Genital herpes in pregnancy
Herpes infections are only rarely passed on to babies during childbirth. If a woman already had herpes viruses inside her body at the start of pregnancy, there's no reason why she shouldn’t give birth naturally – unless there are signs of an outbreak shortly before she goes into labor.
Herpes infections can be life-threatening for newborn babies. Because of this, many women who have genital herpes are afraid of passing herpes viruses on to their child while giving birth. But this only rarely happens.
How best to deal with genital herpes in pregnancy, and whether a natural birth is possible, will depend on
- whether there are any signs of a genital herpes outbreak shortly before the birth and
- when the woman became infected with the virus.
Babies are most likely to become infected if their mother has a genital herpes outbreak at the time of the birth. They may then come into contact with the viruses as they move through the cervix and vagina. People who have herpes should also be particularly careful in the first eight weeks of the baby’s life. For instance, they should take care not to kiss the baby during this time, and wash their hands regularly. If the baby starts showing signs of a herpes infection – such as a fever, listlessness, loss of appetite or a rash – you should seek medical advice immediately.
The risk of infection is much smaller if the woman already had genital herpes before, or at the beginning of, pregnancy. This is because her immune system will have had a chance to produce antibodies to the virus. The mother passes these antibodies on to her unborn child through her placenta, giving him or her a certain amount of protection.
Infection before or at the beginning of pregnancy
Women who become infected with herpes before pregnancy, or in the first three months of pregnancy, only rarely infect their child with it. One big study found that 1 out of 100 babies became infected during childbirth.
Pregnant women who have genital herpes should talk to their doctor about it. He or she can then check the skin for signs of an outbreak shortly before the birth. It’s also important to tell the doctor if there are any early signs of an outbreak, such as tingling in the genital area, around the time of the birth. If there are no signs of an outbreak, there’s no reason why the woman shouldn't give birth naturally. If there are, she is usually advised to have a Cesarean section. This greatly lowers the risk of infecting the baby.
It is estimated that about 13 out of 100 pregnant women who have genital herpes have an outbreak at the time of the birth. The risk of this happening can be reduced by preventive treatment with antiviral medication, which is then taken every day from 35 weeks of pregnancy until the birth. This also increases the chances of the woman being able to have a natural birth. Research has found that Cesarean sections were carried out in
- 13 out of 100 people who didn’t have preventive treatment with antiviral medication, compared to
- only 4 out of 100 women who did have preventive antiviral treatment.
The drug aciclovir is generally used for this purpose because it is the drug that doctors have the most experience with. Studies haven’t found any evidence that it harms the baby.
Women can decide for themselves whether or not they would like to take medication to prevent a herpes outbreak: Some women really don’t want to take any medication while they are pregnant. Others would really like to give birth naturally if possible. And some trust that everything will go well, even without preventive treatment.
Infection in the last trimester of pregnancy
If women become infected with genital herpes in the last three months of pregnancy, the virus is passed on to their baby in about 30 to 50 out of 100 births. Because of this risk, women who get genital herpes in the last trimester of pregnancy usually have a Cesarean section in order to protect the child. It’s also a good idea to talk with a doctor who is specialized in the treatment of infectious diseases.
In order to prevent infection in the last three months of pregnancy, it’s best to avoid sex with people who have (or could have) genital herpes. This is also true when it comes to oral sex with people who have cold sores.
How can herpes outbreaks in pregnancy be treated?
Because initial outbreaks of genital herpes usually cause more severe symptoms, they are often treated with aciclovir in pregnant women, too. If the symptoms are particularly severe, the medication can be given intravenously (through an IV drip).
After that, further outbreaks are normally a lot milder, so antiviral drugs are often no longer used. But medication may be considered if the symptoms are severe or if complications arise.
Brown ZA, Wald A, Morrow RA, Selke S, Zeh J, Corey L. Effect of serologic status and cesarean delivery on transmission rates of herpes simplex virus from mother to infant. JAMA 2003; 289(2): 203-209.
Hollier LM, Wendel GD. Third trimester antiviral prophylaxis for preventing maternal genital herpes simplex virus (HSV) recurrences and neonatal infection. Cochrane Database Syst Rev 2008; (1): CD004946.
Patel R, Alderson S, Geretti A, Nilsen A, Foley E, Lautenschlager S et al. European guideline for the management of genital herpes, 2010. Int J STD AIDS 2011; 22(1): 1-10.
Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64(RR-03): 1-137.
World Health Organization (WHO). WHO Guideline for the Treatment of Genital Herpes Simplex Virus. Genf: WHO; 2016.
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