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Tuesday, February 25, 2014

HPV Positive Pap Smears in Pregnancy May Predict Other Pregnancy Problems

HPV testing and treatment can be very confusing, and definitely time to make a list and get in with your gyno to discuss. Generally we think of HPV as the cause of cervical, vaginal, vulvar, and anal disease. Oral and respiratory cancers have also been linked to HPV, and other than the rare report of association with other gynecologic disease, it has been thought of as a virus that can only induce problems in the epithelium, or the most superficial tissue layers. A new report questions what else physiologically the virus can trigger physiologically. A new report indicates women with high risk HPV virus in early pregnancy have double the risk of developing the hypertensive disease of pregnancy known as preeclampsia as well as delivery prematurely. There is no conclusive research to explain why, but this may have to do with the overall health of the cells of the placenta that are known to be able to bind to HPV. In fact these cells have also been shown to have something to do with some miscarriages. The current general  is to get a pap smear when pregnant, and test for the HPV infection according to your age (over 30). And when a pregnant woman tests positive for HPV, the recommendation is to await until after pregnancy to treat, unless there is evidence of high grade cervical precancer (dysplasia). More specifically patients with atypical pap smears called ASCUS with HPV have been told can delay their colposcopy until 6 weeks after pregnancy. Women with high grade disease have been told to still have a colposcopy and biopsy, but unless actual cancer is found, it may be an options to delay treatment until after pregnancy. But these new findings question whether more women should be offered HPV tests to determine risks of other pregnancy problems.

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