Human Papilloma Virus infection is one of the most common genital infections. If HPV infection occurs on pre-existing pregnancy or is pre-existing, it is unlikely that it will complicate the development of the foetus or the health of the mother. We present the case of a secundigravida, whose HPV IgM and IgG titers and HIV test were found to be positive. Because of the presence of the vulvar condylomatosis it was decided to perform a caesarean delivery.
The new-born had no complication.
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3. Results and discussion
Human papillomavirus (HPV) is the most common sexually transmitted infection and at least 50% of sexually active people will get HPV at some time in their lives [1, 2].
HPV is the most prevalent genital infection, especially in young women of reproductive age. In vitro and animal model experiments provide compelling evidence of the harmful effect of HPV on pregnancy outcomes, but results from epidemiologic studies are inconclusive .
HPV and HIV each display interactions favouring the other infection at the cellular level. HPV infection favours HIV acquisition in women and men, and HIV-infected individuals encompass a heavier burden of HPV-induced dysplasia and cancer due to progressive immune suppression .
The study is a case report of a 24-year-old secundipara at 33 weeks of gestation presented with uterine contractions in the IInd Department of Obstetrics and Gynecology at the “Pius Brânzeu” County Emergency Hospital in Timisoara, Romania. At her first visit at 28 weeks was established the diagnosis of HPV and HIV infection. The patient had been counselled regarding mode of delivery and agreed for surgical intervention. Patient had an uncomplicated caesarean section at 33 weeks.
3. Results and discussion
A 24-year-old secundipara, at 28 weeks of gestation reported with uterine contractions in the IInd Department of Obstetrics and Gynecology at the “Pius Brânzeu” County Emergency Hospital in Timişoara, intensely pruritic, cauliflower like growth over external genitalia, labia major, extending up to labia minor and vaginal orifice (Fig. 1). There was no bleeding or ulceration. There was no history of trauma, drug intake, diabetes mellitus, oral ulcers, urinary complaints or bleeding or discharge per vaginum. There was no history of similar lesion in spouse. She did not give history of sexual encounter outside matrimony; husband’s history could not be elicited. First sexual contact was at 16 years of age.
General and systemic examination were unremarkable. Obstetric examination revealed a gravid uterus of 28 weeks size. At the ultrasound examination no foetal distress was evidence, the haemodynamic in the umbilical vessels were normal [5, 6, 7].
External genitalia showed soft, friable papillomatous growth with ill-defined margins over both labia major extending up to labia minor and vaginal orifice. Oral and nasal mucosa, eyes, nails, palms, soles, were normal. Per speculum examination showed normal healthy cervix and vaginal walls.
Routine biochemical and haematological investigations were normal. HPV IgM and IgG titers were found to be positive. HIV test was positive.
On arrival in the Department of Obstetrics and Gynecology at the Pius Brânzeu County Emergency Hospital in Timişoara at 33 weeks (Fig. 2) uterine contractions were noted every 10 minutes, she was afebrile at 35,9 C, with a pulse rate of 80 bpm, blood pressure of 115/82, fetal heart tones noted to be 133 bpm. Sterile vaginal exam indicated cervical dilatation of 2 cm with 50% effacement. It was decided to perform a cesarean delivery for the indications: previous cesarean section and vulvar condylomatosis. The weight of the baby at birth was 1,800 g, with a cranial circumference of 30 cm and an Apgar score of 9. Both she and the infant are doing well.
The risk factors consistently associated with HPV infection in women are early age of first sexual intercourse and male partner’s promiscuity . In this study the first sexual contact of the patient was at 16 years of age.
Factors that might influence selection of treatment include wart size, number, anatomic site, morphology, patient preference, cost, convenience, adverse effects, and provider experience.
Factors that might affect response to therapy include the presence of immunosuppression and compliance with therapy .
HPV induced lesions tend to get worse during pregnancy due to natural immune suppressive state. Warts may increase dramatically in size so as to obstruct urinary and reproductive passage. Also, a possibility of infecting the fetus exists at the time of labor. Hence caesarian section in such cases is the method of choice . Because in our case the genital warts obstruct reproductive passage, it was decided to perform caesarean section.
Perinatal transmission in different mucosa seems possible although the exact mode of transmission is not well understood. Most cases of vertical transmission may occur at delivery through direct contact of the foetus with maternal infected cells during vaginal delivery or at caesarean section following early membrane rupture . Transmission in utero is also possible through ascending infection from mother’s genital tract or HPV infected semen present in the vagina following sexual intercourse . The new-born was healthy. No infection was identified after birth .
The “wide area” sampling of the lower genital track detects HPV in multiple foci in the cervical and vaginal areas. Also, these are young women (18-30 years) who are more likely to be infected than older women and they obviously all had sexual activity (the most important risk factor for HPV) in a near past as they are pregnant . In our case the gravida was a young woman of 24-year-old with no cardiac or vessels pathology [15, 16, 17]. After one-year minim invasive methods of treatment were applied to correct the remained warts .
The correct management of pregnancy and childbirth reduces the rate of morbidity in the newborn. There are not enough studies to show that HPV infection can complicate pregnancy, increase the risk of spontaneous abortion, pre-term labor, preeclampsia or other pregnancy disturbances. Therefore, HPV tests are not routinely performed in pregnancy.
The presence of human papillomavirus (HPV) by itself should not affect the ability to get pregnant. But in some cases, having HPV can increase the risk of developing precancerous or cancerous cells in cervix, which could affect both fertility and ability to carry a baby to term.
MITRACHE Dana 
ILINA Razvan 
VRINCEANU Luminita 
BRISAN Laura 
 “Pius Brinzeu” Emergency Clinic County Hospital Timisoara, IInd Department of Obstetrics and Gynecology, Timisoara
 “Victor Babes” University of Medicine and Pharmacy Timisoara, Department of Surgery, Timisoara (ROMANIA)
 Medline, Tirgu Jiu (ROMANIA)
Contributo selezionato da Filodiritto tra quelli pubblicati nei Proceedings “4th National Congress of HPV - 1st Congress of the Society of Endometriosis and East-European Infertility - 2018”
Per acquistare i Proceedings clicca qui.
Contribution selected by Filodiritto among those published in the Proceedings “4th National Congress of HPV - 1st Congress of the Society of Endometriosis and East-European Infertility - 2018”
To buy the Proceedings click here.