HPV and Pregnancy: Does It Affect My Chances to Conceive?
Human papillomavirus (HPV), or genital warts, is the most common sexually-transmitted infection (STI) in the United States. One of the primary concerns you may have if you are diagnosed with HPV is whether it will affect your ability to get pregnant. Rest assured that, in most cases, having HPV will not affect your fertility. Still, here are some important things you should know about HPV and pregnancy.
What is HPV?
HPV stands for human papillomavirus. There are many strains of HPV that can cause warts in various parts of the body. The type of HPV we are talking about, however, is transmitted through sexual activity and spreads via genital-to-genital or oral-to-genital contact. There is no cure for HPV, but there are treatments for its symptoms.
Signs and Symptoms
You are most likely to get HPV if you engage in unprotected sexual activity, whether that is oral sex or penetrative sex without the use of a barrier method. However, HPV can still spread even when using protection, if you come into contact with areas of active infection that are not covered by a condom or dental dam.
Once you have it, HPV can cause a number of symptoms, including but not limited to:
- Genital warts. This is the most common sign of HPV infection. Genital warts are small, flat, cauliflower-like lesions on the vulva, anus, penis, or scrotum. They rarely cause pain but may itch or feel tender. You can catch HPV from a sexual partner by coming into contact with unprotected areas of active genital warts.
- Oral warts. If you perform oral sex on a partner with an active HPV infection, you might get warts in your mouth or throat. Sometimes, this is known as oral HPV. Oral HPV can also cause hoarseness and difficulty swallowing.
- No symptoms. It’s important to know that not all types of HPV cause genital or oral warts. Some types of HPV cause no symptoms at all. However, HPV without symptoms can still have consequences on your health later in life. Even if you do not have symptoms, you can still have one of the strains of HPV that may eventually lead to cancer.
How is HPV Diagnosed?
Many times, your doctor may be able to diagnose HPV by looking at areas of genital or oral warts. However, they may perform other tests to confirm the diagnosis, or to screen for HPV when symptoms are not present. These tests include:
- Vinegar (acetic acid) test. Flat lesions of genital warts can be difficult to see. Applying a solution of vinegar — a.k.a. acetic acid — to genital warts caused by HPV turns them white, making them easier for your doctor to identify and differentiating them from other conditions.
- Pap smear. Women are recommended to begin having a Pap smear test to screen for HPV beginning at age 21. For this test, your primary care provider or gynecologist will use a speculum and a small brush to collect cells from your cervix. If your Pap smear test comes back abnormal, your doctor will perform a DNA test on the cells from your cervix to see if the abnormalities are caused by one of the strains of HPV responsible for cervical cancer. There is no such screening test currently available for men.
How is HPV Transmitted?
You can get HPV from any type of unprotected sexual activity involving genital-to-genital or oral-to-genital contact. However, if there are any areas of active HPV lesions that are not covered by a condom or dental dam, it’s still possible to get HPV during protected sexual activity.
Does HPV affect chances to conceive?
If you have HPV or are concerned about your exposure to HPV, and are also trying to conceive, you may be concerned about whether HPV could negatively impact your fertility. Here’s what you need to know about HPV and trying to conceive.
Can you get pregnant with HPV?
You can still get pregnant if you have HPV. The virus itself will not render you infertile, but certain HPV treatments may make it more difficult for you to get pregnant. This means that if you have HPV and do not want to get pregnant, you still need to use a birth control method to prevent pregnancy.
Does HPV affect fertility?
Despite what you may have heard, HPV itself does not make women infertile. However, certain treatments for removing abnormal or cancerous cells caused by HPV can temporarily or permanently impact your ability to get pregnant as these treatments change the structure of the cervix and/or the consistency of your cervical mucus. HPV treatments that can impact female fertility include:
- Cryotherapy. Topical ointments are typically the first line of treatment for genital warts caused by HPV. If these topical treatments do not work, your doctor may recommend cryotherapy, or “freezing off” genital warts. This procedure might temporarily change the consistency of your cervical mucus, making it more difficult for sperm to reach an egg.
- Cone biopsy. If you have abnormal cells on your cervix you might need to have part of your cervix removed to make sure you don’t have cervical cancer. This procedure changes the structure of your cervix and may lead to cervical stenosis, or narrowing of the cervical opening. This can make it more difficult for sperm to fertilize an egg.
