Friday, February 16, 2024

Recurrent Herpes Outbreak During Pregnancy

Protecting The Baby: Women Who Dont Have Genital Herpes

Herpes Simplex Virus in Depth / Alynn Alexander, MD

The greatest risk of neonatal herpes is to babies whose mothers contract a genital herpes 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 herpes virus. If you have a partner who knows they have genital herpes and you dont know whether you have it, you need to discuss this with your doctor.

Treatment If The Blisters Come Back

Go to a GP or sexual health clinic if you have been diagnosed with genital herpes and need treatment for an outbreak.

Antiviral medicine may help shorten an outbreak by 1 or 2 days if you start taking it as soon as symptoms appear.

But outbreaks usually settle by themselves, so you may not need treatment.

Recurrent outbreaks are usually milder than the first episode of genital herpes.

Over time, outbreaks tend to happen less often and be less severe. Some people never have outbreaks.

Some people who have more than 6 outbreaks in a year may benefit from taking antiviral medicine for 6 to 12 months.

If you still have outbreaks of genital herpes during this time, you may be referred to a specialist.

How To Have Safe Sex With Herpes

Even if you have herpes, you can still maintain a fulfilling sex life. Although it might prove to be a bit more complicated, an enjoyable and safe sex life can be reached if you follow some guidelines. The way herpes spreads is through sexual contact between an infected partner and an uninfected partner. Herpes is the most widespread sexually transmitted infection in the world. Thats why it is paramount to understand the safe ways you can perform sexually in order to protect the virus from spreading.

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Treatment The First Time You Have Genital Herpes

You may be prescribed:

  • antiviral medicine to stop the symptoms getting worse you need to start taking this within 5 days of the symptoms appearing
  • cream for the pain

If you have had symptoms for more than 5 days before you go to a sexual health clinic, you can still get tested to find out the cause.

Recognizing The Signs: The Prodrome

When Can You Get Tested For Herpes

Early in the phase of reactivation , many people experience an itching, tingling, or painful feeling in the area where their recurrent lesions will develop. This sort of warning symptomcalled a prodromeoften comes a day or two before lesions appear. To be on the safe side, its best to assume virus is active during these times.

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Pprom And Hsv Infection

An increased risk of transmission occurs with rupture of membranes. For pregnant patients with recurrent HSV infection and preterm premature rupture of the membranes , the risk associated with prematurity must be balanced with the risk of in utero infection on a case by case basis. In women with preterm prelabor rupture of membranes, there is no consensus on the gestational age at which the risks of prematurity outweigh the risks of HSV infection. If delay of delivery is appropriate, IV acyclovir 5 mg/kg every 8 hours is recommended to shorten the duration of active lesions. For pregnant patients with a primary or first episode of genital HSV infection and PPROM, no data are available for the risk of fetal infection for expectant management.

Recurrent Genital Herpes In Pregnancy

Christopher Mabary

Your location also matters. In the United Kingdom, cesareans are generally recommended for recurrent genital herpes in the third trimester, while other European countries such as the Netherlands aim for vaginal births in these cases.It will be up to you to weigh the risks and advocate for your choice of delivery if you have secondary herpes.

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Avoid Withdrawing From Your Partner

A sudden outbreak can be disappointing, especially if you were looking forward to an intimate evening.

But its important to remember that your worth isnt tied to your diagnosis. Youre still the same person, outbreak or not.

If you dont truly believe this, your words might reflect your self-judgment, and you might end up pulling away or conveying the message you do have something to feel embarrassed about .

Instead of saying something like:

  • We cant have sex tonight I understand if you dont want to come over after all.

Try something like:

  • Tonights a no-go for sex, so lets cuddle up with a horror movie.

The second validates the reality that you still have a lot to offer in the way of companionship. And dont forget, a hot makeout session can be pretty sexy. Think of the tension youll build up!

Sex is an important component in many romantic relationships, but it shouldnt be the only thing keeping your relationship going.

To help your relationship thrive, practice connecting with your partner in other ways.

You might try:

  • sharing goals for the future
  • simply existing in the same space

Experts agree this simply isnt true. The virus doesnt live long once outside the body, so the risk of transmission is very low in these scenarios.

Soap and water kills the virus, so if you touch sores to apply medication, all you have to do is wash your hands thoroughly afterward.

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How Can I Avoid Another Outbreak Of Genital Herpes

Herpes and Pregnancy

As the herpes virus stays in the nerves near where the infection first appeared, it will come back in the same area. Recurrent infections can be triggered by:

  • ultraviolet light
  • a weakened immune system for example if youre going through chemotherapy or HIV .

Obviously, a lot of these things are pretty difficult to avoid though. But the risk of genital herpes can be reduced by:

  • Using a condom every time you have sex . The condom needs to cover the infected area.
  • Not sharing sex toys .

