More than one-third of sexually active women have been exposed to at least one type of the human papillomavirus(HPV). Genital wart lesions (condyloma acuminata) often increase in size and area during pregnancy due to rel-ative immune suppression. If extensive, cesarean delivery may be necessary to avoid excessive trauma to the lower genital tract. In pregnancy, cryotherapy, laser therapy, and trichloroacetic acid may be used to treat genital HPV le-sions. Podophyllin, 5-fluorouracil, and interferon are not rec ommended, as they may be toxic to the fetus. Because there arelimited data regarding imiquimod use in pregnancy, it is generally avoided. Treatment of genital HPV lesions is often delayed until after pregnancy, as spontaneous reso-lution may occur. Transmission of HPV from mother to infant is very rare but manifests as laryngeal papillomato-sis. Cesarean delivery does not prevent perinatal transmis-sion of HPV.
Certain HPV types cause abnormal Pap test results and cervical dysplasia. Management of abnormal Pap test results inpregnancy is similar to that in nonpregnant women; however, biopsies and other excisional procedures are often deferred until the postpartum period. Close follow-up which may include a re-peat Pap smear and/or colposcopy in pregnancy is often performed instead. HPV infection and abnormal Pap smears as well as recommendations regarding the HPVvaccine are discussed elsewhere in the text.