Genital herpes during pregnancy — when is the newborn at risk?

A genital herpes outbreak during pregnancy can be a serious risk for your child

What is genital herpes?

There are two main strands of the herpes simplex virus (HSV), type 1 and type 2. The first type is responsible for most oral herpes, which is more popularly known as cold sores. This virus is present in around 80% of people but often it’s dormant and only triggers cold sores when the immune system is weak. HSV type 2 is less common and only found in about 15% of the US population — although the share is gradually rising as people tend to become sexually active at younger ages.

This HSV type 2 is the culprit behind most cases of genital herpes, but type 1 can also cause genital herpes. So, there’s an oral-to-genitals transmission risk, and vice versa. This is what makes herpes so contagious; it’s not just vaginal or anal sex, but even oral sex can pass on a herpes infection — as can sharing sex toys and transmission by finger.

Once the herpes virus is acquired, you are unlikely to ever get rid of it again. However, your body and immune system will learn to live with the virus and control it, which means that you’ll no longer get active outbreaks. In general, only 10-20% of people with genital herpes infections will experience an active outbreak in their lives.

If you belong to this unlucky 20 %, you’ll one day notice small, itchy blisters on your genitalia that after a few days break open and eventually turn into ulcers. The latter can be a bit painful and you may experience low degree fever, flu-like fatigue, and swollen lymph nodes for a few days. Normally, the body quickly suppresses the outbreak and after 3 to 4 weeks the lesions begin to heal over. It’s definitely an unpleasant experience but very rarely harmful to your health. Moreover, if you ever get another outbreak in the future, it will be much milder and go away faster. 

Whether you get the herpes virus in the first place depends on your sexual activity, how many partners you’ve been with, and what protective measures you take. For context: if a couple with a normal sex life has one partner with a genital herpes infection, the odds of the other partner catching the virus over the course of one year are about 10%. This risk can be halved, if the couple takes care to avoid sex during active herpes outbreaks and frequently uses condoms. To learn more about the herpes virus and how to reduce the transmission risk, talk to your doctor or gynecologist.

 

What are the risks of genital herpes for pregnant women?

Firstly, the risks of catching herpes from an infected partner are equally high, regardless of whether a woman is pregnant or not. So, you’ll still need to pay attention to protection and prevention. In fact, as a pregnant woman, you need to be particularly careful. As noted above, herpes is a nuisance, but it very seldom leads to serious complications in adults and teenagers. However, an active genital herpes outbreak during pregnancy can in rare cases infect the newborn child, triggering what’s called ‘neonatal herpes’.

In the US, neonatal herpes occurs in only about 60 out of 100,000 newborns. This is very rare, given that 40-50% of pregnant women are estimated to have either herpes type 1 or 2. This is because it takes a strong active herpes outbreak during pregnancy (especially in the third trimester) to transmit the virus to the baby. The highest risk group are women who only recently caught herpes and now experience their first outbreak, unfortunately, while pregnant. It’s thought that up to 80% of neonatal herpes cases in the US stem from women who recently caught genital herpes for the first time.

The transmission typically occurs during delivery, as the baby is passing through the genital tract, although in-utero infections have also been reported and it’s even possible to transmit oral herpes from a mother to the newborn child. Therefore, doctors often recommend that pregnant women with an active herpes outbreak (and that is also their first outbreak) deliver the baby by C-section. 

If the baby catches the virus and the infection is left untreated, neonatal herpes will be fatal in about 60% of cases. Nowadays, an antiviral drug, acyclovir, is used to treat herpes in newborns. The drug is given in high doses over the course of 2-3 weeks and usually is an effective treatment to stop the initial herpes outbreak. This treatment lowers the mortality rate of neonatal herpes to below 10%.  

 Even if the initial outbreak is cured though, herpes is likely to periodically recur during early childhood, requiring continued antiviral treatment. In some cases, the child’s nervous system may suffer permanent damage, leading to developmental delays and cognitive disorders. 

 

I’m pregnant. What preventive measure can I take to avoid genital herpes?

As there, unfortunately, is no herpes vaccine available, taking preventive steps is the only thing you can do. As the first step, you and your partner should get tested for herpes type 1 and 2. If the test results are negative on all counts, you’ll have nothing to worry about, unless, of course, you or your partner have sex with other partners. If you are herpes negative but your partner has either type of herpes, you should limit your sexual activity to only condom protected intercourse and avoid oral sex of any kind. Some women also prefer to remain entirely sexually abstinent during the third trimester, not just for herpes prevention but a whole variety of health reasons.     

Given how common herpes is, you may already have genital herpes for some time. So, if your herpes test comes back positive or if you know from a previous outbreak that you carry the virus, you have to regularly for signs of a recurring outbreak and strengthen your immune system with a healthy balanced diet and enough sleep (this is something you should do anyway when pregnant). Having a strong immune system makes it unlikely that you get another herpes outbreak.

Moreover, if you already had the herpes virus for a while, the risk of a recurring outbreak infecting the baby during delivery is very low. As mentioned above, 80% of neonatal herpes cases come from women you have a first-ever herpes outbreak. So, if you have had genital herpes for a while and now are pregnant or thinking about getting pregnant, the herpes infection isn’t something to lose sleep over. Just make sure you live healthily and regularly get checked and tested by a doctor. Regular blood tests can monitor the virus blood serum levels and watch for any changes that may signal an impending outbreak.   

 

References

  1. Corey, Lawrence, and Anna Wald. “Maternal and Neonatal Herpes Simplex Virus Infections.” The New England Journal of Medicine, vol. 361, no. 14, 2009, pp. 1376–85, www.ncbi.nlm.nih.gov/pubmed/19797284, 10.1056/NEJMra0807633. Accessed 21 July 2020.
  2.  Wald, Anna, et al. “The Relationship between Condom Use and Herpes Simplex Virus Acquisition.” Annals of Internal Medicine, vol. 143, no. 10, 2005, pp. 707–13, www.ncbi.nlm.nih.gov/pubmed/16287791, 10.7326/0003-4819-143-10-200511150-00007. Accessed 21 July 2020.
  3. Donda, Keyur, et al. “Trends in the Incidence, Mortality, and Cost of Neonatal Herpes Simplex Virus Hospitalizations in the United States from 2003 to 2014.” Journal of Perinatology, vol. 39, no. 5, 1 May 2019, pp. 697–707, www.nature.com/articles/s41372-019-0352-7, 10.1038/s41372-019-0352-7. Accessed 21 July 2020.

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