HPV and Pregnancy

[moldy]

HPV and Pregnancy

[orangetree]

Cervix Treatment May Endanger Pregnancy Later

'Watch and Wait' or Laser Are Often Best Options for Cervical Dysplasia

By Jeanie Lerche Davis
WebMD Medical News Reviewed By Charlotte Grayson, MD
on Tuesday, May 04, 2004

May 4, 2004 -- It's a common condition for women: cervical dysplasia, or precancerous cells on the cervix. Women should carefully consider the treatment options, however. Some could jeopardize a pregnancy later, a new study shows.


The report appears in this week's issue of the Journal of the American Medical Association (JAMA).


In it, researchers outline risks involved with three treatments for cervical dysplasia. It's a big issue for young women, since the abnormal growths are caused by a near epidemic of human papillomavirus (HPV) infections. An estimated 80% of people in the U.S. are infected with various strains of this common virus.


Researcher Lynn Sadler, MBChB, MPH, a professor of obstetrics and gynecology at the University of Auckland in New Zealand, outlines the treatments:


Laser conization and laser ablation involve "burning" precancerous cervical tissue with a laser.
LEEP (loop electrosurgical excision procedure) involves cutting tissue with a low-voltage electrified wire loop.

Doctors have long debated the effects of "chipping away" at the cervix -- since the cervix supports the developing fetus in the uterus during pregnancy. Do these treatments put the fetus in jeopardy? Could membranes rupture prematurely, causing miscarriage? Also, because glands in the mother's cervix that produce protective substances can be destroyed during treatment, is the fetus at risk for infection?


One expert offered his opinion on cervical dysplasia treatments: "If it was my wife or daughter I would encourage her not to have anything done. Many studies show that 75% of these precancerous cells go away on their own," says Ira Horowitz, MD, vice chairman and director of gynecologic oncology at Emory University's Winship Cancer Institute in Atlanta.


How Babies Fare


In looking at these issues, Sadler and her colleagues studied medical records for more than 1,000 patients seen at a New Zealand cervical cancer clinic during a 12-year period. All the women were diagnosed with cervical dysplasia. Nearly half -- 425 women -- were not treated for their cervical lesions; 652 were treated with laser conization, laser ablation, or LEEP.


Sadler found no significant risk of preterm delivery with any treatment.


However, there was a significant risk of premature membrane rupture (or miscarriage):


Nearly a threefold risk of miscarriage with laser conization.
Double the risk with LEEP.
Laser ablation did not increase risk of miscarriage.

Also, the more procedures a woman had, the significantly greater her risk of both miscarriage and spontaneous preterm delivery -- nearly threefold risk -- compared with untreated women, Sadler reports.


The problem likely occurs when the cervix shortens in midpregnancy, explains Sadler. With a smaller cervix to support the fetus, membranes can rupture. Also, less immune-boosting protection from the mother's cervical glands and greater exposure to bacteria put the fetus at risk, she writes.


Her paper makes the case for conservative treatment of young women -- unless they are at high risk for developing cervical cancer. Recurrences of these abnormal cervical cells indicate higher risk, she explains.


Also, women are too often treated for cervical dysplasia the same day as their diagnosis, says Sadler. This often leads to a more radical procedure than is necessary. This same-day service "should be abandoned," writes Sadler. Women should be informed about the risks to future pregnancies. They should also be given antibiotics and steroids if they show early signs of miscarriage, she writes.


'Wait and Watch' Often the Best Option


With the "wait-and-watch" option, Pap smears every six months are necessary, Horowitz says.

But if treatment is needed -- if the lesion has advanced all the way up the cervix -- he does laser ablation because he can limit the width and depth of tissue damage.


LEEP is the most common procedure performed, mainly because the equipment is less expensive so doctors can perform it in their offices, explains Horowitz. "But too many doctors take too much extra tissue when they do LEEP." They don't want pathology reports that leave doubts about whether all abnormal cells have been removed, he explains.


"I've had young patients come to me with hardly any cervix left because they've had so many LEEP procedures," he says. "You can do many laser ablations, too, but you're taking a lot less tissue."

[mommi-is-home]

The risk of vertical transmission to the oral or genital region of newborns is rare

Sex Transm Dis. 2004 Jan;31(1):57-62.

Comment in:
Sex Transm Dis. 2004 Jan;31(1):63-4.

Human papillomavirus prevalence and types in newborns and parents: concordance and modes of transmission.
Smith EM, Ritchie JM, Yankowitz J, Swarnavel S, Wang D, Haugen TH, Turek LP.

Department of Epidemiology, College of Public Health, University of Iowa, Iowa City 52242, USA. elaine-smith@uiowa.edu

BACKGROUND AND OBJECTIVES: The purpose of this investigation was to determine the risk of vertical and early contact transmission of human papillomavirus (HPV) in newborn infants based on concordance and sequence match to HPV types in parents.

