Venereal warts: How did I get this and will it affect my labor and delivery?
I am 35 weeks pregnant and have been diagnosed with three small venereal warts on my vaginal walls. My midwife said that it isn't necessary to remove them unless they grow large enough to impede delivery. She says chances are that the warts will regress after pregnancy. If these are caused by HPV (human papilloma virus), did I necessarily contract it sexually? If so, I would have caught it seven or more years ago, yet my husband has never shown any signs of warts.Question:
Whether or not to treat venereal warts during pregnancy is controversial unless they are large enough to impede delivery. They almost always regress rapidly after delivery, probably due to the return of full immune function. A few authorities have advocated cesarean section to prevent neonatal laryngeal papillomatosis (development of warts on the vocal cords of infants) but cesarean birth does not prevent this in all cases. Fortunately, this is a very rare condition; one major study showed no cases among 44,000 women.
Some authorities feel that treatment with trichloroacetic acid (TCA) or liquid nitrogen is indicated in order to eliminate the external warts, especially if they produce discomfort. This is done not so much to prevent transmission to the newborn, but to reduce potential for involvement in an episiotomy or laceration repair.
Clinically, I have seen many women with warts on their hands, who also had venereal warts; I have never read literature indication this is a case of self-inoculation or if these women are just particularly susceptible to the wart virus.
HPV involves many strains, some of which produce cervical neoplasia and laryngeal papillomatosis, and some of which cause no problems at all. It is vital for women with a history of HPV to get a pap smear at least every year.
Sexual transmission is the vehicle for the spread of this virus throughout the population; we certainly see more of this lately, and it is associated with multiple partners. But, yes, women can suppress the virus and never transmit it to their partners.
It sounds as though your care provider understands this disease and is practicing within approved guidelines. Variations in practice reflect our lack of full understanding of the disease and its potential for transmission.
I would feel comfortable about requesting treatment with TCA and or liquid nitrogen, if this would make you feel better.Answer: