Herpes during pregnancy

What are the risks to my unborn baby if I have genital

herpes?
The biggest concern with genital herpes during pregnancy is that you might transmit it to your
baby during labor and delivery. Newborn herpes is relatively rare (about 1,500 newborns are
affected each year), but the disease can be devastating, so it's important to learn how to reduce
your baby's risk of becoming infected.
You can transmit herpes to your baby during labor and delivery if you're contagious, or
"shedding virus," at that time. The risk of transmission is high if you get herpes for the first time
(a primary infection) late in your pregnancy.
Much less commonly, you can transmit the virus if you're having a recurrent infection. If you've
ever had a herpes outbreak, the virus remains in your body and can become reactivated.
In rare cases, a pregnant woman may transmit the infection to her baby through the placenta if
she gets herpes for the first time in her first trimester. If a baby is infected this way, the virus can
cause a miscarriage or serious birth defects.

Will I need a cesarean delivery if I have herpes?

It depends. If you were first infected with genital herpes before your third trimester or before you
got pregnant, and you have no symptoms of an outbreak (or an impending outbreak) when your
water breaks or your labor starts, you'll be able to labor and try for a vaginal delivery.
In this situation, the risk of your baby contracting the disease is less than 1 percent, according to
the Centers for Disease Control and Prevention. That's because you begin to develop antibodies
to herpes soon after you're first infected, and they're passed on to your baby through the placenta.
In six to 12 weeks, your baby will have some immunity as a result of these antibodies, which
offer him some protection if you're unknowingly shedding virus.
On the other hand, if you're having an outbreak or symptoms of an impending outbreak when
your water breaks or when you go into labor, you'll need an immediate cesarean delivery. This
would be the case if you have any visible sores on your cervix, vagina, or external genitals, or
any symptoms, like tingling, burning, or pain, that sometimes signal an imminent outbreak.
(Currently, there's no quick and reliable way to test whether you're actually shedding virus.)
The only exception might be if you have herpes lesions or symptoms and your water breaks
when your baby is still very premature. In that case, your practitioner may try to postpone
delivery to give your baby more time to develop. (You may be treated with an antiviral
medication in the meantime.)

To improve your chances of being able to deliver vaginally, most experts including the
American College of Obstetricians and Gynecologists recommend that pregnant women with
recurrent genital herpes be offered oral antiviral medication from 36 weeks or so until delivery.
Recent studies show that this reduces the risk of an outbreak at the time of labor.
If you first get genital herpes late in pregnancy and blood tests confirm you've never had it
before, some experts recommend having a cesarean section even if you don't have symptoms
when you go into labor.
With a new infection, your body hasn't had time to develop antibodies and pass them on to your
baby, the virus tends to be present in relatively high concentrations, and it's more likely that
you'll still be shedding virus during labor. If you are, the risk of transmission to your baby is very
high up to 50 percent.

Can my baby catch herpes from me (or someone else) after

delivery?
Yes. About 5 percent of cases of newborn herpes are contracted after birth, and it can be just as
dangerous as herpes contracted during labor. But you can usually prevent this if you take some
simple precautions.
Make sure people always wash their hands before touching your baby, and never let anyone with
a cold sore kiss, nuzzle, or hold your baby. (Any kind of herpes can be dangerous for a newborn,
including the kind that causes cold sores.)
If you have an outbreak anywhere on your body, cover it well to prevent contact with your baby's
skin and thoroughly clean the surrounding area. Wash your hands frequently and carefully,
because herpes can be spread from hand to mouth.
It's possible, though somewhat rare, to get a herpes sore on your finger, called a herpetic
whitlow. Anyone with a herpetic whitlow should avoid touching a baby.

Can I breastfeed if I have a herpes outbreak?

It's safe to breastfeed when you have a herpes outbreak as long as you have no lesions on your
breast, you cover all lesions elsewhere, and you wash your hands carefully.
If you have lesions on only one breast, you can nurse your baby on the other breast. Make sure to
clean the area thoroughly and to cover the lesion with a dressing taped down on all sides with a
clean garment over that.

