Herpes Simplex Infection During Pregnancy

What is herpes simplex infection?

Herpes simplex is a viral infection that a baby can get from the mother during birth. Herpes can cause painful blisters that break open and form sores and swelling in the genital area.

A herpes infection during the first 3 months of pregnancy could cause a miscarriage. An infection during the last 6 months of pregnancy may cause early labor. If you have an active infection when your baby is born, it can harm the child or cause the baby to die.

Breast-feeding is safe as long as there are no sores on or around the breast.

How does it occur?

The herpes simplex virus (HSV) is one of the most common types of viral sexually transmitted diseases (STD). It causes sores in the genital area or cold sores on the mouth, which are common and can go away and return later. You can become infected with the virus by contact with broken blisters or sores on the genitals, mouth, or rectal area of an infected person. The virus can spread from one person to another by kissing, sharing food or drink, or during sex. It can be spread from one part of the body to another by not washing your hands after touching the blisters.

Herpes simplex virus rarely spreads to the baby through the placenta. However, there is a greater risk that the virus will spread to the baby if you have HSV for the first time when you are pregnant. Your baby is most at risk of becoming sick from the virus if you have an active infection when the baby is born. If you have sores in the genital area during labor, your baby has a good chance of coming in contact with the virus and developing the infection when your bag of water breaks or during a vaginal delivery.

If you are pregnant and have had herpes, tell your healthcare provider so steps can be taken to avoid infecting the baby.

What are the symptoms?

The symptoms of a herpes simplex infection in the genital area include:

• sudden itching
• painful sores and blisters (called lesions) on the genitals
• fever (usually only with the first outbreak of blisters)
• tiredness
• general discomfort, muscle aches
• discharge from the vagina
• difficulty or pain when you urinate
• pain when you have intercourse
• tender, enlarged lymph nodes in the groin

If a newborn is infected with herpes simplex, the following signs or symptoms of infection may appear during the first month after birth:

• irritability
• breathing problems
• fever
• convulsions
• jaundice (yellowish skin)
• sores on the skin
• bruising
• low platelet counts (platelets are the part of blood that makes it clot)

How is it diagnosed?

Your healthcare provider will take samples of fluid from the sores for lab tests, including cultures for the virus. Blood tests may also be done to determine if you have had a previous herpes infection. If you have a history of herpes infections, your provider may culture samples from your vagina and cervix during the last month of pregnancy.

The baby can be diagnosed with blood tests and cultures of samples from the nose, throat, mouth, and eyes.

How is it treated?

Genital herpes cannot be completely cured. The virus will always stay in your body. However, your healthcare provider may prescribe antiviral medicine such as acyclovir, famciclovir, or valacyclovir to help prevent an active infection that could be passed to your child during birth. It does not decrease the risk of passing the infection when you have sores. Antiviral medicine is considered a safe medical treatment for infected pregnant women. Discuss the use of this medicine with your provider.

Your healthcare provider may also prescribe medicine to reduce pain and itching.

If your newborn becomes infected, he or she can be treated with acyclovir. This medicine will greatly increase the chances that your child will develop normally.

How long will the effects last?

Your first outbreak of herpes is usually the worst. The sores usually start to heal after about 5 days. They generally disappear in 1 to 3 weeks. Sometimes they may last for as long as 6 weeks.

If you have your first herpes outbreak in the first trimester of pregnancy, you have a higher risk of having a miscarriage or problems with the baby. If the first outbreak is in the second trimester of pregnancy, you have a higher risk of having preterm labor and delivery.

The virus remains in your body and may cause sores to develop again later. Repeat outbreaks of sores tend to be milder than the first outbreak and the sores heal more quickly.

If you have a new infection or repeat outbreak during the last 6 weeks of pregnancy, you have a greater risk of going into labor early (preterm labor). Repeat outbreaks of herpes simplex are not as likely to infect the baby.

The risk of infection increases if you deliver vaginally when you have active genital herpes sores. When a newborn is infected, it can be a severe problem. Babies infected with herpes simplex may die or have eye problems, a small brain, mental retardation, seizures, or other problems. If there are no active or recent lesions at the time of delivery, the risk for transferring the virus to your newborn is low.

How can I take care of myself when I have an outbreak of herpes sores?

• Follow the full treatment prescribed by your healthcare provider.
• Take medicine as prescribed by your healthcare provider. Use a disposable glove to put medicine on the sores. This helps avoid spreading the infection to other parts of your body.
• Wipe yourself from front to back after using the toilet.
• Wear loose clothing, preferably cotton, to allow air circulation and to avoid pressure on the skin, which may cause more blisters.
• Avoid sexual contact with others.
• Avoid using douches, perfumed soaps, sprays, feminine hygiene deodorants, or other chemicals in the genital area.
• Avoid a lot of sunlight and heat, which may cause more blisters.

There are many herpes counseling groups that give support and help to herpes patients. You can get more information by calling the National Sexually Transmitted Diseases Hotline at 800-227-8922.

What can be done to help prevent infection with herpes simplex virus?

Herpes simplex virus is sexually transmitted. To avoid becoming infected with herpes, use latex or polyurethane condoms during foreplay and intercourse. Avoid intimate contact with people who have active sores.

If you have genital herpes sores, the baby's risk of infection is greater after your bag of water breaks and during a vaginal delivery. Your healthcare provider may prescribe oral acyclovir or another antivirus medicine during the last 6 weeks of pregnancy to reduce the chance that you will have herpes sores and pass the virus to your baby. If you are in labor and have an active genital sore, your healthcare provider may suggest a cesarean delivery (C-section) to avoid infecting the baby. If you do not have any sores at the time of labor, you may have a vaginal birth.

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