With respect to pregnancy, the increased prevalence, potential for precluding safe vaginal delivery, and possible maternal-fetal transmission of HPV are reviewed in this issue of Clinical Discussions. Recurrence following treatment is common, and more often results from reactivation of virus than from reinfection by sexual partners. Infected pregnant women also had greater amounts of HPV DNA in their cells. HPV growth is stimulated by estrogen and glucocorticoids. There are several treatment modalities available during pregnancy.
Spontaneous regression is also common, especially postpartum.
Extensive condylomata acuminata may become secondarily infected, resulting in chorioamnionitis, preterm premature rupture of the fetal membranes, and episiotomy dehiscence. Condylomata are extremely vascular, and vaginal delivery may result in extensive hemorrhage, and rarely, in maternal death. Cryotherapy, or in the case of extensive lesions, laser therapy, may be effective in removing enough of the lesions to allow successful vaginal delivery. Debulking of lesions may also reduce the viral inoculum, and in turn, the risk of HPV infection, to the neonate at the time of delivery. In 1871, MacKenzie noted the frequent association of skin warts and laryngeal papillomas.