What precautions should I take if I get cold sores?

If you have a cold sore or a sore inside your mouth, don't kiss your baby until the sore goes away
completely. Experts advise wearing a disposable surgical mask to cover a cold sore whenever
you're handling your baby until the entire sore is crusted and dried.
If you get cold sores frequently, ask your caregiver about prescribing an antiviral medication to
suppress outbreaks. And if you've ever had oral herpes, don't trim your baby's nails with your
teeth, even if you don't have an obvious sore.

What would happen if my baby got herpes during delivery

or as a newborn?
About a third of the time, newborn herpes affects a baby's skin, eyes, or mouth, but not his other
organs. If that's the case, he may have sores at delivery or develop them up to four weeks later.
They typically turn up between 1 and 2 weeks of age.
Herpes lesions usually look like blisters and can appear anywhere on a baby's body. They often
appear where there has been a small break in the skin or any trauma like where the hospital
wristband was or where an electrode was placed on his head to monitor his heart rate during
labor.
If your baby has herpes that's limited to the skin, eyes, and mouth and gets prompt treatment with
intravenous acyclovir, he'll most likely do well eventually. One study showed that more than 90
percent of babies with this form of herpes were developing normally when they were tested as 1year-olds, although an infected baby can have serious recurrent outbreaks or long-term problems.
If not treated promptly, a baby who starts out with herpes limited to the skin, eyes, and mouth
can go on to develop an even more serious form of herpes.
In another third of newborns who get herpes, the central nervous system is affected. This most
often shows up at about 2 to 3 weeks of age with symptoms such as irritability, fever, lethargy,
poor feeding, or seizures.
The remaining third of newborns get what's called disseminated herpes, which involves multiple
organs, often the lungs and liver. It typically shows up during the first week after birth. Babies
with disseminated herpes may or may not have skin lesions. (If they don't, diagnosing herpes as
the source of the baby's illness is tricky.)
These latter forms of herpes are very serious. Unfortunately, even with prompt treatment, a
number of these babies will die, and many of the survivors will end up with serious long-term
health and developmental problems.
Call your baby's healthcare provider right away if he has a fever; seems lethargic or unusually
irritable; is feeding poorly; has sores, blisters, or red or infected-looking eyes; or just doesn't
seem right to you. And be sure to let your child's doctor know if you or your partner has herpes.

How do you get herpes?

Oral herpes, which may show up as cold sores or fever blisters on or near your mouth or sores
inside your mouth, is almost always caused by herpes simplex virus type 1 (HSV-1). It's spread
by direct contact with the sores, often by kissing.
Herpes simplex virus type 2 (HSV-2) most commonly causes genital herpes, which may show up
as blisters or sores on your genitals. If you've never had genital herpes, you're considered
susceptible and can contract the virus if you have sex with a contagious partner.
You can also get genital herpes if your partner has oral herpes and performs oral sex on you. Up
to a third of cases of genital herpes are caused by the type 1 virus transmitted through oral sex,
and this number appears to be increasing.

What happens once someone is infected?

Once you contract the virus, it settles in a bundle of nerves near your spine forever and may
surface again at any time. Some herpes carriers have outbreaks frequently, others only rarely.
You may or may not notice any symptoms during a recurrence, so you may not know when
you're having one. This is a problem because you "shed the virus" at these times, which means
you're contagious and can infect your partner if you have sex or infect your baby during labor
and birth.
Herpes can be treated but not cured. Let your caregiver know at your first prenatal visit if you
think you or your partner has ever had a herpes outbreak.

What are the symptoms of a genital herpes infection?

Symptoms, if they occur at all, can vary a lot from person to person. They're likely to be most
severe in a primary infection that is, when you first contract genital herpes and have no oral or
genital herpes antibodies to help fight the virus.
Between two and 14 days after exposure to the virus, you may get red bumps on your vagina or
vulva, which will turn into blisters and eventually rupture and become painful sores. There may
be just a few or you might have a large cluster, and they can last for up to three weeks with a
primary infection.
You may have an itchy, burning, painful, or tingling sensation in your genital area, have vaginal
discharge, have tender swollen lymph nodes near the groin, and experience some pain when you
urinate.
With a primary infection, you might also have flu-like symptoms, including fever, headache, and
muscle aches. Some pregnant women get very sick during a primary infection and need to be
treated intravenously with an antiviral medication called acyclovir.

