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Herpes and pregnancy
How can herpes simplex spread to an infant?
• If a woman with genital herpes has virus present in the birth canal during delivery, herpes simplex can be spread to an infant, causing neonatal herpes.
• Herpes can also be spread to the baby in the first weeks of life if he or she is kissed by someone with an active cold sore (oral herpes). In rare instances, herpes may be spread by touch, if someone touches an active cold sore and then immediately touches the baby.
However, there are precautions that can be taken to lower the risk of transmission from mother to baby.
How many babies get neonatal herpes?
Less than 0.1% of babies born in the United States each year get neonatal herpes. By contrast, some 25-30% of pregnant women have genital herpes. This means that most women with genital herpes give birth to healthy babies.
Which babies are most at risk?
Babies are most at risk for neonatal herpes if the mother contracts genital herpes late in pregnancy. This is because a newly infected mother does not have antibodies against the virus, so there is no natural protection for the baby during birth. In addition, a new herpes infection is frequently active, so there is an increased possibility the virus will be present in the birth canal during delivery.
What about pregnant women who have a history of genital herpes?
Women who acquire genital herpes before they become pregnant have a very low risk of transmitting the virus to their babies. This is because their immune systems make antibodies that are temporarily passed to the baby through the placenta. Even if herpes is active in the birth canal during delivery, the antibodies help protect the baby. In addition, if a mother knows she has genital herpes, her doctor or midwife can take steps to protect the baby.
How can herpes harm a baby?
Neonatal herpes can cause an overwhelming infection resulting in lasting damage to the central nervous system, mental retardation, or death. Medication, if given early, may help prevent or reduce lasting damage, but even with antiviral medication, this infection has serious consequences for most infected infants.
Women with genital herpes
If you are pregnant and you have genital herpes, you may be concerned about the risk of spreading the infection to your baby. Be reassured that the risk is extremely small—especially if you have had herpes for some time. The following steps can help make the risk even smaller:
• Talk with your obstetrician or midwife. Make sure he or she knows you have genital herpes.
• At the time of labor, your health care provider should examine you early in labor with a strong light to detect any sores or signs of an outbreak. Let your provider know if you have any signs of an outbreak—itching, tingling, or pain.
• If you have an active outbreak at the time of delivery, the safest course is a Cesarean section to prevent the baby from coming into contact with virus in the birth canal. If you do not have an active outbreak, you can have a vaginal delivery.
• Ask your doctor not to break the bag of waters around the baby unless necessary. The bag of waters may help protect the baby against any virus in the birth canal.
• Ask your doctor not to use a fetal scalp monitor (scalp electrodes) during labor to monitor the baby's heart rate unless medically necessary. This instrument makes tiny punctures in the baby's scalp, which may allow herpes virus to enter. In most cases, an external monitor can be used instead.
• Ask that a vacuum or forceps not be used during delivery unless medically necessary. These instruments can also cause breaks in the baby's scalp, allowing virus to enter.
• After birth, watch the baby closely for about three weeks. Symptoms of neonatal herpes may include a skin rash, fever, crankiness, or lack of appetite. While these can be symptoms of several mild illnesses, don't wait to see if your baby will get better. Take him or her to the pediatrician at once. Be sure to tell the pediatrician you have genital herpes.
• The odds are strongly in favor of your having a healthy baby.
Women who don't have genital herpes
The greatest risk of neonatal herpes is to babies whose mothers contract a genital infection late in pregnancy. While this is a rare occurrence, it does happen, and can cause a serious, even life-threatening, illness for the baby. The best way you can protect your baby is to know the facts about HSV and how to protect yourself. The first step may be finding out whether you already carry the virus.
How can I get tested for genital herpes?
Visit our testing section for more information on viral cultures (if a symptom is present) or accurate blood tests.
How can I make sure I don't get genital herpes?
If you test negative for genital herpes, but your partner has genital or oral herpes, you may acquire it unless you take steps to prevent transmission. The following steps can help protect you from getting an infection during pregnancy:
- If your partner has genital herpes, abstain from sex during active outbreaks. Between outbreaks, use a condom from start to finish every time you have sexual contact, even if your partner has no symptoms. (HSV can spread when no symptoms are present.) Consider abstaining from sex (oral, vaginal, and anal) during the last trimester.
- Do not let your partner perform oral sex on you if your partner has an oral herpes (cold sores, fever blisters). This can give you genital herpes.
- If you don't know whether your partner has genital HSV, you may wish to ask your partner to be tested.
What if I contract genital herpes during late pregnancy?
If you experience genital symptoms, or believe you have been exposed to genital HSV, tell your obstetrician or midwife at once. However, be aware that herpes can lie dormant for several years. What appears to be a new infection is occasionally an old one that is causing symptoms for the first time. Talk with your provider about the best way to protect your baby.
When a pregnant woman does contract a new genital HSV infection during the last trimester, many providers will prescribe antiviral medication. If lesions or prodromal: hyperlink symptoms are present at the time of labor, a Cesarean section is the safest course to prevent the baby from coming into contact with virus in the birth canal. If the infection is acquired late in pregnancy, many providers would recommend a Cesarean section even without lesions present.
How can I protect the baby after birth?
On rare occasions, babies get neonatal herpes after birth. Such infections are almost always caused by a kiss from an adult who has active oral HSV, often a cold sore. To protect your baby, don't kiss him or her when you have a cold sore, and ask others not to. If you have a cold sore, wash your hands before touching the baby.
Pregnancy and antiviral medication
Many women wonder about taking antiviral medication during pregnancy to suppress outbreaks in the third trimester. The U.S. Food and Drug Administration (FDA) has approved no drug against herpes for this purpose. Nonetheless, acyclovir is used by some physicians to treat women with genital herpes at the end of pregnancy. Small studies suggest that acyclovir taken daily during the last month of pregnancy will prevent recurrences and, therefore, decrease the need for Cesarean sections, but some experts remain concerned about the safety of fetal exposure to the medication.
At the present time, acyclovir's manufacturer does not recommend its use during pregnancy. On the other hand, the company has tracked the experiences of several hundred women who took the drug during pregnancy, some of them inadvertently, and the evidence to date suggests that acyclovir does not carry increased risk of birth defects or adverse pregnancy outcome. On the strength of this data, the use of daily, suppressive treatment during the last month of pregnancy is becoming increasingly common.
For partners of pregnant women
If your partner is pregnant, and she does not have genital herpes, you can help ensure that the baby remains safe from infection. Find out whether you have genital herpes (see “How can I find out if I have herpes?”). Remember, more than 20% of Americans have genital herpes, and most do not have symptoms. If you find that you have the virus, follow these guidelines to protect your partner during the pregnancy:
- Use condoms from start to finish every time you have sexual contact, even if you have no symptoms. Herpes can be spread when no symptoms are present (through a process called asymptomatic shedding).
- If you have genital outbreaks, abstain from sex until the outbreak has completely healed.
- Talk with your health care provider about taking antiviral medication to suppress outbreaks and to significantly reduce the risk of transmission between outbreaks.
- Consider abstaining from sex (oral, vaginal, and anal) during the last trimester. Explore alternatives such as touching, kissing, fantasizing, and massage.
If you have oral herpes (sometimes called cold sores or fever blisters), avoid performing oral sex on your partner to prevent transmitting the virus.
For more information on herpes and pregnancy, call our National Herpes Hotline, send us an email, or read our book, Managing Herpes, which has a chapter on pregnancy.
Learn more about herpes in ASHA's quarterly newsletter, The Helper. 
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