Dealing with genital warts during pregnancy

It is important for a pregnant woman to go for antenatal care for early diagnosis and treatment. Photo / myafrobaby.com

What you need to know:

  •  She was a first time mom who had been referred from a smaller health centre for delivery. She had attended her antenatal clinics there but did not tell the midwife what afflicted her private parts.

Veronicah* lay on her bed facing the wall. She did not make a sound despite the painful contractions washing over her in waves. The only visible signs of her pain were the sweat beads on her brow and the paleness of her knuckles as she clutched tightly to the rail on the head of her bed.

 She was a first time mom who had been referred from a smaller health centre for delivery. She had attended her antenatal clinics there but did not tell the midwife what afflicted her private parts.

Veronicah had tested positive for HIV four years prior. She was pregnant after two long years of trying to conceive in marriage. Her husband Rodger, was present during their first clinic visit and they were both counselled and tested for HIV as was part of routine care. They were extremely shocked by the news that they were both HIV positive.

Depression
It was a harrowing moment for both of them but the counsellor did not give up. She religiously followed up on them and ensured they had both enrolled into the facility’s comprehensive HIV care clinic. Veronicah had a miscarriage and nearly sank into depression. It had been a long walk for the couple but eventually they were able to get on with their lives.

It took three years for them to take a leap of faith and try again. Veronicah was very scared of a recurrence of a miscarriage. She religiously counted the weeks to the birth of their baby, fervently praying to God for favour. By week 28, she was confident enough to shop for the baby.
At week 30, Veronicah noticed multiple dry growths around her genital area. She mentioned it in passing to the midwife at the clinic, who took a look and reassured her that it would pass. This did not really happen and although she could not see the growths anymore due to her large tummy, she knew something was not right.

Examination
When her husband took a break from field work in anticipation of the baby’s birth, Veronicah was too self-conscious to share her concerns. She simply cited the advanced pregnancy as the reason for avoiding intimacy. As a vaginal examination was not routinely required, the midwife never had an opportunity to see these growths. Her biggest concern was ensuring that Veronicah’s HIV viral load was low enough to allow for the safe delivery of the baby.

The D-day finally arrived and the apprehensive mother checked into the maternity unit. The unit was run by midwives and was capable of handling normal labour. However, upon review, the midwife found that Veronicah had widespread warts covering her genital area and even extending inwards to the vaginal canal. This was a no-go zone for the team and they quickly summoned an ambulance and referred Veronicah to us.

There was not much time for Veronicah and her baby. Her labour was advancing quickly and she could not be allowed to have a normal delivery. In between the contractions, I had to educate Veronicah about genital warts as I prepared her for surgery. She needed to learn so much about her condition but there was little time. We agreed to pick up the conversation after delivery but she understood that delivery by caesarian section was to avert complications for both mother and baby.

Immune suppression
Genital warts are caused by the Human Pappiloma Virus (HPV), commonly subtypes 6 and 11. They colonise the skin around the genital area and result in wart formation. These warts are generally small and will mostly disappear without treatment. However, in the face of immune suppression, they can grow extensively in size and number, all over the external skin and into the walls of the vaginal canal.

For Veronicah, being both HIV positive and pregnant served her a double portion of lowered immunity, causing the warts to grow like they were on steroids. They paused a serious risk of breaking off and bleeding uncontrollably if she had a vaginal birth.

 They also posed a risk of transmitting the HPV infection to the baby during delivery.
The good news is that Veronicah did not require any immediate treatment. The delivery of the baby went a long way in reversing the warts and the general rule of thumb is to review her in six months’ time. For many women, the warts will regress without treatment.

 For the few who experience persistence, surgery may be required to cauterise them. Veronicah was on the positive side of things, the warts went away as quietly as they had come.

What treatments are available to pregnant women?
The treatment of genital warts during pregnancy varies from case to case. Most of the time, your doctor will suggest not treating genital warts during pregnancy because they are so unlikely to cause any complications to the pregnancy or danger to the baby.

However, if you do really want to treat genital warts during your pregnancy, there are options:
● Freezing them using liquid nitrogen.
● Surgically removing them.
● Using laser currents to burn off warts.

It is normally advised that you avoid topical treatments and medical creams because of the risk of side effects that could impact your pregnancy. These treatments can also cause pain and irritation on sensitive skin.

If you want to treat genital warts while you are pregnant, you should consult your doctor, practice nurse or local sexual health clinic first.

Source: theindependentpharmacy.co.uk
Dr Nelly Bosire is an Obstetrician/gynaecologist