Herpes and Pregnancy

It is common for genital herpes-infected mothers to give birth without passing the virus on to their infant, even with normal vaginal delivery. In fact, according to the American Social Health Association, less than 0.1% of infants born in America each year contract genital herpes during delivery.

A woman who contracts herpes before pregnancy passes herpes antibodies on to her fetus, which protects it from contracting the virus. The child loses these antibodies post partem.

Infants are more at risk of contracting the virus during later stages of pregnancy, particularly the last trimester, because the mother’s body does not have time to produce antibodies, according to Zane Brown, M.D., professor of obstetrics at the University of Washington in Seattle.

Brown adds, "More than 40 percent [of infants who contract herpes at birth] die or have severe brain damage.”

If the primary infection occurs during the latter part of pregnancy, or if the mother has long-standing genital herpes or symptoms during the time of labor, Brown recommends a cesarean section. He also suggests that a type-specific blood test be administered at the first trimester of pregnancy. If both HSV-1 and HSV-2 tests return negative results, her partner should be tested. If the partner’s results are positive, sexual contact in the last trimester of pregnancy should be avoided.

Infants can contract herpes up to several months after delivery. It is recommended that people with oral herpes (cold sores) should avoid kissing the baby and wear a mask over the cold sore when coming in contact with the child.

Early treatment is vital, if an infant contracts herpes. To treat infant herpes, physicians may use an injectable form of the FDA-approved drug acyclovir.

EXPECTANT MOTHERS WITH HSV

Expectant mothers with genital herpes, may be worried about the risk of passing the virus to their infants. Rest assured that the chance of passing the virus on to your infant is slim, particularly if you have had herpes for a while. Here are some tips on reducing the chance even more:

* Speak with your physician, obstetrician or midwife. Make certain he or she is aware of your genital herpes diagnosis.

* During labor, examine yourself for any genital symptoms - sores, itching, tingling or tenderness. Your physician will also examine you with a powerful light to identify signs of an episode.

* Preferably, early in the pregnancy your obstetrician should discuss the options for controlling an active herpes outbreak at the time of delivery. The choices are to carry on with a vaginal delivery or to have a Caesarean section. There is currently insufficient information to clearly support one option or the other; the risk of transmission with vaginal delivery is very low and must be weighed against the danger of C-section.

* Request that your physician does not manually break the water around the infant unless necessary. The bag may help prevent any virus in the birth canal from being contracted.

* Request that your physician does not use a fetal scalp monitor during labor to monitor the baby's heart rate unless medically required. This instrument makes tiny punctures in the baby's scalp, which may permit HSV entry. Often, an external monitor can be substituted.

* Request that doctors do not use forceps during delivery. They may cause breaks in the baby's scalp, which may permit HSV entry.

* After delivery, closely monitor the infant for about 4 weeks for symptoms of neonatal herpes: blisters, fever, fatigue, irritability, or lack of appetite. Symptoms may be mild, but don't delay. Take the infant to a doctor immediately. Inform the doctor of your genital herpes diagnosis.

* Maintain a positive attitude! Most likely your infant will be healthy.

How Expectant Mothers without genital herpes can Protect their Infants

The highest chance of neonatal herpes occurs in infants whose mothers contract the virus in the last pregnancy trimester.

While this is rare, cases have been documented, and can cause a severe, even deadly, illness for the infant. The best method of protecting your infant is to get the facts about herpes and learn how to protect yourself. First, find out whether you already have HSV. If your partner knows s/he has HSV-2 but you are unaware of your status, you need to talk to your physician about testing.

If tests results are negative for genital herpes, try these preventative measures listed below to ensure you don’t contract the virus during pregnancy:

• If your partner is infected with genital herpes, avoid sex during active outbreaks. And between outbreaks, use latex condoms from beginning to end each time you have sex, even if your partner has no symptoms. Get your partner to speak to your physician about suppressive oral antiviral medication during pregnancy. Abstaining from sex during the last trimester is a wise decision.

* If you are unsure if your partner has genital herpes, it is a good idea to ask him to be tested. If s/he has genital or facial herpes, there is a risk that you may contract it unless you take preventative measures.

• Do not receive oral sex from your partner if a cold sore is present.

PARTNERS OF EXPECTANT MOTHERS

If you are the partner of an expectant mother, and she does not have genital herpes, there are things you can do ensure that the infant is protected from the virus. Find out if you have genital herpes (see "How can I get tested?"). Keep in mind that about 20% of sexually active adults have genital herpes with no symptoms. If it’s determined that you have HSV-2, follow these tips to prevent passing it to your partner during pregnancy:

* Be sure to use latex condoms from beginning to end each time you have sex, even in the absence of symptoms.

* Avoid sex during outbreaks until it’s cleared up.

* Speak to your physician about suppression therapy - this may decrease the chance of spreading virus between episodes.

* Avoid sex during the last trimester of pregnancy, as the fetus is very sensitive to the virus if exposed during this phase.

* When you have active cold sores, do not perform oral sex.

* Inform your partner’s physician if you have genital herpes.

The most effective method of protecting infants from contracting neonatal herpes is to avoid contraction of genital herpes during pregnancy, especially during the last trimester.

PREVENTING NEONATAL HERPES

Genital herpes is a virus passed from individuals; it is not hereditary. It is not related to fertility and is not transmitted through sperm or eggs.

A female who has genital herpes can have a safe pregnancy and normal vaginal childbirth, especially when she is diagnosed before pregnancy. When the mother has a history of genital herpes, antibodies will already be present in her bloodstream that will prohibit the virus from being passed to the child.

Only two situations exist where the fetus can contract genital herpes:

* During the first trimester (12 weeks), a severe initial outbreak occurs that can result in a miscarriage. This is very rare and can also occur as a result other virus infections.

* During the last trimester, a severe initial outbreak occurs. This is risky because a large amount of virus is present with insufficient time for the mother to develop protective antibodies. Neonatal herpes can be fatal but is rare in developed countries. With careful monitoring and use of antiviral therapy and/or choosing to get a C-section can decrease likelihood of neonatal herpes.

What to Do During Pregnancy

Expectant mothers must alert their physician if either she or her partner has genital herpes. When the male partner is infected with genital herpes and the female has no sign of infection, the following tips may help keep the female from contracting the virus:

* Get a blood test to detect HSV antibodies in the female’s bloodstream

* Use latex condoms if you engage in sexual intercourse throughout pregnancy

* To reduce genital herpes recurrences, the male should take oral antiviral drugs throughout the pregnancy

* Avoid oral sex during pregnancy if the male has facial herpes.

* Get regular checkups and discuss the prospect of a C-section possibly a prescription of antiviral drugs for the female.

Besides this, the expectant mother should observe the normal guidelines for healthy pregnancy. It is even more necessary to practice good nutrition and rest habits during pregnancy.

Though they may cause discomfort during pregnancy, genital herpes recurrences only present slight risks.

Parenting

A child is typically unaffected by the presence of genital herpes and if normal hygiene is maintained, the chance of the child contracting the virus is small.

It is important for parents to know, however, that HSV can be passed from cold sores simply by kissing and can cause severe, widespread infection in the infant. Luckily, when a child reaches about six months old, his or her immune system is more capable of handling exposure to the virus. The first contact in infants and young children, after being kissed by someone with a cold sore, can cause gingivostomatitis, an infection of the mouth and gums, which is often undetected and therefore, not treated.