This page was last reviewed in February 2018

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Can You Breastfeed If You Have Herpes

Yes, most women can breastfeed their babies even when infected with herpes, as the virus cant be passed through breast milk. But be on the lookout for sores and lesions on your breasts, which can spread the virus and always wash your hands with soap and water before and after each feeding session. If do you spot a sore, dont feed your infant from that side.

And as for milk thats been pumped or expressed by hand from a breast that has an active lesion, its a no-go for your infant. This milk may be contaminated and must be discarded since it may have come in contact with the sore during the process. But if your other breast is sore-free, you can pump and feed that side to your infant, though be sure both your hands and the pump parts are super clean to avoid any transmission.

From the What to Expect editorial team and Heidi Murkoff, author of What to Expect When You’re Expecting. What to Expect follows strict reporting guidelines and uses only credible sources, such as peer-reviewed studies, academic research institutions and highly respected health organizations. Learn how we keep our content accurate and up-to-date by reading our medical review and editorial policy.

Ways To Avoid Getting Herpes While Pregnant

Women who don’t have genital herpes should be careful about sex during the third trimester. Unless you know for sure that your partner is herpes free, avoid sex altogether during the third trimester. If your partner gets cold sores , they should not perform oral sex on you during this time.

Some doctors think all women should be tested for herpes when they get pregnant, especially if their sex partners have herpes. Ask your doctor if you or your partner should be tested.

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Meet Nearby People With Herpes

PositiveSingles is the largest online dating and support community for people with herpes. Online since 2001, it has the largest user base among all the STD dating sites and APPs. You will find out there are plenty of people around you.

Join for free now

Thank you Positive Singles for providing me the avenue to meet my life long Soul Mate, the Love of my Life. It has been a wonderful year since we met and I am looking forward to spending the rest of my life with Lisa.

It started as a long distance relationship for 6 months but after that we moved in together. Wishing the same for everyone else searching for their mate.

Can You Give Birth Naturally If You Have Herpes

Preventing Herpes Simplex Virus in the Newborn

Most people with herpes can have a vaginal birth. A doctor can test the skin for signs of herpes shortly before the birth. If a person shows signs of infection, doctors may recommend a C-section to lower the risk of transmitting the infection to the baby.

C-sections lower this risk by delivering the baby through incisions in the abdomen and uterus. This prevents them from contracting the virus in the birth canal.

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No Ulcers Doesnt Equal No Herpes So Then What

If youve never had genital ulcers and as far as you know, have never been exposed, is it worth getting tested? Thats a controversial point and in fact, the widely followed official guidelines discourage screening.

Why? Many reasons: Lets say the test comes back positive for HSV-2. This means that the patient may have been exposed to HSV-2 at some point in their lives, somehow, somewhere. Research tells us that these folks may be periodically shedding virus particles in their genital fluids. These patients would then be diagnosed with genital herpes, encouraged to share their status with future partners, and offered daily antiviral medication to prevent possibly spreading the virus.

All of this can be a tough pill to swallow, so to speak. There is significant social stigma and shame associated with herpes. In addition, there are occasionally false-positive tests. Labeling someone with the diagnosis can be devastating to their future relationships, and asking someone to take a pill for a condition they may or may not have and may or may not spread seems unreasonable.

However, many experts disagree with the official guidelines. I wrote to Dr. John Gnann, professor of infectious disease at the Medical University of South Carolina and co-author of a review in the New England Journal of Medicine . He has suggested the below guidelines, and outlines the rationale:

  • The person has had herpes with symptoms.
  • The person has had herpes with symptoms but didnt realize the cause.
  • Transmission Prevention During Sex

    Genital herpes suppressive treatment can also help reduce your risk of transmitting the infection to new sexual partners. Other steps can help ensure that you dont infect a sexual partner, as well. For example, genital herpes infection can be transmitted through mouth-to-genital contact in addition to genital-to-genital contact, so you should use a condom or

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    Infection Before Or At The Beginning Of Pregnancy

    Women who become infected with herpes before pregnancy, or in the first three months of pregnancy, only rarely infect their child with it. One big study found that 1 out of 100 babies became infected during childbirth.

    Pregnant women who have genital herpes should talk to their doctor about it. He or she can then check the skin for signs of an outbreak shortly before the birth. Its also important to tell the doctor if there are any early signs of an outbreak, such as tingling in the genital area, around the time of the birth. If there are no signs of an outbreak, theres no reason why the woman shouldn’t give birth naturally. If there are, she is usually advised to have a Cesarean section. This greatly lowers the risk of infecting the baby.

    It is estimated that about 13 out of 100 pregnant women who have genital herpes have an outbreak at the time of the birth. The risk of this happening can be reduced by preventive treatment with antiviral medication, which is then taken every day from 35 weeks of pregnancy until the birth. This also increases the chances of the woman being able to have a natural birth. Research has found that Cesarean sections were carried out in

    • 13 out of 100 people who didnt have preventive treatment with antiviral medication, compared to
    • only 4 out of 100 women who did have preventive antiviral treatment.

