Genital herpes and pregnancy

If you have herpes should you give up your plans to have children?

No. Since herpes is spread from active skin infection and not from latent infection, a newborn baby can be infected with herpes only if he or she is born while the virus is active. Neonatal herpes generally occurs if the baby's skin becomes infected during the birth process. If herpes is latent in the mother, there is no virus along the birth canal to infect the baby. If herpes sores are present at the time of labor, then, and only then, a cesarean section may be required to reduce the possibility of direct contact between the infection and the baby. Before birth, the membranes surrounding the baby are a natural barrier that helps to prevent the virus from traveling from the mother's skin to the baby's skin. If the membranes rupture (the bag of water breaks) and a herpes sore on or near the vagina is active, a cesarean section is often performed as an emergency operation. If no sores are present, however, normal labor may safely proceed. Many centers are now studying the use of regular oral acyclovir during the last 2 to 4 weeks of pregnancy to prevent reactivations and allow for a normal vaginal delivery.

Can a fetus become infected with herpes inside the womb?

Yes. In this situation, herpes could have a harmful effect on the fetus before birth. This syndrome of congenital herpes is very rare. Some physicians believe that primary herpes (the first episode of herpes) in the mother may lead to infection in the womb, especially if primary herpes occurs in early pregnancy. However, the overwhelming majority of women who have primary herpes during the first 2 trimesters of pregnancy give birth to perfectly normal babies. Primary herpes in early pregnancy is not considered an absolute indication for abortion, although some women in this situation may choose to have abortions.

One study from Seattle showed that one in 5 such situations (true primary herpes in the first trimester of pregnancy) led to a miscarriage where the fetus was shown to have been affected by herpes in the uterus. Because this situation is so uncommon, the study may have underestimated or overestimated the true incidence. Follow-up unpublished studies from the same medical center suggest that one in 5 may be an overestimate.

Nothing specific can be done to prevent congenital herpes, but the risk is very low. In fact, even women with a proven herpes infection inside the womb often have completely normal and unaffected babies. Most healthy and well-nourished babies who are born to women with herpes are very unlikely to develop problems.

How to avoid passing on herpes to your baby

In order to avoid giving herpes to your baby, you must also tell your doctor that you have herpes or that a previous partner had or your present partner has herpes. During labor, the doctor will carefully inspect your genitals, especially the external genital area, for herpes sores. You must take an active role and discuss the problem well in advance with your doctor. Regular, careful examinations of the external genitals by your physician during the last 2 or 3 weeks of pregnancy may be useful, depending upon how frequently you get recurrences. You and the doctor should increase your awareness of your herpes outbreaks - what they feel like, what they look like, and so on. If possible, your doctor will take a herpes culture from the skin around the vagina during labor; in the unlikely event that a sore has been missed, there will be time to watch and treat the baby, if necessary. The chances that a mother with recurrent genital herpes will give birth to a baby who becomes ill with neonatal herpes are only about one in several thousands, as long as you and your doctor are aware of the status of your infection and are attuned to prevention.