Conception, Pregnancy and Childbirth
Herpes is not a genetic condition and so cannot be passed on from parent to child in this way. Herpes is also not spread through blood, saliva, semen or vaginal fluids, instead, the herpes virus is spread by direct skin to skin contact.
Having herpes does not mean that you will not be able to have children (whether you are male or female). In fact, nearly 25% of all pregnant women have genital herpes.
The following information will help you to understand the rare complications that can arise with herpes, and how they can be prevented.
Most women with genital herpes do not experience any problem
Women with a history of genital herpes before becoming pregnant have a very low risk of transmitting the virus to their baby because of antibodies circulating in the mother’s blood which protect the baby during pregnancy.
The main concern for women who already have herpes is to prevent the baby’s skin from coming into contact with an active outbreak during childbirth.
If a woman is having an outbreak during labor and delivery and there is an active herpes outbreak in or near the birth canal, the doctor will do a cesarean section to protect the baby.
Most women with genital herpes, however, do not have signs of active infection with the virus during this time and can have a normal delivery.
Genital herpes does not affect a man’s ability to father children
Herpes does not affect a man’s sperm count or ability to conceive. it is also not a genetic condition so will not be passed onto your children this way. The main consideration for a man who has herpes (including genital herpes and cold sores) is to take precautions not to infect an uninfected female partner during the pregnancy, as this could have serious complications.
Rare complications to be mindful of
If a woman has primary herpes (her first ever 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. 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.
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 HSV1 or HSV2)
- Non-primary first episode (an infection of HSV2 in a person with previous antibodies to HSV1)
Ask your doctor to make the appropriate arrangements and to advise the lab of how many weeks pregnant you are.
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. In this case the developing baby will be safe and protected by the body’s antibodies.
If you have ever been exposed to herpes talk with your doctor before planning a pregnancy, even if you have never had symptoms or have not experienced a recurrence in a long time.
You will need to contact your health care professional for more information about pregnancy with herpes, and to obtain appropriate tests and follow-up care for the pregnancy.
For some women herpes outbreaks may 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 and the change in hormones. Attention to diet and nutrition can be helpful here, as well as reducing stress where possible.
Recurrent genital herpes presents only a minimal risk in pregnancy. Although the outbreaks are stressful and definitely not a lot of fun they are not harmful to the baby, other than the effects that they are having on the woman physically, such as stress and discomfort.
- 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. Here are the facts and statistics:
- If a woman has “active” herpes at the time of delivery, a Cesarean section is usually performed and the Doctor will help assess this.
- 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.
- 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
- 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. 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 a woman experiences her first ever “primary” outbreak during any stage of the pregnancy there is a chance of transmission via the placenta (5% of cases).
- 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.
You should inform and consult your doctor or obstetrician if you or your partner have herpes.
When a male partner has 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
- The infected male partner taking medication or supplements 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.
Cold sores are a form of herpes and therefore pose a risk to the baby if contracted during pregnancy.
- 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.
As long as the infected area does not come into direct contact with the child there is no particular risk in holding your baby, breastfeeding or having your baby in bed with you.
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.
Protecting your loved ones
- Herpes can be spread to a child if a person kisses them while having an active cold sore. If you have an active outbreak, or a family, friend or relative does, take care to avoid the cold sore coming into contact with the child.
- Babies can also contract herpes from being kissed by someone with a cold sore (5 – 8%). A young child cannot fight off infections as easily as an adult can, so serious health problems can occur. If you suffer from cold sores take every precaution not to put an infant child at risk.
- 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 a young child
Symptoms, such as blisters on the body, can be 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 pediatrician immediately, instead of waiting to see whether the situation will improve.