Dear Dr Mitchell,
I'm a 23-year-old woman who is pregnant for the first time. Ever since I found out I was pregnant I have noticed these little warts growing on my vagina. At my regular check-up I told the doctor about my situation and he said due to the fact that I am pregnant, it's difficult to treat the warts because of the baby. What are these warts? I am really concerned because they are increasing. Is there any way to remove them without harming the baby? I am seven months along.
The problem that you are experiencing is genital warts which are caused by the human papilloma virus. This virus is sexually transmitted and is extremely common. Once you have ever been sexually active, you are at risk of contracting the HPV infection. In pregnancy, due to the hormonal changes, women tend to have an increase in the number and size of genital warts. The infection might have been there for a long time and then becomes very pronounced and obvious as the pregnancy progresses.
Women who have the HPV infection can sometimes clear their systems of the virus with time, especially if their immune systems are good. Women who are diabetic, on steroids, or who have the human immunodeficiency virus can have a significant increase in the size and number of genital warts in pregnancy because these conditions interfere with the immune system.
Genital warts can be treated by surgically removing them. These can be either burnt off or cut away by a simple outpatient procedure done using local anaesthesia. It is important to have them removed before delivery to reduce the chance of your baby contracting the virus during delivery.
The human papilloma virus can cause the baby to get the infection in the larynx or throat and this can cause cancer in adult life if the infection is persistent. You will also need to have a pap smear done to determine if the HPV has also infected the cervix. This can put you at risk for cervical cancer. A colposcopy should be done at the time the warts are removed to establish if the cervix and vagina are also involved.
Your partner will also need to be examined to see if he has any obvious genital warts that will need to be removed. This will help to reduce your risk of recurrence. Sometimes men do not show any obvious sign of virus in what appears to be normal tissue on the penis, scrotum or inner thighs. Condom usage reduces your risk of exposure to the human papilloma virus but does not completely prevent it because the virus may be present in areas that the condom does not cover.
All women should get a pap smear done every year once over the age of 21 or starting three years after sexual activity if under 21. All women between the ages of 10 years to 55 years should receive the vaccine to prevent cervical cancer. Cervical cancer is caused mainly by the human papilloma virus types 16, 18, 31 and 45. CERVARIX is the vaccine that will give you long- lasting protection against these four main types that cause most cases of cervical cancer. The vaccine should be administered after you have delivered and expressed breastfeeding.
There is a cream called ALDARA that can be used to treat genital warts but this is not recommended for use in pregnancy so you will need to have the warts burnt off. Consult your doctor who will advise you further on this matter.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@ jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 968-2025. Dr Mitchell cannot provide personal responses.
The contents of this article are for informational purposes only and must not be relied upon as an alternative to medical advice or treatment from your own doctor.