Can HPV Be Transmitted to the Fetus?
Yes, HPV can be transmitted from mother to fetus/newborn, but this occurs rarely and the transmission route is not completely understood. 1
Transmission Mechanisms and Frequency
The route of HPV transmission to infants remains incompletely understood and may occur through multiple pathways 1:
- Transplacental transmission (during pregnancy through the placenta) 1
- Perinatal transmission (during passage through the birth canal) 1
- Postnatal transmission (after birth) 1
Recent high-quality evidence from the 2023 HERITAGE cohort study found that neonatal HPV detection occurred in only 7.2% of infants born to HPV-positive mothers, with the conjunctiva being the most frequent site (3.2%), followed by the mouth (2.9%) and genital area (2.7%). 2 Importantly, all HPV detected in children at birth cleared before 6 months of age in this cohort. 2
Clinical Significance: Respiratory Papillomatosis
The primary clinical concern regarding perinatal HPV transmission is juvenile-onset recurrent respiratory papillomatosis (JORRP), caused by HPV types 6 and 11 1:
- This condition can cause warts on the infant's larynx 1
- It is rare 1
- Can potentially lead to aphonia or severe respiratory obstruction 3
- May develop during the first 5 years of life 3
Pregnant women with genital warts should be counseled about the low risk of laryngeal papillomatosis in their infants. 1
Cesarean Section Is NOT Recommended for HPV Prevention
Cesarean delivery should NOT be performed solely to prevent HPV transmission to the newborn. 1 This is a critical clinical point because:
- The preventive value of cesarean section for preventing HPV transmission is unknown 1
- Laryngeal papillomatosis has occurred even in infants delivered by cesarean section 1
- Whether cesarean section prevents respiratory papillomatosis remains unclear 1
Cesarean delivery is indicated only when 1:
- The pelvic outlet is obstructed by genital warts
- Vaginal delivery would result in excessive bleeding
Prevalence and Natural History in Pregnancy
HPV infection is common during pregnancy, with prevalence ranging from 31-40% in recent studies 3, 2:
- The 2023 HERITAGE study found 40.3% of pregnant women were HPV-positive at recruitment 2
- Among HPV-positive pregnant women, 66.4% harbored at least one high-risk genotype 2
- Genital warts can proliferate and become friable during pregnancy 1
Placental HPV detection occurred in 10.7% of placentas overall, but only 3.9% of biopsies from the fetal side under the amniotic membrane were positive, suggesting most placental detection may represent contamination rather than true infection 2
Clinical Management During Pregnancy
Treatment of genital warts during pregnancy can be considered, though resolution may be incomplete until after delivery. 1
Contraindicated treatments during pregnancy include 1:
- Imiquimod
- Podophyllin
- Podofilox
- Sinecatechins
Safe treatment options include 4:
- Trichloroacetic acid (TCA)
- Liquid nitrogen cryotherapy
- Laser ablation
- Electrocautery
Key Clinical Pitfalls to Avoid
Do not perform cesarean section solely for HPV prevention - this is not supported by evidence and exposes the mother to unnecessary surgical risks 1
Do not withhold counseling - pregnant women with genital warts should be informed about the low (but present) risk of respiratory papillomatosis 1
Recognize that most neonatal HPV clears spontaneously - the 2023 data shows all detected infections cleared by 6 months, suggesting transient contamination rather than persistent infection in most cases 2
Avoid teratogenic treatments - ensure proper medication selection during pregnancy 1