Herpes and Pregnancy

As a pregnant woman awaiting the birth of your baby, you have taken steps to ensure your baby’s health. One step recommended by many experts is to learn about the herpes simplex virus. This common virus causes a mild infection in adults. However, HSV causes a rare but serious disease in newborns.

What is Herpes Simplex Virus?

HSV can cause sore-like lesions around the mouth (oral herpes) or in the genital area (genital herpes). HSV-1 is the usual cause of oral herpes, while HSV-2 is more likely to cause genital herpes. However, both types can affect these two areas. Both types can infect babies.

How Common Is Herpes Simplex?

In New Zealand, about 80% of adults have oral herpes and 20% have genital herpes. These figures are based on New Zealand studies and studies from other countries with similar population groups to New Zealand. You can get genital herpes if you have sex with an infected partner, or oral herpes if someone with active herpes has oral sex with you. Many people who carry HSV don't know it because they sometimes have no symptoms or are very subtle.

How is Herpes Simplex Transmitted to Newborns?

• Herpes Simplex is most commonly transmitted to a newborn during birth from a mother who is an HSV carrier while the baby is traveling through the birth canal.

• HSV can also be passed on if you are kissed by someone who has active oral herpes.

• In rare cases, HSV can be spread by touch if a person touches an active cold sore and then immediately touches the baby.

How Does Herpes Harm Babies?

HSV can cause a rare but life-threatening disease called neonatal herpes. Neonatal herpes can cause eye or throat infections, central nervous system damage, mental retardation, or death. Early medical treatment can help prevent or reduce permanent damage.

How Many Babies Get Neonatal Herpes?

In the United States, 0.1% of babies born in a year will have neonatal herpes. Limited data from Australia and Asia suggest that the incidence is even lower in Australia and New Zealand (4 per 100,000 births in Australia). In contrast, 20-25% of pregnant women carry genital herpes. This means that the vast majority of women with genital herpes give birth to healthy, happy babies.

Which Babies Are More At Risk?

Babies are at the highest risk for neonatal herpes if the mother first contracts HSV in the late stages of pregnancy, because a newly infected woman does not have antibodies against the virus, so there is no natural protection for the baby at birth. In addition, a new herpes infection is often active, meaning the virus is likely to be present in the birth canal at the time of birth.

What About Pregnant Women With a History of Genital Herpes?

Women who contract genital herpes before pregnancy have a very low risk of passing the virus to their baby (less than 1%) because their immune system produces antibodies that pass through the placenta to the baby. Even if HSV is active in the birth canal at the time of birth, these antibodies protect the baby. Additionally, if the mother knows she has genital herpes, her doctor will take steps to protect the baby.

Protecting the Baby for Women with Genital Herpes:

If you are pregnant and have genital herpes, you may be concerned about the risk of passing the infection to your baby. Again, rest assured that this risk is very low. Especially if you have had herpes for a while. Taking these steps will further reduce the risk:

-Explain your condition to your gynecologist and make sure he/she knows that you have genital herpes.

-Check the findings in your genital area during birth

– such as pain, itching, tingling or tenderness. Your doctor will also examine you under a strong light for disease activity.

-Ideally, the choices in case of disease activation should be discussed with your doctor early in pregnancy. These options are vaginal vaginal delivery or cesarean section. The risk of viral transmission vaginally is low and should be weighed against the risk of cesarean section for the mother. Other factors that may affect your delivery should also be considered before making a decision.

- Ask your doctor not to rupture the amniotic sac around the baby unless necessary. This sac will protect the baby from the virus during its passage through the birth canal.

- Ask the mother not to use a fetal scalp monitor during labor unless medically necessary. This device can create small holes in the baby's scalp, allowing the virus to enter. An external monitor is usually used instead.

- Ask that vacuum or forceps not be used unless medically necessary. These tools can damage the baby's skin and make it easier for the virus to enter.

