Abstract

Anogenital warts are one of the most common sexually transmitted diseases in the UK caused by HPV infection.^{1 2} The condition is not purely benign with significant symptoms present in some patients related to severity and site of disease with an increased risk of cervical and other anogenital cancers.^{2 3} HPV infection is higher in pregnant women with rapid growth of warts observed which is thought to be related to immunological factors.⁴ Treatment, even in non-pregnant individuals is difficult and cure elusive.⁵ Treatment options are limited in pregnancy to conservative, non-teratogenic medical management and surgery.^{4 5} We present a case of massive condylomata in a pregnant patient complicated by brittle diabetes and mental health issues.

A 30 year old parous patient presented in early pregnancy with hyperemesis, poorly controlled type1 diabetes and a massive growth of vulval warts causing severe pain and difficulty mobilising. This large exophytic mass covered the vulvae and would preclude vaginal delivery. Genito-urinary medicine suggested a conservative course of treatment. Subsequently the patient had several admissions with hyperemesis and poor glycaemic control. The patient disclosed suicidal ideation related to the vulval warts and desire to not continue pregnancy. A termination of pregnancy was requested on this basis. Psychiatry review documented a depressive episode and suicide risk. In view of these factors a surgical resection was performed. This was complicated by significant blood loss requiring return to theatre, blood transfusion and HDU admission. Currently the pregnancy is ongoing.