Herpes Simplex & Pregnancy

As an expectant parent awaiting the birth of your new baby, you are probably taking a number of steps to ensure your baby’s health. One step many experts recommend is that you become informed about herpes simplex virus (HSV). This common virus is usually a mild infection in adults. But in infants, HSV can cause a rare, but serious, illness.

HSV can cause sores near the mouth (oral herpes or “cold sores”) or sores on the genitals (genital herpes). HSV-1 is the usual cause of oral herpes, and HSV-2 is the usual cause of genital herpes. But either type of HSV can infect either part of the body. Either type can infect a baby.

An estimated 80% of American adults have oral herpes (“cold sores”), and more than 20% have genital herpes. You can get genital herpes if you have sexual contact with a partner who is infected, or if a partner who has an active cold sore performs oral sex on you. Most people with HSV don’t know they are infected because they have no symptoms, or symptoms too mild to notice.

How herpes simplex spreads to an infant

1. Herpes simplex is most often spread to an infant during birth, if the mother has HSV in the birth canal during delivery.

2. HSV can also be spread to the baby if he or she is kissed by someone with an active cold sore.

3. In rare instances, HSV may be spread by touch, if someone touches an active cold sore and then immediately touches the baby.

Herpes – Harmful to baby

HSV can cause neonatal herpes, a rare but life threatening disease. Neonatal herpes can cause eye or throat infections, damage to the central nervous system, mental retardation, or death. Medication may help prevent or reduce lasting damage if it is given early.

Statistics of neonatal herpes

Less than 0.1% of babies born in the United States each year get neonatal herpes. By contrast, some 20-25% of pregnant women have genital herpes. This means that the great majority of women with genital herpes give birth to healthy, happy babies.

At greatest risk

Babies are most at risk for neonatal herpes if the mother contracts genital HSV late in pregnancy. This is because a newly infected mother does not have antibodies against the virus, so there is no natural protection for the baby during birth. In addition, a new herpes infection is frequently active, so there is a real chance that the virus will be present in the birth canal during delivery.

Pregnant women with history of genital herpes

Women who acquire genital herpes before they become pregnant have a very low risk of transmitting the virus to their babies. This is because their immune systems make antibodies that are passed to the baby through the placenta. Even if HSV is active in the birth canal during delivery, the antibodies help protect the baby. In addition, if a mother knows she has genital herpes, her doctor can take steps to protect the baby.

How to protect baby

If you are pregnant and you have genital herpes, you may be concerned about the risk of spreading the infection to your baby. Be reassured that the risk is extremely small – especially if you have had herpes for some time. The following steps can help make the risk even smaller:

1. Talk with your obstetrician or midwife. Make sure he or she knows you have genital herpes.

2. At the time of labor, check yourself for any symptoms in the genital area – sores, itching, tingling or tenderness. Your health care provider will also examine you with a strong light to detect any signs of an outbreak.

3. If you have an active outbreak at the time of delivery, the safest course is cesarean section to prevent the baby’s coming into contact with virus in the birth canal. If you do not have an active outbreak, you can have a vaginal delivery.

4. Ask your doctor not to break the bag of waters around the baby unless necessary. The bag of waters may help protect the baby against any virus in the birth canal.

5. As your doctor not to use a fetal scalp monitor (scalp electrodes) during labor to monitor the baby’s heart rate unless medically necessary. This instrument makes tiny punctures in the baby’s scalp, which may allow herpes virus to enter. In most cases, an external monitor can be used instead.

6. Ask that a vacuum or forceps not be used during delivery unless medically necessary. These instruments can also cause breaks in the baby’s scalp, allowing virus to enter.

7. After birth, watch the baby closely for about three weeks. Symptoms of neonatal herpes include blisters, fever, laziness, crankiness, or lack of appetite. While these can be symptoms of several mild illnesses, don’t wait to see if your baby will get better. Take him or her to the pediatrician at once. Be sure to tell the pediatrician you have genital herpes.

8. Think positively! The odds are strongly in favor of your having a healthy baby.

Protecting Baby: Women who don’t have herpes

The greatest risk of neonatal herpes is to babies whose mothers contract genital infection late in pregnancy. While this is a rare occurrence, it does happen, and can cause a serious, even life-threatening, illness for the baby. The best way you can protect your baby is to know the facts about HSV and how to protect yourself. The first step may be finding out whether you already carry the virus.

How to get tested for HSV

If you have symptoms, the best test is a viral culture. To perform this test, your health care provider must take a sample from an outbreak while it 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 tell you whether you carry HSV-2, the type of herpes that usually infects the genital tract. (A blood test may also tell you whether you have HSV-1, but in many cases this simply means you have oral herpes.) The most accurate blood test is the Western blot, available from the University of Washington at Seattle.

How can I make sure I don’t get genital HSV?

If you test negative for genital herpes, the following steps can help protect you from getting an infection during pregnancy:

1. If your partner has genital herpes, abstain from sex during active outbreaks. Between outbreaks, use a condom from start to finish every time you have sexual contact, even if your partner has no symptoms. (HSV can spread when no symptoms are present.) Consider abstaining from sex during the last trimester.

2. If you don’t know whether your partner has genital HSV, you may wish to ask your partner to be tested. If your partner has genital or oral HSV, there is a very real chance that you may acquire it unless you take steps to prevent transmission.

3. Do not let your partner perform oral sex on you if your partner has an active cold sore (oral herpes). This can give you genital herpes.

What if I contract genital HSV during late pregnancy?

If you experience genital symptoms, or believe you have been exposed to genital HSV, tell your obstetrician or midwife at once. However, be aware that herpes can lie dormant for several y ears. What appears to be a new infection is usually an old one that is causing symptoms for the first time. Talk with your provider about the best way to protect your baby. When a pregnant woman does contract a new genital HSV infection during the last trimester, some providers will prescribe the medication acyclovir. Some recommend a cesarean delivery under these circumstances, even if no outbreak is present.

How can I protect the baby after birth?

A baby can get neonatal herpes in the first eight weeks after birth. Such infections are almost always caused by a kiss from an adult who has a cold sore. To protect your baby, don’t kiss him or her when you have a cold sore, and ask others not to. If you have a cold sore, wash your hands before touching the baby.

Positive Partners of Negative Pregnant Women

If your partner is pregnant, and she does not have genital HSV, you can help ensure that the baby remains safe from infection. Find out whether you have genital HSV (see “How can I get tested?”). Remember, more than 20% of Americans do have genital HSV, and most do not have symptoms. If you find that you have the virus, follow these guidelines to protect your partner during the pregnancy:

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