Management of Genital Warts in Pregnancy

Diagnosis and Treatment

The Centers for Disease Control and Prevention (CDC) recommends cryotherapy with liquid nitrogen as the most appropriate management for pregnant women with genital warts, with efficacy rates of 63-88% and recurrence rates of 21-39% 1
Cryotherapy with liquid nitrogen can be applied to each wart individually, repeated weekly if necessary, and is safe during pregnancy 1
Trichloroacetic acid (TCA) 80-90% can be used to treat genital warts, applied only to warts, allowed to dry until white "frosting" develops, and neutralized with talc or sodium bicarbonate, with the option to repeat weekly as needed 2, 3
Surgical removal is reserved for large or treatment-resistant warts and may be necessary if warts are obstructing the birth canal 1, 2
Podophyllin and podofilox are contraindicated in pregnancy due to potential systemic absorption and risk of teratogenicity 1, 2, 3
5-fluorouracil is not recommended for genital warts and is contraindicated in pregnancy 1

Genital warts may proliferate and become friable during pregnancy due to hormonal changes and relative immunosuppression 2, 3
Many experts advocate removal of visible warts during pregnancy to reduce complications during delivery 1, 2
Cesarean delivery is not indicated solely for prevention of HPV transmission to the newborn, but may be considered if warts obstruct the birth canal or if vaginal delivery would result in excessive bleeding 2, 3

Patients should be monitored for recurrence, which is common, especially in the first 3 months after treatment 2
There is no need for colposcopy based solely on the presence of genital warts 1, 2
Genital warts caused by HPV types 6 and 11 are not associated with cervical cancer 3
The use of condoms may reduce transmission to uninfected partners 1, 2

Patients should be educated about the risks of transmission to uninfected partners and the newborn, as well as the potential for recurrence despite appropriate treatment 1, 2