Herpes and Pregnancy: All Your Burning Questions Answered

Herpes: an overlook

Approximately one in every five women has the herpes virus. Genital herpes is caused by the herpes simplex virus (HSV), and it’s one of the most common sexually transmitted infections (STIs) in the world.

Genital herpes can cause symptoms such as:

• Small, fluid-filled blisters on the genital area
• Inflamed, open sores
• Unusual vaginal or urethral discharge
• Abnormal sensations (tingling, itching, or burning) in your genitals
• Painful urination

Many women who get pregnant already have herpes or are infected with herpes during pregnancy. If the virus is transmitted to the baby, it can cause a condition called neonatal herpes.

What are the chances of spreading the infection to a baby?

Most people who are infected with HSV don’t even know that they have the virus. In fact, nearly 80 percent of all babies who contract neonatal herpes are born to mothers who didn’t report having HSV before.

The risk of passing HSV to the fetus varies greatly depending on when the mother was infected. If you were infected with herpes before your pregnancy and have a herpes outbreak while pregnant, the chance of passing the infection to your baby is less than 1 percent. The risk is so low because your body has already had time to develop antibodies against the virus.

Women who contract herpes during the later stages of their pregnancy have a higher risk of passing the virus to their babies. The risk of neonatal herpes ranges between 30–50 percent when a primary HSV infection occurs during late pregnancy.

There are many strains of the herpes virus, but the two that are commonly referred to as herpes are called herpes simplex virus type 1 and herpes simplex virus type 2. Approximately one third to half of all cases of neonatal herpes are caused by HSV-1. It’s estimated that the incidence of neonatal herpes in the United States is 1 per 15,000 live births. However, these estimates vary greatly from location to location.

How can a baby become infected?

Approximately 85 percent of neonatal herpes infections occur during delivery. This happens when the mother is shedding the virus from her genitourinary tract. As the baby passes through the birth canal, they can become infected with HSV.

In-utero transmission only accounts for approximately five percent of all cases of neonatal herpes. A baby can also contract an HSV infection after birth, usually from being kissed by someone who has active oral herpes. They can also get the virus while breastfeeding if there are any open sores on their mother’s nipples or areolas. Around 10 percent of all cases of neonatal herpes is contracted after birth.

What are the consequences of giving the infection to a baby?

Neonatal herpes is a serious condition, and in some cases, it can even be fatal. Neonatal herpes can cause different symptoms, which can be categorized as:

• Skin, eye, or mouth (SEM) disease, a localized infection that doesn’t affect other organs.
• Central nervous system (CNS) disease, which causes encephalitis with or without SEM disease.
• Disseminated disease, which can involve the CNS, liver, lungs, gastrointestinal tract, adrenal glands, and SEM disease.

If a baby is born by vaginal delivery to a mother with a primary HSV infection during late pregnancy, they will usually receive antiviral treatment. These babies also need to be monitored and different tests are carried out to determine whether they have contracted the virus. The baby’s medical team will decide how to treat them depending on the severity of their infection.

How to treat and prevent herpes during pregnancy

Since many people are unaware of the fact that they have herpes, it’s very important to get a full STI screening during pregnancy. Your partner should also get tested. Herpes tests are included in TORCH syndrome screening, which your doctor could order before or during pregnancy.

If you develop a primary HSV outbreak during your pregnancy, you’ll probably receive oral antiviral drugs. These medications can shorten the duration of the outbreak and reduce your symptoms. These are the most commonly used medications to treat herpes:

• Acyclovir
• Famciclovir
• Valacyclovir

Intravenous antivirals could be recommended for pregnant women with severe genital herpes or disseminated infection. Women who suffer recurrent herpes outbreaks while pregnant at or beyond week 36 of pregnancy usually also receive oral antivirals.

If you have active herpes during pregnancy, your doctor could recommend scheduling a C-section. But mothers who were infected with HSV before pregnancy or during the first trimester may still have a vaginal delivery, depending on their status during delivery. It’s very important to check whether you have any active herpetic genital lesions before birth.

Not HSV-positive: how to avoid becoming infected

It’s very important to prevent herpes during pregnancy if your partner has the virus.

You’re more likely to become infected if your partner has active herpetic lesions. However, viral shedding can still occur even if a person doesn’t have any sores. Try to avoid sex — including oral sex — if your partner has active lesions, particularly during the third trimester. If you do have sex, make sure you’re using condoms. You should also use condoms if you have a new partner who hasn’t been tested for herpes.

You can also get herpes from oral contact with someone who has active oral herpes. It’s still possible for oral herpes to spread even without an outbreak, since the virus can still shed. However, this is far less likely to occur. Avoid oral-to-oral contact with anyone who has cold sores.

Wrapping up on herpes during pregnancy

Having herpes during pregnancy is far more common than you may think. Around 70 percent of all Americans, for example, carry the herpes virus. In most cases, the risk of passing herpes to your baby is very small.

However, it’s very important to get a full STI screening before or during your pregnancy. If you develop a primary HSV infection during your pregnancy, antiviral treatment can help protect you and your baby. It’s also important to prevent getting herpes during pregnancy if your partner has the virus.

Although neonatal herpes is a serious condition, most women who have herpes during pregnancy will go on to have healthy babies. Your doctor will be able to advise you on how to treat or prevent these STIs so that both you and your baby thrive during this time.