Herpes Simplex Infection During Pregnancy

What is herpes simplex infection?

Herpes simplex is a viral infection that a baby can get from the mother during birth. If you have an active herpes simplex infection when your baby is born, it can harm the child.

How does it occur?

The herpes simplex virus can cause sores in the genital area or cold sores, which are common and recurring sores that usually appear around the mouth. You can become infected with the virus by contact with broken blisters or sores on the genitals, mouth, or rectal area of an infected person. The virus can spread from one person to another by kissing, sharing food or drink, or during sex. It can be spread from one part of the body to another by not washing your hands after touching the blisters.

Herpes simplex virus rarely spreads to the baby through the placenta. However, there is a greater risk that the virus will spread to the baby if you have HSV for the first time when you are pregnant. Your baby is most at risk of being infected if you have an active infection when the baby is born. If you have sores in the genital area during labor, your baby has a good chance of coming in contact with the virus when your bag of water breaks or during a vaginal delivery.

What are the symptoms?

The symptoms of a herpes simplex infection in the genital area include:

• itching
• painful sores and blisters (called lesions) on the genitals
• fever (usually only with the first outbreak of blisters)
• tiredness
• general discomfort, muscle aches
• discharge from the vagina
• difficulty or pain when you urinate
• pain when you have intercourse
• tender, enlarged lymph nodes in the groin.

Sometimes repeat herpes infections do not cause any symptoms.

If a newborn is infected with herpes simplex, the following signs or symptoms of infection may appear during the first month after birth:

• irritability
• breathing problems
• fever
• convulsions
• jaundice (yellowish skin)
• sores on the skin
• bruising
• low platelet counts (platelets are the part of blood that makes it clot).

How is it diagnosed?

Your health care provider will take samples of fluid from the sores for lab tests, including cultures for the virus. Blood tests may also be done to determine if you have had a previous herpes infection. If you have a history of herpes infections, your provider may culture samples from your vagina and cervix during the last month of pregnancy.

The baby can be diagnosed with blood tests and cultures of samples from the nose, throat, mouth, and eyes.

How is it treated?

Genital herpes cannot be cured. The virus will stay in your body. However, your health care provider may prescribe acyclovir, famciclovir, or valacyclovir to help prevent an active infection that could be passed to your child during birth. Discuss the use of these medicines with your provider.

Your health care provider may also prescribe medicine to reduce pain and itching.

If your newborn becomes infected, he or she can be treated with acyclovir. This medicine will greatly increase the chances that your child will develop normally.

How long will the effects last?

Your first outbreak of herpes is usually the worst. The sores usually start to heal after about 5 days. They generally disappear in 1 to 3 weeks. Sometimes they may last for as long as 6 weeks.

The virus remains in your body and may cause recurrences. Repeat outbreaks of sores tend to be milder than the first outbreak and the sores heal more quickly.

If you have a new infection or repeat outbreak during the last 6 weeks of pregnancy, you have a greater risk of going into labor early (preterm labor). Repeat outbreaks of herpes simplex are not as likely to infect the baby.

The number of babies who become infected with herpes after birth is small, 1 in 4000 to 5000. The risk of infection increases if you deliver vaginally when you have genital herpes sores. When a newborn is infected, it can be severe. Babies infected with herpes simplex may die or have eye problems, a small brain, mental retardation, seizures, or other problems.

How can I take care of myself when I have an outbreak of herpes sores?

Follow the treatment prescribed by your health care provider. When sores are present you can:

• Put acyclovir cream on the sores to ease discomfort and speed healing.
• Use a disposable glove to put medicine on the sores. This helps avoid spreading the infection to other parts of your body.
• Avoid sexual contact with others.
• Wear loose clothing, preferably cotton, to allow air circulation and to avoid pressure on the skin, which may cause more blisters.
• Avoid using douches, perfumed soaps, sprays, feminine hygiene deodorants, or other chemicals in the genital area.
• Avoid a lot of sunlight and heat, which may cause more blisters.

What can be done to help prevent infection with herpes simplex virus?

Herpes simplex virus is sexually transmitted. To avoid becoming infected with herpes, use latex or polyurethane condoms during foreplay and intercourse. Avoid intimate contact with people who have active sores.

If you have genital herpes sores, the baby's risk of infection is greater after your bag of water breaks and during a vaginal delivery. Your health care provider may prescribe oral acyclovir during the last 6 weeks of pregnancy to reduce the chance that you will have herpes sores and pass the virus to your baby. If you are in labor and have an active genital sore, your health care provider probably will deliver the baby by cesarean section to avoid infecting the baby. If you do not have any sores at the time of labor, you may have a vaginal birth.