    Symptoms Of Herpes During Pregnancy

    Toxoplasmosis, Rubella, Cytomegalovirus (CMV), Herpes, syphilis – Torch Infections in Pregnancy

    Most people with genital herpes either have no symptoms or have only very mild symptoms that often go unnoticed. According to the CDC, nearly 90 percent of people who have herpes don’t realize it.

    Symptoms, if they occur at all, vary widely. They’re usually most severe when you’re first infected with genital herpes because you don’t yet have antibodies against the virus.

    Other possible symptoms include:

    • Tender, swollen lymph nodes near your groin
    • Painful urination
    • Flu-like symptoms, including fever, headache, and muscle aches

    Some pregnant women get very sick when they get herpes for the first time and need to receive the antiviral medication acyclovir intravenously.

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    Why Do I Get Cold Sores So Often

    Find out why you get cold sores so often and what can be done to reduce the number of recurring outbreaks.The facts about cold sores

    Cold sores are an infectious chronic inflammatory skin disease caused by the herpes simplex virus. The infection occurs in the form of vesicular eruptions, usually located on the periphery of the mouth and lips. Herpes is a contagious and recurrent disease thats why its impossible to get rid of. Unfortunately, outbreaks will erupt and subside throughout your lifetime. However, that doesnt mean you have no control over the frequency with which that typical tingling and burning sensation will be felt.

    What causes cold sore outbreaks?

    You can stop wondering why you get cold sores so often and instead make every effort to avoid conditions that trigger an outbreak. They include:

    • stress and anxiety
    • some foods and allergies

    It goes without saying that you should also avoid kissing anyone when you have a cold sore, as well as sharing your utensils or towels.

    Nothing works

    If youve tried to avoid conditions that can encourage cold sore outbreaks, and still cant seem to avoid them, you may need to consult a doctor and get some more advice on what you can do to control it.

    Ask your doctor for help

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    Understanding Herpes With H Hunter Handsfield Md

    Herpes expert H. Hunter Handsfield, MD, explains the basics about genital herpes, including the difference between genital HSV-1 and HSV-2 infection, testing options and the importance of knowing virus type, and the three-prong strategy for prevention. See more herpes videos at

    Have a question about herpes youd like Dr. Handsfield or our other experts to answer? Visit our Ask the Experts page to learn how.

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    How Long Do Herpes Symptoms Take To Show

    On average, it takes about 4 days after exposure to start showing the symptoms of herpes. The herpes incubation period ranges between 2 and 12 days. The most common early sign of herpes is sores around the genitals or mouth.

    The first time you get the herpes virus, it may cause flu-like symptoms, such as a fever, headache, and body aches. Then, subsequent outbreaks may cause sores and less severe symptoms. Generally, the frequency of outbreaks lessens over time.

    How Can I Manage Herpes During Pregnancy

    Herpes Treatment, Prevention and Support

    There is no evidence to suggest pregnancy causes flare-ups. The American College of Obstetricians and Gynecologists says 75% of pregnant women who have herpes, however, can expect to have an outbreak during pregnancy.

    During pregnancy, you should watch for symptoms of the virus becoming active, such as tingling, itching, or burning around where the sore will eventually appear.

    If you have a history of herpes , your provider may prescribe an antiviral medication such as acyclovir to reduce the risk of spreading the virus or having an outbreak around the time of your delivery.

    We typically recommend starting an antiviral at 36 weeks or sooner if you are at risk for preterm birth. The antiviral medications are safe during pregnancy. In fact, we can give the same medications to your baby if needed.

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    Routine Antiviral Suppression For Gravidas With A History Of Genital Hsv

    In 1998, Brocklehurst et al performed a double-blind placebo-controlled trial that involved 63 women with a history of recurrent HSV infection. These women were randomized to either acyclovir or placebo, both beginning at 36 weeks’ gestation. Nonsignificant reductions were found in recurrent HSV outbreaks at delivery, cesarean deliveries for HSV, and total cesareans in the acyclovir group. No infant in either group developed neonatal HSV, and no gravida experienced toxicity from acyclovir. The authors concluded that the sample size was too small to demonstrate a significant benefit from acyclovir and recommended that acyclovir be used only in clinical trials.

    Since that time, additional randomized clinical studies have been performed, each demonstrating nonsignificant reductions in cesarean deliveries for recurrent HSV outbreaks and no differences in neonatal outcomes.

    A 2003 meta-analysis pooled the results of five randomized clinical trials evaluating the use of antenatal suppressive acyclovir in 799 gravidas. The results of the meta-analysis are shown in Table 4.

    Table 4. Antiviral Trial Results


    Recurrent HSV infection at delivery

    Asymptomatic HSV shedding at delivery

    Recommended regimens for suppressive therapy for pregnant women with recurrent genital herpes are as follows:

    • Acyclovir, 400 mg orally three times per day
    • Valacyclovir, 500 mg orally twice a day

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