Fewer topics in obstetrics and virology will generate stronger opinions backed only by anecdotal data than the issue of human papillomavirus (HPV) infection during pregnancy. Any effort to address the topic of management of the pregnant patient with genital HPV must confront the vast literature from virologists, epidemiologists, obstetrician-gynecologists, dermatologists, and ears, nose, and throat specialists, each with its particular medical and philosophic bias. Few consensus opinions among these diverse disciplines exist, although most would agree that (1) HPV genital infections in women (and men) have increased dramatically in the past two decades, (2) our ability to detect smaller amounts of HPV DNA continues to improve, and (3) laryngeal papillomatosis (by far the worst neonatal “outcome” of maternal HPV infection) is an uncommon but potentially devastating problem best treated by prevention, if possible. The situation has become more complicated by the inevitable arrival of personal injury attorneys seeking damages for nonprevention of laryngeal papillomatosis by failure to perform prophylactic cesarean section in women with genital HPV infection. In addition, some effective therapies for HPV are medically contrain- dicated during pregnancy because of theoretical adverse fetal effects, thereby limiting our available “arsenal” against this agent.
KeywordsHuman Papilloma Virus Obstet Gynecol Genital Tract Lower Genital Tract Clin Obstet Gynecol
Unable to display preview. Download preview PDF.
- 3.Stone KM. Epidemiologic aspects of genital HPV infection. Clin Obstet Gynecol 1989; 1: 112–116.Google Scholar
- 9.Manos MM, Ting Y, Wright DK, Lewis AJ, Broker TR, Wolinsky SM. Use of polymerase chain reaction amplification for the detection of genital human papillomaviruses. In: Furth M, Greaves M, eds. Cancer Cells 7: Molecular Diagnostics of Human Cancer. New York: Cold Spring Harbor Laboratory Press; 1989: 209–214.Google Scholar
- 10.Greennberg H, Mann WJ, Chumas J, Zuna R, Patsner B. Cervical and vaginal pathology in women with vulvar condylomata. J Reprod Med. 1987; 32: 801–804.Google Scholar
- 15.National Cancer Institute Workshop. The 1988 Bethesda System for reporting cervi-cal/vaginal cytologic diagnoses. JAMA. 1988; 262: 931.Google Scholar
- 17.Ullman EV. On the etiology of the laryngeal papilloma. Acta Otolaryngol. 1923; 5: 317.Google Scholar
- 24.Tang CK, Shermeta DW, Wood C. Congenital condylomata acuminata. Am J Obstet Gynecol. 1978;131:912. Bruce Patsner, David A. Baker, and Earl JackmanGoogle Scholar
- 29.Sedlacek TV, Lindheim S, Eder C, et al. Mechanism for human papillomavirus transmission at birth. Am J Obset Gynecol. 1989; 161: 55–59.Google Scholar
- 30.Chriastiansen PL, Jorgensen K, Gontued A. Juvenile papillomatosis of the larynx. Acta Otolaryngol. 1984; 412 (suppl): 37.Google Scholar
- 31.Lindbergh H, Elbrond 0. Laryngeal papillo-mas: The epidemiology in a Danish subpopulation 1965-84. Clin Otolaryngol. 1990;15:125– 131.Google Scholar
- 33.Schneider A. Methods of identification of human papillomaviruses. In: Syrjanen K, Gissman L, Koss LG, eds. Papillomaviruses and Human Disease. Berlin: Springer-Verlag; 1987; 19–39.Google Scholar