Outbreaks and Infection with genital herpes simplex virus (HSV) remains a common viral sexually transmitted disease, and a major universal problem in women of reproductive age, as women that are newly diagnosed, will often experience psychological distress and worry about future sexual relationships and childbearing.
Around 1500-2000 new cases of neonatal HSV infection are diagnosed each year. The incidence of neonatal herpes varies considerably in international studies. It is in the ratio of 1:3,200 births and 1:60,000 births in the US and the UK respectively.
Untreated neonatal HSV infection is associated with a mortality rate of 60%, and even with early and appropriate treatment, survivors experience considerable disadvantages that might result in disability. Pregnant women who receive anti-herpes treatment have a lower risk of preterm delivery compared to untreated women, and their preterm delivery risk is similar to that seen in unexposed women.
How Herpes Simplex Can Spread To an Infant
Herpes simplex is most often spread to an infant through the following:
- During birth if the mother has HSV in the birth canal during delivery
- If he or she is kissed by someone with an active cold sore.
- In rare instances, if someone touches an active cold sore and then immediately touches the baby.
How Herpes Can Harm a Baby
Herpes Simplex Virus can cause neonatal herpes (babies up to 28 days old, being infected by herpes). It is a rare but life-threatening disease, because neonatal herpes can cause eye or throat infections, damage to the central nervous system, mental retardation, or death. Medication and treatment may help prevent or reduce lasting damage if it is given early.
Less than 0.1% of babies born in the United States each year have been recorded to get neonatal-herpes, in contrast to the 25-30% of pregnant women having it. This shows that the great majority of women with genital herpes give birth to normal healthy babies.
However, babies are most at risk from neonatal herpes if the mother contracts genital HSV for the first time late in pregnancy, because a newly infected mother does not have antibodies against the herpes virus. A new herpes infection is frequently active and there is no natural protection for the baby during birth, so there is a real chance that the herpes virus will be present in the birth canal during delivery.
Protecting the Baby
Pregnant women with genital herpes may be concerned about the risk of spreading the herpes infection to their baby. Be reassured that the risk is extremely small, especially if you have had herpes for some time. Meanwhile the following steps can help make the risk even smaller:
- Talk with your doctor or midwife. Make sure he or she knows you have the genital herpes virus.
- As delivery approaches, check yourself for any symptoms in the genital area (sores, itching, tingling or tenderness).
- Have your health care provider examine you with a strong light to detect any signs of an outbreak.
- The choices regarding if you experience an active herpes outbreak at the time of delivery should be discussed with your obstetrician early in the pregnancy. You ideally have two choices of proceeding with a vaginal delivery (avoiding routine use of instruments) or have a caesarian section. Other factors that might affect or complicate delivery should be considered too before a decision can be made.
- Ask your Labour Management Centre not to use foetal scalp monitor (scalp electrodes) during labour to monitor the baby’s heart rate unless medically necessary, because this instrument makes tiny punctures in the baby’s scalp, which may allow herpes virus to enter easily. An external monitor can be used instead.
- Make a request that a vacuum or forceps not be used during delivery unless medically necessary, because these instruments can also cause breaks in the baby’s scalp, allowing the herpes virus to gain entrance easily.
- After birth, monitor the baby closely for about a month for symptoms of neonatal herpes which include blisters on the skin, fever, tiredness, irritability, or lack of appetite. Don’t wait to see if your baby will get better, take him or her to the pediatrician at once if symptoms are noticed, and ensure to tell the pediatrician you have genital herpes.
Herpes Treatment During Pregnancy
Antiviral medications are commonly administered for genital herpes during pregnancy. Recommended guidelines by the Centers for Disease Control and Prevention, for treating herpes during pregnancy include:
- Acyclovir (Zovirax) is given to pregnant women during the last 4 weeks of pregnancy to reduce the risk of a recurrent outbreak emerging during the period of delivery.
- Acyclovir may be given to women during the first or second trimester too.
- Women with severe Herpes Simplex Virus infections may be given intravenous acyclovir medication.
- For women with primary herpes infections, acyclovir may also be prescribed to reduce the severity of the symptoms and delay or prevent recurrent herpes infection breaking out during pregnancy.
For Partners of Pregnant Women
Partners for pregnant women can help ensure that the baby remains safe from the infection. Firstly, find out whether you have a genital HSV, having in mind that approximately 20% of sexually active adults have genital HSV, and most do not show herpes symptoms. If you find that you have the herpes virus, observe the following guidelines to protect your partner during the pregnancy:
- Use condoms from start to finish every time you have sex, even if you have no symptoms, because HSV can be spread even when no symptoms are present.
- If you have herpes outbreaks, abstain from sex until the outbreak has completely healed and gone.
- Talk with your health care provider about taking antiviral medication to suppress herpes outbreaks and to reduce the risk of herpes outbreak and transmission between outbreaks.
- Consider abstaining from intercourse during the last trimester of your partner’s pregnancy because outbreaks and infection at this period is more complicated.
- The best way to protect a baby from neonatal herpes is to prevent infection with genital HSV during late pregnancy, especially during the last six weeks.
- If you have cold sores, avoid performing oral sex on your partner when a lesion or sore is present.
- Both you and your partner needs to tell your doctor if you have genital herpes so that all the issues can be discussed.
Herpes Outbreak and Breastfeed
It is safe to breastfeed during a herpes outbreak as long as you don’t have lesions or sores on your breasts. If you have sores on one breast, you can nurse your baby on the other breast, but wash the area thoroughly first, and cover the sore with a dressing taped down on all sides.
Cover all lesions you have anywhere else, and always wash your hands carefully with antiseptics.
In conclusion, it is worth to note that 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 HSV-1 (cold sore). To protect your baby, do not kiss him or her when you have a cold sore symptoms, and ask others not to do same. If you have a cold sore, make sure to wash your hands before touching the baby.