I am a mom with a newborn and due to HPV I am experiencing a lot of stress about transmitting it to my baby, which is why I decided to ask for your help.

Brief summary:

- normal sex history, hetero, otherwise healthy, 34y

- 4 years ago I had a CIN 1 cleared to PAP A in about 1 year, since then PAP A.

- In the same time I had GW, which were treated with laser 2 times, last time 2 years ago. Since then I do not have outside GW, my Gyn said I am ok. I have some bumps inside the vagina, gyn thinks are normal rugae, but I suspect that hpv has remained and could be still inside the vagina

- I diagnosed myself of oral hpv 3 y ago, coz I had a pedunculated lesion on my gum which I removed and did not return. After that I noticed some cobblestone appearence on my gums and I was pretty sure its from hpv, all though my dentist thinks it is just a reaction on calcare.

I was vaccinated 3x with Gardasil after I discovered the infections, to help with the clearance and maybe reduce transmission to others.

My questions:

- I am very stressed about the possibility to infect my newborn through normal care, it is impossible that he would not touch or put in the mouth something that can be contaminated, what precautions would you take in my place?

- My gyn said I shouldn’t worry about infecting my baby at labour, coz it is an extraordinary rare event, but I still worry about it, any experience about that? How could I stop thinking about that?

- The fact that I was vaccinated only AFTER my infection means that my body did not produce IgG for the strains I already have, that could protect my baby? ( internet says vaccine does not protect from strains already encountered- why is that?)

Hope you can help me to stop worrying. Thank you

First a quick response to your opening statement -- then I'll go through and answer your specific questions. With past genital HPV infection, if your baby was born by vaginally (not cesarean), there may have been a small risk of the baby being exposed to HPV during delivery. However, in absence of overt genital warts, this rarely result in the baby being infected. If you had active warts, your baby might have been at risk for respiratory papillomatosis, i.e. warts of the larynx and vocal cords. If your baby is outwardly healthy, this probably isn't a problem. If you remain concerned, discuss it with the baby's pediatrician.

Now reading the rest:  My general sense is that you are overreacting to your past HPV infections. (I use plural intentionally:  most sexually active persons acquire genital HPV more than once, and people with genital warts often have more than one HPV infection. Your warts and CIN1 may or may not have been due to the same HPV strain.) Getting and having HPV is a normal, expected, unavoidable aspect of human sexuality. It happens to at least 90% of all people. And yet newborn HPV is very rare, and few if any household members of infected persons ever acquire HPV themselves, other than by sex.

For those reasons, your situation is no different than for the large majority of women with newborn babies! To the specifics:

"I suspect that hpv has remained and could be still inside the vagina":  I doubt it and see no reason to not trust your gyn on this.

" I diagnosed myself of oral hpv 3 y ago..." This also sound very unlikely. A "pedunculated lesion on my gum" doesn't sound suspicious for an oral wart.

"I am very stressed about the possibility to infect my newborn through normal care" and "what precautions would you take...?" I see no need for any particular precautions to protect your baby from HPV. S/He is not at risk on account of your previous experiences with HPV.

"My gyn says....":  I agree; see my opening comments. (Your gyn probably knows more about the risks of transmission of HPV to babies during delivery than I do.)

Antibody production to vaccination is strong, including production of antibody to previously infecting strains. The issue isn't antibody production, but the degree of protection against new infection with that type and/or reactivation of those previous infections. The most recent research suggests there is a reduced chance of reactivation following vaccination -- so you probably are at lower risk of reactivation than you would be if not vaccinated.

With or without reactivation, as noted above, household members of HPV are rarely if ever at risk of HPV despite years of sharing toilets, showers, towels, eating utensils, etc. Babies rarely if ever are infected by their moms during routine and loving neonatal care. I suggest no special precautions of any kind. If you remain concerned about this, I would suggest you also discuss it with your baby's pediatrician. I'm confident she will give you the same sort of reassurance.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

I would like some more insight about the efficiency of the HPV vaccine to produce Ab for strains, that a person already has. When I read online it says that the vaccine does not protect against strains that a person has already encountered. Does this mean that for these strains the vaccine does not produce Ab or just a way to say that the vaccine will not cure an existing infection? For example- if I cleared the previous infections- is the vaccine going to protect me against the same strains in the future or not? And finally- if the vaccine produced Ab to the strains I had, I would have passed these IgG to the baby through the placenta and protect him against infection during delivery?

