Observational Management of Genital Warts in Pregnancy

Objective/methods: Condyloma in pregnancy is strongly predictive of juvenile-onset respiratory papillomatosis in children. Supported by the observation that genital warts often grow during pregnancy, gynecologists ever since have focused on safe and efficient treatment strategies. Medical treatments traditionally are avoided. Therefore, surgical ablation of all warts has become the standard of care in most institutions. However, anesthesia is required and premature contractions often occur. We collected data of 46 women from our colposcopy unit (1998 to 2003) to evaluate different treatment strategies.

Results: 20 women were treated by LASER vaporization right away, if clinical findings were only little or delivery could be expected soon. In 26 cases of larger condyloma went for observation. No surgical procedures were undertaken in these women before fetal lung maturity could be assumed. 6 patients received complete ablative therapy in week 35. 20 patients had no surgery in pregnancy at all, 6 of which showed complete spontaneous remission at follow-up (week 34). 2 more showed remission at a post partum control, and 10 patients then reported to be free of warts. Only 2 women received post partum treatment due to cervical dysplasia; one patient who had attended immediate treatment showed recurrence at delivery. No c-sections were performed due to condyloma. No case of respiratory papillomatosis has been reported.

Conclusions: While smaller condyloma lesions in pregnant women can be treated easily under local anesthesia, there is no reason for extensive surgery before week 35. In contrary, wait-and-see strategy in larger Condylomata acuminata during pregnancy can lead to spontaneous regression of lesions in a considerable proportion of patients.