Herpes simplex virus (HSV), more commonly known simply as herpes, is one of the most common sexually transmitted infections (STIs). This virus can be spread through vaginal, anal, and oral sex.
It is estimated that about 50-80 percent of the population is infected with oral herpes (typically HSV-1). Genital herpes (typically HSV-2 but can also be HSV-1) affects about 20 percent of the population, but as many as 90 percent of these people do not realize that they have it. Herpes can be spread even when you do not think that you have an outbreak.
Pregnancy is an important time to talk about genital herpes because of the potentially serious effects it can have on the pregnancy and the baby. With the proper precautions, however, it is possible to have a healthy pregnancy with herpes.
Diagnosis of herpes
Herpes diagnosis often occurs before pregnancy, but it is standard prenatal care to screen women for the virus. This is usually done at the first prenatal appointment. It can be done with a blood test or by testing the cells of a sore or lesion if one is present.
Risks of herpes during pregnancy
It is rare for herpes to be transmitted to the baby in the uterus. However, it is more common to see transmission occur at the time of the delivery or birth. What can be risky is to have untreated herpes during pregnancy. If you have untreated herpes in the first or second trimester, you have an increased risk of preterm labor.
About 75 percent of pregnant women who have herpes can expect an outbreak while they are pregnant. The greatest risk comes if you have your first outbreak in pregnancy. Women who have been diagnosed prior to pregnancy are at lower risk. Further, if the woman does not have herpes but her partner does, or the partner has a different strain of the virus than the woman, she should avoid genital contact or use condoms when engaging in sexual behaviors to prevent infection.
Herpes treatment during pregnancy
Treatment in pregnancy is generally reserved for outbreaks, as opposed to treatment designed to prevent outbreaks. Your doctor may also discuss treatment if you have your first outbreak during pregnancy, or if you tend to have four or more outbreaks a year.
If you have frequent outbreaks, one of the things your doctor may offer is prophylactic treatment with antivirals in the end of pregnancy. This reduces the frequency of viral shedding, but it’s unclear whether it protects against the risks of herpes transmission during childbirth. Because the risk of passing herpes to your baby during delivery is low if you do not have an active outbreak, your provider may counsel you about your options so that you can decide whether you want to do this treatment. This treatment has been shown to reduce the number of cesarean births for herpes infections.
It is also possible to have procedures like an amniocentesis when pregnant, even with an active outbreak. This does not pose a risk to the baby.
Herpes treatment during labor
The vast majority of women who have herpes have a normal, uncomplicated vaginal delivery. In most cases, women with herpes are not restricted when it comes to the type of birth they can have (vaginal or cesarean) or even invasive procedures like fetal scalp monitoring. Herpes is not an issue in labor unless there are active lesions or you have prodromal symptoms, which are symptoms that indicate you are about to have an active infection. It is important to note that active sores that are not near the vagina or labia may mean that a vaginal delivery is still possible. If you have these symptoms, a cesarean birth is recommended.
Risks to the newborn
Newborn infections of herpes are fairly uncommon. About 1 in 3,200 newborns will develop a herpes infection. The biggest risk is if the baby is not treated. When neonatal herpes is not treated, there is a high risk of lifelong problems, disability, and even death.
You should also know that breastfeeding is possible with herpes, even during an active outbreak, as long as the outbreak is not on the breast, nipple, or areola.
The key to a healthy pregnancy with herpes is good communication with your health care provider and your partner. Get treatment for active lesions, and pay attention to potential new lesions, particularly around the time of birth. A vaginal birth is safe as long as you do not have an active lesion around the vaginal opening or are not experiencing your first herpes outbreak. Talk to your practitioner about medications for treatment should you have an outbreak.
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Robin Elise Weiss, Ph.D., LCCE, CLC, AdvCD(DONA) is a childbirth educator, doula, founder of Childbirth.org, and the award-winning pregnancy and parenting author of “The Complete Illustrated Guide to Pregnancy” and more than 10 other books. Between her nine children, teaching childbirth classes, and attending births for more than two decades, she has built up an impressive and practical knowledge base. You can follow Robin on Twitter @RobinPregnancy, Instagram, and Facebook.