I am two months pregnant. Yesterday my doctor told me I have genital warts. Can I still carry this baby full-term? Will I have a miscarriage? Is this very dangerous? What if it's herpes? Will the baby come out sick? I am so afraid.

L.

Genital warts, or warts in the vaginal area, are caused by the human papilloma virus (HPV). HPV may also infect the cervix, causing an abnormal Pap smear, without ever producing a visible wart. There are over 60 subtypes of HPV. The main danger of HPV is that a few of these subtypes increase the risk of cervical cancer; for this reason, all women who have been diagnosed with HPV, either on the basis of an abnormal Pap smear or by external warts, must have a Pap every six to 12 months. Genital warts are not related to herpes, and the appearance is very different; warts look like tiny cauliflower buds, while herpes generally produces blisters.

HPV infection during pregnancy does not increase the risk of miscarriage or birth defects. In someone who is already infected with HPV, pregnancy itself may cause warts to appear for the first time, or to grow. Cesarean sections are only recommended if the warts are huge and obstruct the birth canal (I've only had to do one C-section for this reason in my 12 years of practice).

There is a very, very small risk -- only 0.04 percent -- that HPV will be transmitted to the baby during a vaginal delivery and cause laryngeal papillomatosis (warts on the vocal cords). Laryngeal papillomatosis can be treated if it does occur.

Other than perhaps indicating you should have more frequent Pap smears and screening for other STDs, the diagnosis of genital warts does not change the management of pregnancy. Small warts can be treated with application of acid. Larger warts can be lasered, cut or burned off, and very, very large warts may necessitate a cesarean delivery. With the rare exception of a case of laryngeal papillomatosis, warts do not affect the baby at all. You should follow up with your doctor after the pregnancy for further medical treatment.