HPV and pregnancy: the implications on fertility

Human papillomavirus (HPV) is the most common sexually transmitted infection (STI). According to the Centers for Disease Control and Prevention (CDC), more than 80% of sexually active people will get HPV in their lifetime (NFID, 2019). Most of the time, HPV does not cause any symptoms and is cleared from your body. Sometimes it can linger and, depending on the type of HPV, lead to genital warts or cancer; low-risk HPV types 6 and 11 cause genital warts and high-risk types 16 and 18 lead to cervical cancer, among other diseases. Most cases of HPV infection occur in young women and young men in their teens, 20s, and 30s. What if you are pregnant or trying to become pregnant? What does HPV infection mean for you?

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Pregnant women with HPV usually do not have any symptoms, similar to non-pregnant women. If you have a particular strain of HPV (HPV types 6 or 11), you may develop genital warts, regardless of your pregnancy status. These can be flat or cauliflower-shaped lesions in your genital area, like the vagina or vulva, or around the anus. The difference is that due to the hormonal and immune system changes of pregnancy, your genital warts may be larger or greater in number.

Additionally, cervical cell changes may occur (cervical dysplasia) during pregnancy; these abnormal cells may not be an indication of precancerous lesions. Your healthcare provider will monitor these changes throughout pregnancy and after childbirth to see if they resolve or perform repeat Pap tests throughout your pregnancy. Let your provider know about any history of HPV, warts, abnormal Pap tests, or cervical procedures.

Several STIs, such as gonorrhea and chlamydia, are known to have a significant effect on fertility. Studies of HPV have shown that there is a potential link between HPV and infertility, for both men and women.

Multiple studies have reported that HPV can affect men’s sperm by decreasing sperm motility (how well they swim) and increasing the rate of sperm cell death; these mechanisms are not well understood (Pereira, 2015). Also, HPV is noted to be more prevalent in infertile men, and men with HPV have worse semen quality (Pereira, 2015). In women, HPV has been linked to a decreased ability of the fertilized embryo to implant in the wall of the uterus and an increase in embryo cell death (Pereira, 2015).

For the majority of women, HPV does not affect their pregnancy. There are many things about HPV that we still do not entirely understand. Many studies are investigating how HPV can affect pregnancy, and the results are not definitive. Some studies have shown that there is a possible association between HPV infection and the following (Pereira, 2015):

• Early membrane rupture — also called preterm rupture of membranes (PROM) — this is when the amniotic sac surrounding the fetus breaks before labor begins

• Premature birth — the baby is born before the 37th week of pregnancy 

• Increased rate of miscarriages 

More research needs to be done to understand HPV in pregnancy better. Talk to your healthcare provider if you have a history of HPV and are pregnant or trying to become pregnant.

Pregnant women usually get a Pap test (or Pap smear) during their first prenatal exam to test for HPV-affected cervical cells. This is the same test used for routine cervical cancer screening and may be accompanied by an HPV DNA test.

There is no treatment for HPV, only for the diseases that it may cause like genital warts or cervical dysplasia. If you have an abnormal Pap test, talk to your healthcare provider about your treatment options. Sometimes treatment will be done at that time or, depending on the diagnosis, it may be delayed until after the baby is born. Additional testing, like colposcopy, may be performed. Alternatively, your provider may decide to watch you with repeat Pap tests during your pregnancy and again after childbirth. In some cases, abnormal cervical cells found during pregnancy resolve after the baby is born.

If you have genital warts while pregnant, your provider will usually delay treatment until after you give birth, unless the warts are large and blocking the vagina (birth canal). Treatment may lead to early labor, so it is generally avoided unless absolutely necessary. If your genital warts have a high risk of bleeding during delivery, your provider may recommend a cesarean section.

HPV transmission from mother to baby during childbirth (also known as vertical transmission) is rare, less than 5% (Smith, 2010). However, the risk of vertical transmission is higher if the mother has HPV or genital warts before delivery. There have been reports of babies getting HPV in their throat, called respiratory papillomatosis, from mothers with genital warts at the time of delivery; however, this is not common. The transmission rates vary widely amongst the different studies, and more research is needed in this area to come up with a definitive answer. Regardless, you should talk to your healthcare provider about your HPV history.

There are currently three FDA-approved HPV vaccines: Gardasil, Gardasil-9, and Cervarix. However, the HPV vaccine is not recommended for pregnant women. There have not been any adverse effects reported from the few women who have gotten the HPV vaccine while unknowingly pregnant, but more research in this area is needed before it can be considered truly safe for the fetus. If you started getting the vaccine series before getting pregnant, you should wait until after delivery to get the remaining injections.

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Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

September 20, 2019

Written by

Chimene Richa, MD

Fact checked by

Tzvi Doron, DO

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About the medical reviewer

Tzvi Doron, DO

Dr. Tzvi Doron is Board Certified in Family Medicine by the American Board of Family Medicine.