Human papillomavirus (HPV) is a DNA virus with at least 100 different types. These viruses cause warts, genital dysplasia, cervical carcinoma (types 6 and 11), and laryngeal papillomatosis. Transmis- sion occurs through direct contact and sexual contact. Laryngeal papillomas are thought to result from acquiring the virus in passage through the birth canal. Infection in pregnant women or during pregnancy does not lead to an increase in abortions or the risk for prematurity, and no evidence indicates intrauterine infection. HPV is one of the most common viruses in adults and one of the most com- monly sexually transmitted infections.

Diagnosis is usually by histologic examina- tion or DNA detection. Spontaneous resolution does occur, but therapy for persistent lesions or growths in anatomically problematic locations is appropriate. Therapy can be with podophyllum preparations, trichloroacetic acid, cryotherapy, electrocautery, and laser surgery. Interferon is being tested in the treatment of laryngeal papillomas, with mixed results.109 Prevention against transmis- sion means limiting direct or sexual contact, but this may not be sufficient because lesions may not be evident and transmission may still occur.

Rintala et al346 examined the occurrence of HPV DNA in the oral and genital mucosa of infants dur- ing the first 3 years of life. HPV DNA was identified in 12% to 21% of the oral scrape samples and in 4% to 15% of the genital scrape samples by PCR. Oral HPV infection was acquired by 42% of children, cleared by 11%, and persisted in 10% of children; 37% of the children were never infected. They did not report on breast milk or breastfeeding in that study. The question of the source of the infection remains undetermined.

The breast is a rare site of involvement.110 HPV types 16 and 18 can immortalize normal breast epi- thelium in vitro.441 HPV DNA has been detected in breast milk in 10 of 223 (4.5%) of milk samples from 223 mothers, collected 3 days postpartum.361 No attempt was made to correlate the presence of HPV DNA in breast milk with the HPV status of an infant or to assess the “viral load” of HPV in breast milk or its presence over the course of lactation. A second study found DNA of cutaneous and mucosal HPV types in 2 of 25 human milk samples and 1 of 10 colostrum samples.64 No reports of HPV lesions of the breast or nipple and documented transmission to an infant secondary to breastfeeding are available.

No increased risk for acquiring HPV from breast milk is apparent, and breastfeeding is acceptable. Even in the rare occurrence of an HPV lesion of the nipple or breast, no data suggest that breastfeeding or the use of expressed breast milk is contraindicated.

Rintala MAM, Grenman SE, Jarvenkyla ME, et al: High risk types of human papillomavirus (HPV) DNA in oral and genital mucosa of infants during their first 3 years of life: Experience from the Finnish HPV family study, Clin Infect Dis 41:1728–1733, 2005.deVilliers EM, Sandstrom RE, zur Hausen H, et al: Presence of papillomavirus in condylomatous lesions of the mamil- lae and in invasive carcinoma of the breast, Breast Cancer Res 7:R1–R11, 2005.

deVilliers EM, Sandstrom RE, zur Hausen H, et al: Presence of papillomavirus in condylomatous lesions of the mamil- lae and in invasive carcinoma of the breast, Breast Cancer Res 7:R1–R11, 2005

Sarkola M, Rintala M, Grenman S, et al: Human papil- lomavirus DNA detected in breast milk, Pediatr Infect Dis J 27:557–558, 2008.

Cazzaniga M, Gheit T, Casadio C, et al: Analysis of the pres- ence of cutaneous and mucosal papillomavirus types in ductal lavage fluid, milk and colostrum to evaluate its role in breast carcinogenesis, Breast Cancer Res Treat 114:599–605, 2009.

Breastfeeding

A GUIDE FOR THE MEDICAL PROFESSION

Seventh Edition

Ruth A. Lawrence, MD

Robert M. Lawrence, MD

Transmission of Infectious Diseases Through Breast Milk and Breastfeeding p.437