For unknown reasons, genital warts frequently increase in number and size during pregnancy. hese lesions may sometimes grow to fill the vagina or cover the perineum, thus making vaginal delivery or episiotomy diicult. Maternal HPV infection does not appear to be related to preterm labor (Subramaniam, 2016).
Genital wart eradication during pregnancy is usually not neces sary unless they are symptomatic. herapy is directed toward ity to the mother and fetus. Several agents are available, but no deinitive evidence supports superiority of one over another (Workowski, 2015). Response to treatment during pregnancy may be incomplete, but lesions frequently improve or regress rapidly following delivery.
Trichloroacetic or bichloracetic acid, 80-to 90-percent solu tion, applied topically weekly, is an efective regimen for external warts. Some prefer cyotherapy, laser ablation, or surgical excision.
Agents not recommended in pregnancy because of concerns for maternal and fetal safety include podophyllin resin, podoilox solution or gel, imiquimod cream, and sinecatechins.
There are three vaccines available for long-term prevention.
Gardasil (HPV 4) is a quadrivalent vaccine against HPV types 6,11, 16, and 18. his is being replaced by Gardasil9 (HPV9), a nonavalent vaccine that protects against all the types in HPV 4 plus types 31,r33,r45, 52, and 58. Cervarix (HPV2) is a bivalent vaccine against HPVs 16 and 18. One of these vaccines is selected and given as a three-dose series on a schedule of 0, 1-2, and 6 months for those aged 15 to 26 years. A two-dose regimen, given at 0 and again at 6 to 12 months, is now recommended for girls aged 9 to 14 years (Meites, 2016). Vaccines are licensed for females aged 9 to 26 years, and the target age is 11 to 12 years. he vaccines are not recommended for pregnant women, however, inadvertent exposures do occur. No adverse pregnancy outcomes are associated with the vaccines (Moreira, 2016; Panagiotou, 2015; Vichnin, 2015). If a woman is found to be pregnant after starting the vaccination series, the remaining doses are delayed and given after delivery (American College of Obstetricians and Gynecologists, 2017a). Women who are breastfeeding may receive the vaccine.
Vertical transmission rates ofHPV to the newborn are minimal. Juvenile-onset recurrent respiratory papillomatosis QoRRP) is a rare, benign neoplasm of the larynx. It can cause hoarseness and respiratory distress in children and is most often caused by HPV 6 or 11. Risks for infection are maternal genital HPV infection and longer labors (Niyibizi, 2014). Many newborns are likely exposed to HPV, but few develop JoRRP (Silverberg, 2003; Smith, 2004; Tenti, 1999). For example, the national incidence of JoRRP in 2006 in the United States ranged from 0.5 to 1 per 100,000 children (Marsico, 2014).
The beneit of cesarean delivery to decrease transmission risk is unknown, and thus it is currently not recommended solely to prevent HPV transmission (Workowski, 2015). HPV vaccination may ultimately decrease JoRRP rates in the uture (Matys, 2012).