genital herpes and pregnancy/childbirth

Genital Herpes and Pregnancy/Childbirth.

Herpes and having children:

Having genital herpes does not mean that you will not be able to have children (whether you are male or female).

Facts about being pregnant and and giving birth - with herpes
Situations in which the developing fetus may be at risk
Care during Pregnancy
After the Birth
Can I breast-feed if I have herpes?
Being a parent
Symptoms to look out for
Painful Urination

Women with genital herpes often experience pain on urinating. It is important to avoid problems of urinary retention by drinking plenty of fluids to dilute the urine and thereby reduce pain and stinging. Visit the treatments page for self-help tips that may be useful in relieving the pain and discomfort.

Is there a connection with genital herpes and cervical cancer?

It is important to note that having genital herpes is not associated with the development of cervical cancer.

Facts about being pregnant and and giving birth - with herpes

Women with genital herpes can experience a safe pregnancy and normal vaginal childbirth.
At present, HSV screening for all pregnant women nationwide is not practical as an accurate, type-specific serology (blood test) is not available in most commercial laboratories. However, one accurate serology, the Western blot is available.

If you experience your first outbreak late in pregnancy, get a Western blot serology, if at all possible.

If performed promptly, a Western blot can tell you whether:

the outbreak is a true primary (a new infection in a person with no previous antibodies to either HSV-1 or HSV-2)
a non-primary first episode (an infection of HSV-2 in a person with previous antibodies to (HSV-1)
a recurrence
Ask your doctor to make the appropriate arrangements and to advise the lab of how many weeks pregnant you are.

Pregnancy and herpes:

20-25% of pregnant women have genital herpes

Women with a history of genital herpes, before becoming pregnant, have a low risk of transmitting the virus to their baby. This is because of antibodies circulating in the mother's blood - these antibodies should protect the baby during pregnancy.

"Recurrent" genital herpes presents only a minimal risk in pregnancy, though it may interfere with the woman's enjoyment of pregnancy

If a woman has primary herpes (her first encounter with the virus) at any point in the pregnancy, there is the possibility of the virus crossing the placenta and infecting the baby in the uterus (about 5% of cases).

This transmission of the virus to the fetus causes neonatal herpes, a potentially fatal condition

Mothers who acquire genital herpes in the last few weeks of pregnancy are at the highest risk of transmitting the virus.

Many women find that their outbreaks tend to increase as the pregnancy progresses. This is probably because of the immune suppression that takes place to prevent the mother's body from rejecting the fetus.

Many women who have their first outbreak of genital herpes during pregnancy do not actually have a new infection, instead, the outbreak is the first symptomatic recurrence of a longstanding infection. That is, the first time symptoms of an outbreak have occurred, even though the infection was contracted some time ago.

The use of a fetal scalp monitor (scalp electrodes - used to monitor the baby's heartbeat during childbirth) makes tiny punctures in the baby's scalp, which may serve as portals of entry for the herpes virus

Childbirth and the delivery:

The spread of herpes to newborns is rare

If a woman has active genital herpes at the time of delivery, a Cesarean section is usually performed.

There is a high risk of transmission if the mother has an active outbreak at the time of delivery

There is also a small risk of transmission from asymptomatic shedding (when the virus reactivates without causing any symptoms)

Between 10-14% of women with genital herpes have an active lesion at delivery (the odds are higher for women who acquire herpes during pregnancy, and lower for women who have had herpes for more than six years).
Newly infected people (whether pregnant or not) have a higher rate of asymptomatic shedding for roughly a year following a primary episode, and this higher rate of asymptomatic shedding, plus the lack of antibodies, create the greater risk for babies whose mothers are infected in
the last trimester

Less than 0.1% of babies get neonatal herpes. In about 90% of cases, neonatal herpes is transmitted when an infant comes into contact with HSV- 1 or 2 in the birth canal during delivery.

Newborns may be infected by mothers who first get herpes just before giving birth because there has not been enough time to build up natural protection (immunity) and, when the virus is active during delivery, the baby is at risk

Babies born prematurely may be at a slightly increased risk, even if the mother has a long-standing infection. This is because the transfer of maternal antibodies to the fetus begins at about 28 weeks of pregnancy and continues until birth.

Maternal illness following a cesarean is approximately 28%, compared with 1.6% following a vaginal delivery
Situations in which the developing fetus may be at risk:

A severe first episode during the first trimester (12 weeks) of pregnancy, which can lead to miscarriage.
A first episode in the last trimester of pregnancy, when there is a large amount of virus present and insufficient time for the mother to produce antibodies to protect the unborn baby

If a woman has primary herpes (her first encounter with the virus) at any point in the pregnancy, there is the possibility of the virus crossing the placenta and infecting the baby in the uterus (about 5% of cases).

Mothers who acquire genital herpes in the last few weeks of pregnancy are at the highest risk of transmitting the virus.
To be infected with herpes in the last few weeks of pregnancy is rare but it may account for almost 50% of all cases of neo-natal herpes.

If the infection is a true primary (no previous antibodies to either HSV-1 or HSV-2), and a mother becomes HSV positive at the end of pregnancy, the risk of transmission can be as high as 50%. The risk is also higher if a mother has prior infection with HSV-1, but not HSV-2.

Care during pregnancy

You should inform and consult your doctor or obstetrician:

If you or your partner has genital herpes
When a male partner has genital herpes and the woman has no evidence of infection, you may need to consider:

A blood test to establish if the woman has HSV antibodies
The use of condoms from after the time of conception through to until the birth
Your partner taking oral antiviral medication for the duration of the pregnancy to suppress genital herpes outbreaks
Avoiding oral sex for the duration of the pregnancy if the woman's partner has a history of facial herpes or cold sores
Exploring alternatives to intercourse, such as touching, kissing, fantasizing, massage

As the last stage of pregnancy approaches:

Regular check-ups should be made
The woman and her doctor can discuss the possibility of a Caesarean delivery
The use of antiviral drugs can be considered
While the risk from the scalp monitor may be quite small, a cautious approach would be for a pregnant woman to ask that it not be used unless there is a compelling medical reason (an alternative is the external monitor, which tracks the baby's heartbeat through the mother's abdomen).
The pregnant woman should observe normal guidelines for healthy pregnancy
Good nutrition and rest are even more important at this time.
After the Birth

HSV can also be spread to the baby if someone kisses the
baby with an active cold sore
An infant with herpes can become very ill, causing eye or throat infections, damage to the central nervous system, mental retardation or death

By the time a baby is around six months old, his/ her immune system is better able to cope with exposure to the virus
If you have an outbreak of genital herpes, be sure to wash your hands before touching the baby.

Be sure to take all the necessary precautions not to spread the virus to the child

Can I breastfeed if I have herpes?

As long as the infected area does not come into direct contact with the child there is no particular risk in:

Holding the baby
Breastfeeding
Having the baby in bed with you

Being a parent

Genital herpes, in either parent, does not generally affect children and there is little risk of transmission so long as normal hygiene and herpes prevention methods are practiced.

Initial exposure to HSV in babies and young children, after being kissed by someone with a cold sore, can cause gingivostomatitis, an infection of the mouth and gums which goes largely unrecognized and untreated.

Symptom to look out for:

Symptoms, such as blisters on the body, are indicative of herpes. Other symptoms, such as lethargy, poor feeding, irritability, or fever could stem from any of a number of minor problems.

If the baby is not behaving well, is feverish, irritable, and has blisters, do not delay. Take him or her to your paediatrician immediately, instead of waiting to see whether the situation will improve.

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