Is the first outbreak more or less severe than future

outbreaks?
Studies show that many people have no recognizable symptoms even during a primary episode
of genital herpes, although some may have an outbreak with symptoms at a later date. Outbreaks
tend to occur more frequently in the first year after you develop the infection.
If you've already had oral herpes when you get your first genital herpes infection, it's called a
non-primary first episode, and your symptoms will probably be less severe because the
antibodies your body has made against HSV-1 will offer some protection against HSV-2. You're
less likely to get severe flu-like symptoms and will generally have fewer sores and less pain for a
shorter time than with a primary infection.
Outbreaks that occur after a primary infection or a non-primary first episode are called recurrent
(or reactivated) infections. With a recurrent infection, you generally have less pain and many
fewer sores than with either of the initial infections, and they tend to clear up more quickly
although symptoms vary widely from woman to woman.
If you have a primary or first-episode herpes infection with symptoms during pregnancy, your
caregiver may prescribe oral antiviral medication to take for a week or two to help your lesions
heal more quickly and reduce shedding of the virus. If you have recurrent outbreaks with
bothersome symptoms, talk to your caregiver about taking medication to relieve your symptoms.

Could I have genital herpes and not know it?

Yes. In fact, most people with genital herpes don't know they have the virus, either because
they've never had symptoms, they've had only very mild symptoms, or they just don't know what
a herpes outbreak is. Researchers estimate that more than 45 million people in the United States
have genital herpes, including about 25 percent of pregnant American women.

Are there ways to tell whether my partner or I have herpes?

Yes. If you notice any sores or blisters in the genital area, or even on your buttocks, thighs, lower
abdomen, or back, see your practitioner as soon as possible for a culture to determine whether it's
herpes.
A culture won't always pick up the virus, but it's most sensitive early in an outbreak, so it's
important to see your caregiver when you first notice a little blister. Newer methods using DNA
are more sensitive, but it's still important to be seen early on.
You can also have a blood test to see whether you have antibodies from a previous infection.
Good tests can differentiate between HSV-1 and HSV-2 antibodies. A positive test for HSV-2
antibodies almost always means that you've had genital herpes sometime in the past. If you test
positive for HSV-1 only, it means you've had either oral or genital herpes.

If your test results are negative, your partner may be tested as well. That way, you can find out
whether you're at risk for acquiring genital herpes during pregnancy and how to prevent it. If you
test positive for either type of herpes, you'll need to pay special attention to the sometimes subtle
signs of an outbreak as labor approaches.
Because herpes is so often a "silent" disease, there's a debate about whether all pregnant women
should have these tests regardless of their specific circumstances. Currently, neither the Centers
for Disease Control and Prevention nor the American College of Obstetricians and Gynecologists
recommends routine screening.

What if I've never had herpes but my partner has?

Even if your partner has had herpes for years without passing the infection to you, it's important
to take extra care to stay herpes-free now that you're pregnant.
Guidelines to follow throughout pregnancy:

Abstain from skin-to-skin contact near your partner's genitals or mouth when he has an
active outbreak or feels one coming on (some people notice a tingling or painful
sensation before sores actually appear).

Be sure to use latex condoms when you have sex, even when your partner isn't having an
outbreak. They don't always prevent transmission, but they'll reduce your risk.

Some experts recommend that your partner take an antiviral medication throughout your
pregnancy (or from the time you find out he has herpes), because preliminary research
has shown that this lowers the risk of his passing the infection to you. Ask your caregiver
about this option.

Guidelines for the third trimester:

It's most critical to avoid contracting herpes close to your due date so skip intercourse
and other genital contact altogether in your third trimester, even if your partner has no
sores or symptoms.

Skip oral sex in the third trimester if your partner has ever had oral herpes.