications maternal and fetal as infertility, birth prematurity, disorders of fetal growth or fetal malformations.

In the case of cervical pathology by HPV seems to be the progression of infection to premalignant stages very uncommon, and in our experience, we have never had a quick progressions of the Dysplastic as NICs forms simple HPV infection; and patients with NICs have not progressed to malignant changes. Of course, we have always made it an ablative treatment of injury when we are in the presence of NIC2 and 3 because we want to have control over the whole of the lesion.

In the case of Pathology condilomatosa of genital tract and external genitalia have seen disease skyrockets violently during the first two thirds of the pregnancy (in some patients) but almost invariably the lesions disappeared by full weeks before delivery. In some chaos injuries were so extensive that suspended all kinds of control of warts treatment and when we had given up the lesions disappeared spontaneously in a matter of days to a few weeks. This was really amazing. Warts can get bothered much by the friction and contact with clothing, in addition, some can infect and cause local problems with pain, suppuration, and skin infection type cellulite

In the case of your baby you can be calm because it is known that HPV does not affect the fetus.

What is the management of infection with human papillomavirus during pregnancy?

Cervical: If only HPV is present in the cervix without generating premalignant changes all that is required is assessed by smear or colposcopy the progression of infection every 3 months during pregnancy and after 3 to 4 months after delivery. If there is dysplasia and this is of severe degree (2 and 3 NICs) can think of performing an ablative procedure such as resection with diathermic handle taking care to remember that during pregnancy the cervix bleeding abundantly so we recommend that the procedure is carried out in the operating room and with the expertise and the appropriate equipment. The latter is very rare and most of the patients infected with HPV only require conservative surveillance

Condilomatosis: when there is Vulvovaginal condylomata may be recommended the use of substances caustic that locally applied control the number and size of lesions. It is much discussed if these lesions should be treated during pregnancy, but many patients so wish because of the inconvenience they suffer by friction, some of them bleeding or secondary infection. I particularly try to visible lesions to lower viral load and limit auto foci viral inoculation. We must remember that during pregnancy the lesions extend alarmingly in some patients and that it accomplished little with local therapy; You should not be forgotten that in the majority of patients the lesions tend to disappear spontaneously as we approach the end of the pregnancy. Substances such as podophyllin, 5-fluoracil or imiquimod can not use.

HPV during childbirth and the puerperium.

Childbirth or caesarean section?

HPV, even the oncogenic serotypes, is not a contraindication to vaginal birth. Although the baby is exposed to the virus d uring its passage by the risk of infection manifests birth canal is so low that the authorities in HPV do not consider that caesarean section should be practiced by the presence of the virus, but by the appropriate obstetrical reasons; It is believed that the newborn has antibodies that protect you from virus and that would explain the low rate of neonatal complications of HPV when we consider the large number of patients who stop their children vaginally in the presence of the virus.

The condition would be that it may occur in the newborn infected by HPV is the laryngeal Condilomatosis. This picture is presented with hoarseness, cough, and difficulty feeding due to the growth of condylomas in the vocal cords that narrow the airway light. It is known that lesions can appear up to 3 years after birth vaginally. The reported risk of this disease is 1:2000.

If the condilomatosas lesions are very extensive for the moment of birth we prefer a cesarean for fear that there is bleeding genital by disruption of the diseased tissue and of course to avoid the baby to pass through a region with high viral load.

In many cases we let the couple that the decision of a c-section due to the presence of HPV and the risk of laryngeal Papillomatosis, condition, though rare, is difficult to treat and is highly larigeo to future cancer risk and recurrent.

Management of HPV after birth

After the birth is expected to have the changes pregnancy and post-partum effect to be able to re-evaluate the patient. This is done between 6 and 12 weeks after the birth of the baby. Cytology is taken and practiced colposcopy and biopsy of tissue if necessary.