- Loop electrosurgical excision procedures (LEEP). LEEPs remove abnormal cells from the cervix using an electrically-charged wire loop to prevent these cells from turning into cancer. Your doctor might recommend a LEEP if your Pap smear results come back abnormal or if they find precancerous cervical polyps during a gynecological exam. LEEP can cause difficulty getting pregnant for the first year after the procedure.
Sometimes, these treatments may also weaken the cervix, leading to cervical insufficiency. This widening and thinning of the cervical opening does not cause difficulty getting pregnant, but may make it more challenging for you to carry a pregnancy to term.
Does HPV Affect Pregnancy?
If you have been recently diagnosed with HPV or infected with HPV in the past, you might be concerned about how this virus could impact your pregnancy. Thankfully, most women with HPV do not need to worry. While pregnancy can worsen HPV symptoms, it usually will not affect your long-term health or the health of your baby.
HPV Pregnancy Guidelines
Most of the time, genital warts clear up on their own with time, meaning that pregnant women do not require treatment. Large or bothersome warts can be removed with cryotherapy or excision. If your Pap smear test found abnormal cells, your doctor may want to treat you with a LEEP procedure or cone biopsy. However, they will likely wait until after you deliver to treat you to reduce the risk of cervical insufficiency and other complications.
It’s important to know that changing hormones during pregnancy can worsen the symptoms of HPV. As you produce more vaginal discharge during pregnancy, the warm, moist environment provides ideal conditions for warts to grow faster and larger. Rarely, genital warts caused by HPV can grow large enough to block the entrance to the vagina. This can make vaginal delivery difficult or even impossible. In the unlikely event this happens during your pregnancy, your doctor may recommend a C-section.
Can HPV be spread to a baby?
While some studies show that as many as 11% of newborns born to mothers with HPV tested positive for the virus, it does not usually pose a risk to an unborn baby. In fact, most babies who develop HPV in utero will clear the virus before birth with no long-term complications.
Rarely, genital or oral warts can spread to the baby. If warts grow on the vocal cords, a complication called recurrent respiratory papillomatosis can occur. These growths are benign, or non-cancerous, but can cause hoarseness, chronic coughing, and problems swallowing. Severe or aggressive cases may need surgery to remove the growths.
What is the treatment for HPV?
Genital warts due to HPV can be treated with topical treatments, cryotherapy, or excision. If they cause abnormal cervical cells to form, you may need more aggressive treatment with a LEEP procedure or cone biopsy.
However, the best treatment for HPV is prevention. HPV can be prevented through abstinence and vaccination. Because abstinence is not realistic for most of us, especially if we are trying to conceive, everyone should be vaccinated against HPV.
HPV Vaccine Before Pregnancy
Ideally, female adolescents should be vaccinated for HPV with the Gardasil 9 vaccine between the ages of 11 and 26 (21 for males). This vaccine is delivered as a series of two or three doses, depending on how old you are when you get the vaccine. However, If you were not previously vaccinated for HPV, current guidelines state that adults between the ages of 27 and 45 should still get the Gardasil 9 vaccine.
HPV Vaccine After Pregnancy
If you are currently pregnant and are not vaccinated against HPV, your doctor will likely recommend you get the vaccine after giving birth. Current guidelines do not recommend the Gardasil 9 vaccine for pregnant women.
✔️ Medically Reviewed by Dr Roohi Jeelani, MD, FACOG and Lauren Grimm, MA
Dr Roohi Jeelani is Director of Research and Education at Vios Fertility Institute in Chicago, Illinois. Dr Jeelani earned her medical degree from Ross University School of Medicine in Portsmouth, Dominica. She then completed a residency in Obstetrics and Gynecology and a fellowship in Reproductive Endocrinology and Infertility at Wayne State University, Detroit Medical Center, where she was awarded a Women’s Reproductive Health NIH K12 Research Grant. She is board certified in Obstetrics and Gynecology. Dr Jeelani has authored numerous articles and abstracts in peer-reviewed journals, and presented her research at national and international scientific meetings. A Fellow of the American College of Obstetrics and Gynecology, Dr Jeelani is a member of the American Medical Association, the American Society of Reproductive Medicine, and the American Association of Gynecologic Laparoscopists.
Lauren Grimm is Research Coordinator at Vios Fertility Institute in Chicago, Illinois. Lauren earned her bachelor’s degree from Loyola University Chicago, where she also completed her masters in Medical Sciences. Lauren has worked alongside Dr. Jeelani for the last 3 years, authoring a number of abstracts and articles in peer-reviewed journals, and presented her research at national and international scientific conferences. Lauren will be continuing her education this fall at Rush University Medical College in Chicago, IL as an MD candidate.
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