HPV and Vaginal Delivery

11.12.10: Do I need a c-section?


One of my readers wants my opinion on HPV and vaginal birth. I’m for it. Not HPV, of course, but vaginal birth is usually no problem for women who have HPV or human papillomavirus.

HPV is a group of more than 100 viruses. About 40 are transmitted through sexual activity, usually vaginal or anal sex. A few of these 40 are high-risk types that can (but usually don’t) cause cervical cancer. A few are low-risk types because they can (but don’t always) cause vaginal warts. Vaginal warts aren’t pretty, but they aren’t usually dangerous. The rest of those hundred HPVs just hang around in the body without causing any symptoms or problems.

HPV is the #1 most common sexually transmitted disease and more than half of all sexually active adults between the ages of 15 and 49 have it and don’t realize it. They’ll recover from it all on their own without ever having symptoms or problems or needing any treatment. The only way most women know they’ve been exposed to HPV is because they develop genital warts or it shows up on their Pap Smear.

Here’s what the Department of Health and Human Services says about high-risk HPV:

Having high-risk HPV is not the same as having cervical cancer. But high-risk HPV can lead to cancer. Most often, high-risk HPV causes no health problems and goes away on its own. High-risk HPV cases that don’t go away are the biggest risk factor for cervical cancer.

We’ve heard a lot about HPV in the last several years because of Gardasil, a vaccination marketed to young girls and women through their One Less Campaign. Super cool girls do stuff like knit while practicing roller derby and say “I’m going to be One Less,” [to get cervical cancer]. It’s a major marketing campaign and will no doubt have a positive affect down the road on diminishing cervical cancer rates. But it doesn’t protect against all HPV viruses; only the few that cause cervical cancer.

Even though most cases of cervical cancer are caused by HPV; most women who get HPV will not get cervical cancer. Gardasil does not protect against the type of HPV that cause warts. You can’t get a Gardasil vaccine while you’re pregnant. Doctors can remove the warts by freezing, excising or applying topical solutions, but they might come back. There is no cure for HPV. Our immune system usually just fights it off on its own.

I’m thinking my reader was concerned about HPV either because she has genital warts or because her Pap smear came back indicating HPV. I asked Heather Weldon, MD, OB-GYN in Portland, OR if HPV has any affect on normal vaginal delivery. Weldon says, “It’s pretty common to carry HPV while pregnant. For the vast majority of affected moms, it doesn't present any risk for the fetus during pregnancy or at the time of delivery. However, for the woman with a heavy vaginal or external genital wart infection (in other words, a large amount of viral load or presence), she may be advised by her provider to avoid vaginal birth to minimize transmission to the baby at the time of delivery. Often times warts will grow or multiply during pregnancy, so it's highly dependent on the amount present closer to birth. It's really the women who have cauliflower-like lesions all over their external genitalia that are risky. A few small, scattered warts aren't a problem. It is safe to treat them locally with freezing and other topical in-office treatments.” Most women won’t get cauliflower warts.

And what does the Department of Health and Human Services say?

Most women who had genital warts, but no longer have them, do not have problems during pregnancy or birth. For women who have genital warts during pregnancy, the warts may grow or become larger and bleed. In rare cases, a pregnant woman can pass HPV to her baby during vaginal delivery. Rarely, a baby who is exposed to HPV gets warts in the throat or voice box. If the warts block the birth canal, a woman may need to have a cesarean section (C section) delivery. But HPV infection or genital warts are not sole reasons for a C section.

That part about infecting the baby is a worry, right? Well, not very often and c-section isn’t necessarily a big help. Here’s what the CDC says about it:

HPV types 6 and 11 can cause respiratory papillomatosis in infants and children. The route of transmission (i.e., transplacental, perinatal, or postnatal) is not completely understood. Whether cesarean section prevents respiratory papillomatosis in infants and children is unclear; therefore, cesarean delivery should not be performed solely to prevent transmission of HPV infection to the newborn. Cesarean delivery might be indicated for women with genital warts if the pelvic outlet is obstructed or if vaginal delivery would result in excessive bleeding. Pregnant women with genital warts should be counseled concerning the low risk for warts on the larynx (recurrent respiratory papillomatosis) in their infants or children. No controlled studies have suggested that cesarean section prevents this condition.

So there you have it. Unless you have such giant warts that they’re blocking baby’s way out, you can go ahead and delivery vaginally.

Jeanne Faulkner, R.N., lives in Portland, Oregon with her husband and five children. Got a question for Jeanne? E-mail it to labornurse@fitpregnancy.com and it may be answered in a future blog post.

This Fit Pregnancy blog is intended for educational purposes only. It is not intended to replace medical advice from your physician. Before initiating any exercise program, diet or treatment provided by Fit Pregnancy, you should seek medical advice from your primary caregiver.