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Genital Herpes during Pregnancy

Genital Herpes during Pregnancy

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Herpes is one of the most common viral infections known to man, affecting more than 80% of the population at one time or another, including more than 20% of pregnant women.

Women who have a history of genital herpes often wonder whether or not it is safe for them to deliver their baby naturally. The good news is most women with genital herpes will be able to deliver their baby safely without the need for a cesarean section, provided their disease is long standing and they do not have any active lesions at or near term.

It is vital if you have a history of herpes that you discuss your condition with your healthcare provider, who can determine whether or not you are at risk for transmitting the disease to your newborn baby.

Diagnosis of Herpes in Pregnancy
Herpes is caused by an infection of the HSV virus. This virus can be diagnosed in a number of ways during pregnancy. Your healthcare provider may order a viral culture, polymerase chain reaction (PCR), direct fluorescent antibody testing and other forms of testing including serologic tests. Of these, the PCR test is considered one of the more sensitive. Typically it is able to demonstrate the presence of HSV even when patients tested negative using other methods.

Genital Herpes and Pregnancy
If you have genital herpes, the virus will stay with you your entire life, including during your pregnancy. Most women will worry about spreading the herpes virus to their baby if they become pregnant.

Fortunately you can breathe a sigh of relief… most women will not actually transmit herpes to their baby during pregnancy. In fact the rates of transmission are relatively low unless a woman is experiencing her first episode of genital herpes during pregnancy.

Sometimes women will have a recurrence of the virus during pregnancy, but typically this is the result of the added stress and anxiety that accompany pregnancy. Usually these outbreaks are short lived, and will not impact delivery as long as they do not occur at or near term.

However, if you do have an active herpes outbreak at or near the time of delivery, your healthcare provider will need to perform a cesarean to ensure that you do not spread the virus to your baby. Typically transmission to a newborn baby only occurs if a woman is experiencing an active outbreak at the time of delivery, though in very rare circumstances it is possible for a woman to transmit the virus to her baby without any active lesions or symptoms.

If you have a history of herpes your healthcare provider will check to make sure that you don’t have any active lesions at the time of delivery.

Neonatal Herpes
Though considered somewhat rare, neonatal herpes is a real risk for women who have genital herpes. Many pregnant women are concerned about the possibility that they might transmit herpes to their newborn baby during birth or delivery. Herpes can be a devastating disease when contracted by a newborn baby.

The good news however is that the risk of transmitting herpes to your newborn baby is relatively low. This is particularly the case in women that have had long-standing infections, particularly if there is no active outbreak during the time of delivery. Women who have had genital herpes for many years have developed antibodies that will cross the placenta to the fetus. These antibodies will actually protect the baby from acquiring an infection during birth even if some virus is present in the birth canal during delivery. The chance of passing herpes on to your newborn baby is considered very slim among the 20 percent or more pregnant women that have genital herpes.

Studies suggest that 5 percent of women who will test positive for HSV at the time of labor will pass the infection on to their newborn baby. When a cesarean section is performed however, only 1.2 percent of women will pass the infection to their newborn baby.

The timing of an infection seems to be the most important aspect of transmission. If the mother has an active HSV infection or is infected for the first time near the time of delivery, a woman is much more likely to pass the virus on to their newborn baby.

Premature delivery (defined as delivery before 37 weeks) may also increase a newborn’s susceptibly to the herpes virus.

Late acquisition of a primary episode of HSV infection has been associated with a number of pregnancy complications including:

• Preterm delivery.
• Spontaneous abortion.
• Low birth weight.

Treatment During Pregnancy
There are a number of studies that suggest that treatment of genital herpes infections during pregnancy with the antiviral acyclovir is safe even during the first trimester. There have been long term studies that suggest the long term use of acyclovir during pregnancy is safe. Thus this drug may be used in certain circumstances to prevent a break out during pregnancy. At this time further research is needed before the use of valacyclovir and famciclovir can be recommended during pregnancy, though both seem to have similar actions as acyclovir.

If you have recurrent herpes infections during pregnancy, your healthcare provider might recommend suppressive therapy with acyclovir near term to prevent viral shedding or an active outbreak during delivery.

If you have genital herpes, it is vital that you talk with your healthcare provider to discuss your concerns and any potential risks for your baby before, during and after delivery. Keep in mind that the highest risk of infections is when an infant contracts herpes during pregnancy for the first time. You should take any precautionary steps necessary to ensure that you don’t transmit herpes during this time and it is likely that your baby will be born healthy and happy.