STUDY DESIGN: The genitals of pregnant women and newborns and oral cavity of parents and newborns were analyzed using polymerase chain reaction and DNA sequencing. Data were collected about reproductive health and risk factors for HPV.

RESULTS: Only one mother/newborn and no father/newborn pair was concordant for an HPV type. All other infected newborns had uninfected or discordant type infected parents.

CONCLUSION: The risk of vertical transmission to the oral or genital region of newborns is rare, and transmission between parents and the hospitalized newborn does not appear to occur. Lack of parent/child concordance suggests that newborns detected with HPV in their oral cavity or genitals could have become infected by their mother at untested intervals during pregnancy or in newborns with infection in the oral cavity by other contacts after birth.

PMID: 14695959 [PubMed - indexed for MEDLINE]

[KILLINGMESOFTLY]

the you for the info orangetree..........i've been just diagnosed and i was scared about that.......now i feel a whole lot better.

[rockgod]

HOW CAN I HAVE KIDS IF I HAVE THIS VIRUS AND MY GIRLFRIEND DOESNT? PLEASE HELP ME OUT. IM SO MISERABLE LATELY. MY DOCTOR HASNT REALLY TOLD ME ALOT ABOUT THIS SUBJECT.[color=red][/color]

[rockgod]

WHAT SHOULD I DO? SHOULD I TELL HER I HAVE IT? BECAUSE IF I DO THAT I RISK HER BREAKING UP WITH ME.

[need help 24]

[quote="rockgod"]:( [size=18][color=blue] HOW CAN I HAVE KIDS IF I HAVE THIS VIRUS AND MY GIRLFRIEND DOESNT? PLEASE HELP ME OUT. IM SO MISERABLE LATELY. MY DOCTOR HASNT REALLY TOLD ME ALOT ABOUT THIS SUBJECT.[color=red][/color[/color][/size]][/quote]



Hi I'm kate I find out that I have this to and my doctor today told me I can still have kids and by read some of this information that I got, said that the woman can but she dose it vaginal delivery the baby can exposed to HPV very rarely develops warts in the throat or voice box. I'm tell you this so you can tell her and I'm not trying to scary you at all.
Need help 24

[C36]

links to articles about hpv spread to infants in pregnancy. Note that many of these studys are talking about subclinical infection, ie spread of the virus but not neccessarily any problems ie warts or cancers or rrp.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Link&db=PubMed&dbFrom=PubMed&from_uid=15634997

[C36]

: Crit Rev Oral Biol Med. 2000;11(2):259-74. Links
Human papillomavirus infections in children: the potential role of maternal transmission.Syrjanen S, Puranen M.
Department of Oral Pathology and Radiology, Institute of Dentistry, Turku, Finland. stina.syrjanen@utu.fi

To date, more than 100 types of human papillomavirus (HPV) have been identified. In the past 20 years, there has been an increasing interest in HPVs because of their potential role in the pathogenesis of malignant tumors. HPV infections are known to affect predominantly adult, sexually active age groups, whereas skin warts, at various anatomic sites, are usually associated with younger individuals. The modes of viral transmission in children remain controversial, including perinatal transmission, auto- and hetero-inoculation, sexual abuse, and, possibly, indirect transmission via fomites. Recent studies on perinatal infection with HPV have been inconclusive. It is still unclear how frequently perinatal infection progresses to clinical lesions, whether genital, laryngeal, or oral. Conflicting reports have been published on the prevalence of HPV infections in children. The current consensus is, however, that newborn babies can be exposed to cervical HPV infection of the mother. The detection rate of HPV DNA in oral swabs of newborn babies varies from 4% to 87%. The concordance of HPV types detected in newborn babies and their mothers is in the range of 57% to 69%, indicating that the infants might acquire the HPV infection post-natally from a variety of sources. HPV antibodies have been detected in 10% to 57% of the children, and there is usually no correlation between seropositivity and the detection of HPV DNA in either the oral or the genital mucosa. There is also evidence that transmission in utero or post-natal acquisition is possible. The mode of in utero transmission remains unknown, but theoretically the virus could be acquired hematogenously, by semen at fertilization, or as an ascending infection in the mother. The understanding of viral transmission routes is important, particularly because several vaccination programs are being planned worldwide. The serologic response to HPV detected in different populations of young women or women at risk of cervical cancer might be due to genital infections, but the possibility that HPV infection has been acquired earlier in life through the oral mucosa or respiratory tract cannot be ruled out.

PMID: 12002819 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=12002819&query_hl=9&itool=pubmed_docsum

[please_knock]

Hi, I remember when I was diagnosed and freaking out (being a woman and thinking that it ment I wouldn't be able to have children) my doctor informed me that if delivered by c-section the baby is perfectly safe because it's not passing through any infected tissue that would be found in the birth cannel. Don't know if that helps any, but just through I'd throw that out there