-After birth, monitor the baby closely for 4 weeks. Symptoms of neonatal herpes include blisters on the skin, fever, weakness, restlessness and loss of appetite. These can also be symptoms of various mild illnesses. However, the baby should not be expected to recover, but should be seen by a pediatrician immediately. Do not forget to tell the pediatrician that you have genital herpes.

-Your chances of giving birth to a healthy baby are much higher.

Protecting the Baby for Women Without Genital Herpes:

The greatest risk for neonatal herpes occurs after contracting a genital infection in late pregnancy. Although this is rare, it can cause serious and life-threatening illness for the baby. The best way to protect your baby is to learn about HSV and to protect yourself. The first step is to find out if you are carrying the virus. If you know your partner has genital herpes and you don't know if you are, you should discuss this with your doctor.

How Can I Get Tested for Genital HSV?

If you have symptoms, the best test is a viral culture. To do this, your doctor will need to take a sample while the disease is active, preferably on the first day. Test results are available in about a week.

If you don't have symptoms, a blood test can show if you have HSV-2, the type of herpes that most often infects the genital tract. A blood test can also tell if you have HSV-1, but that usually just means you have oral herpes.

The most accurate blood test is the Western blot. Other commercial tests, such as the Immunoblot assay, are also available. Ask your doctor about these tests, as they vary from region to region and some tests are inaccurate. Also, your doctor should be able to interpret these tests correctly, considering your clinical situation.

How Can I Protect Myself from Genital HSV?

If you test negative for genital herpes, the following steps will protect you from infection throughout your pregnancy:

-If your partner has genital herpes, avoid sexual intercourse during active disease. Between episodes of disease, use condoms from beginning to end of sexual intercourse, even if your partner is asymptomatic (HSV can be transmitted without symptoms). Consider abstinence during the last 3 months of pregnancy.

-If you don't know if your partner has genital HSV, you can ask him or her to get tested. If your partner has oral or genital HSV, you may be able to pass the virus on to him or her unless you take steps to prevent transmission.

-If your partner has active cold sores (oral herpes), do not allow him to have oral sex with you. This can lead to genital herpes infection in you.

What Happens If I Get Genital HSV Late in My Pregnancy?

If you notice genital symptoms or think you have been exposed to genital HSV, tell your doctor right away. However, you should know that herpes can lie dormant for several years. What seems like a new infection may be the first symptoms of an old infection. Talk to your doctor about the best way to protect your baby. If a pregnant woman becomes infected with HSV during the last six weeks of pregnancy, a cesarean section is recommended, even if the disease is not active, because the risk of HSV in the newborn is greater than 50%.

How Can I Protect My Baby After Birth?

Babies can get neonatal herpes in the first 8 weeks after birth. These infections are usually transmitted by kissing adults who have active herpes. To protect your baby, do not kiss or allow others to kiss you while you have an active herpes. If you have a cold sore, wash your hands before touching your baby.

For Partners of Pregnant Women

If your partner is pregnant and does not have genital HSV, you can help prevent the baby from getting the infection. Find out if you have genital HSV (See: How do I get tested for genital HSV?). Remember, about 20% of sexually active adults have genital HSV, and the majority of them have no symptoms. If you find out you have the virus, take these steps to protect your partner during pregnancy:

-Use a condom throughout sexual intercourse, from start to finish, even if you don't have symptoms. HSV can be spread without symptoms.

-If genital disease is active, avoid sexual intercourse until it is completely healed.

Talk to your doctor about using antiviral medications to suppress disease activation and reduce the risk of transmission between diseases.

-Consider abstaining from intercourse during the last trimester of pregnancy. Try alternatives such as touching, kissing, fantasizing, and massage.

-If you have a cold sore (usually caused by HSV-1), avoid performing oral sex on your partner while you have a cold sore.

-Your partner should let his or her doctor know if you have genital herpes so that all options can be discussed.

The best way to protect your baby from neonatal herpes is to avoid getting genital HSV late in pregnancy, especially in the last six weeks.