I found a paper online that says: no baby born to vaccinated mothers had RRP in Australia- but I don’t know how to interpret it- is it because the mothers did not get infected, or is it a protection from the Ab generated by the vaccine?

My Gyn said that he never heard about a baby with this problem in his career and that CS is indicated only in extreme cases of GW. I was ok with that but after delivery I started to worry. The neonatologist also said that she never had a newborn with problems due to hpv in her career, and not to worry.

It seems nobody is concerned about it.

How do you comment a lot of papers online talking about hpv transmission through fomites?

Can hpv be transmitted if I had it in the mouth and kiss him on the cheek? Or if I wipe my intimate parts in a towel and then my breast s, where he is feeding?

This seems a problem without solution- how to behave, as a risk of a serious disease as RRP is to big to relax.

Thank you!

The first question is mostly answered above. Re-read my reply starting with "Antibody production...." Probably immunization reduces the frequency of reactivation, but not by much; and nothing is known to reliably cure HPV forever:  many (most? all?) infections persist for life in inactive form.

Good question about whether maternal anti-HPV antibodies, whether from vaccine or natural infection, pass through the placenta and contribute to protection of the fetus or of the baby during delivery. Most antibodies cross the placenta, so I assume HPV antibodies do. If you correctly interpreted the Australia paper, it sounds even more likely. That your gyn hasn't seen a case of RRP only means it is rare, not that it doesn't happen. As I already said above, my understanding is that overt maternal warts are the main predictor, but I do not know if there are data about risk from "extreme" vs routine genital wart cases. These are issues rarely addressed by us STD experts. As noted above, your gyn or the baby's pediatrician might have better information. From all I know, however, it is entirely reasonable that "nobody [your doctors] is concerned about it".

I am unaware of scientific data that document HPV transmission through fomites. I have to assume the "papers" you refer to are anecdotal reports or unfounded opinions, not the result of expert analysis or research. Many doctors probably tell patients this because they don't understand chronic infection and thus don't understand that warts and other HPV infections are common in people not at risk for STDs in recent years or decades -- so fomites, toilets, etc become an easy assumption and explanation.

As I also said above, there are few if any known cases of HPV transmitted in households, including between parents and their children in the course of normal day to day interactions. That implies that moms kissing their babies is risk free, even though 90% of moms have had genital HPV, just as you have. Therefore it is logical to conclude there is no risk.

Rather than "a problem without a solution", it seems to me you are looking for solutions to problems that don't exist. At least thedr problems are sufficient rare that they should be ignored.

My last questions:

1) what is the prevalence of GW in the population of pregnant woman? One paper says the chance of JRRP is 1/144 if the woman has GW at birth. That seems a lot and not in line what my doctors said- that there is no reason to worry and that this is extremely rare. 

2) if the chance is really 1/144 and GW are so common, why we do not talk more about this risk?

3)The info about HPV are really confusing- why are everybody talking about the fact that 90% of people CLEAR the virus if the infection is persistent for life like HIV? If this is the case this means that 90 % of unvaccinated people are infected 4) About the vaccine still isn’t clear for me- did I produce specific antibodies to HPV 6 and 11 ( if these are my case) that could cross the placenta even if I was vaccinated after the infection?

5)https://pubmed.ncbi.nlm.nih.gov/29136168/ Does this mean that woman who are vaccinated protect their babies from vertical transmission even if they are infected? I would love your comment on this. 

I would love to hear how would you act and think about it if you were in my shoes? Thank you!

2) True that people tend not to discuss their warts in public -- but true for STIs in general. Typically we're fine telling our friends about our experience with covid and innumerable other health problems, but stigma keeps STIs under the table. You probably didn't tell many of your friends or coworkers about your abnormal pap and HPV, right? And warts have their own special "yuck" factor -- just think of the common old myths about contact with toads! But on the other side of the coin, GWs are properly considered an inconvenience, not a serious health risk and not a high priority for public education and discussion.

3) Once suppressed by the immune system, many people do not consider those with persistent DNA -- but testing negative for the virus -- to be an active problem. Reactivation isn't all THAT common. The truth is that the vast majority of HPV infections, as for warts themselves, are a minor inconvenience not a major health problem. But there certainly has been a whole lot more recognition of HPV than in past years, largely because of all the news (and TV ads) about HPV immunization.

4,5) I thought my comments above were quite clear. All people with HPV have antibodies to the virus, and so do all vaccinated persons. And as I said above, I would assume the antibodies cross the placenta and are a major reason why neonatal HPV is rare, which obviously supported by that PubMed citation. 

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes to you and your newborn!