Human Papillomavirus Infection at the Time of Delivery

Human papillomavirus (HPV) is one of the most encountered viral etiologies of genital infections that are transmitted through the sexual route in sexually active females. In the genital area, condylomata acuminate warts and the Buschke-Loewenstein tumor (giant condyloma acuminatum) are described. These lesions are associated with benign HPV6 and HPV 11 types. Condylomata acuminate may appear as exophytic growth similar to a cauliflower and is usually asymptomatic. The Buschke-Loewenstein tumor appears as ulcerated cauliflower-like lesions, often associated with fistulas and abscesses. They present exophytic and endophytic growth, local invasion, and high recurrence rates. This type of lesion may be associated with malignant HPV types. Here we present the case of a 34-year-old year pregnant woman who presented herself at the emergency room in labor with no previous medical evaluation during the pregnancy. The local examination revealed normal pubic hair, vulvar hyperpigmentation, and tonic and continent anal sphincter. At the vulvar level, a bulky cauliflower-like formation appeared. All routine investigations were normal. Immunological tests revealed the presence of antibodies anti-HPV immunoglobulin M (IgM) and immunoglobulin G (IgG). Treponema pallidum hemagglutination (TPHA) and HIV tests were negative. Samples collected from the genital lesions tested positive for both 6 and 11 DNA/HPV. The patient was diagnosed with condylomata acuminate and C-section was indicated as the methodology of birth so HPV infection of the newborn was avoided. We believe that HPV infection during pregnancy must be documented and treated when detected in order to avoid transmitting it to the newborn baby in a manner similar to TORCH testing. In pregnant women and women that want to conceive, in order to avoid transmission of infectious diseases from the mother to the newborn baby, TORCH testing is recommended. TORCH represents an acronym that includes: toxoplasmosis, other infectious diseases, rubella, cytomegalovirus infection, and herpes simplex infection.