Genital Herpes During Pregnancy
Prevention of neonatal herpes depends both on preventing acquisition of genital herpes during late pregnancy and avoiding exposure of the neonate to herpetic lesions and viral shedding during delivery. Mothers of newborns who acquire neonatal herpes often lack histories of clinically evident genital herpes . The risk for transmission to the neonate from an infected mother is high among women who acquire genital herpes near the time of delivery and low among women with prenatal histories of recurrent herpes or who acquire genital herpes during the first half of pregnancy . Women who acquire HSV in the second half of pregnancy should be managed in consultation with maternal-fetal medicine and infectious disease specialists.
All pregnant women should be asked whether they have a history of genital herpes or genital symptoms concerning for HSV infection. At the onset of labor, all women should be questioned thoroughly about symptoms of genital herpes, including prodromal symptoms , and all women should be examined thoroughly for herpetic lesions. Women without symptoms or signs of genital herpes or its prodrome can deliver vaginally. Although cesarean delivery does not eliminate the risk for HSV transmission to the neonate , women with recurrent genital herpetic lesions at the onset of labor should have a cesarean delivery to reduce the risk for neonatal HSV infection.
Acyclovir 400 mg orally 3 times/dayORValacyclovir 500 mg orally 2 times/day
What To Do To Alleviate Symptoms
In order to try to alleviate the pain caused by genital herpes sores and have them heal as soon as possible, it will be important:
- Wash the sores carefully with soap and water.
- Dry the sores well by gently patting them dry.
- Wear loose-fitting clothing and, preferably, avoid synthetic fabrics and opt for cotton underwear.
- Put cold on the area of the sores.
- Take antiviral treatment as prescribed by the specialist and consult if analgesics can be taken to try to relieve the pain.
On the other hand, it is very important to wash hands thoroughly after touching the sores, otherwise the virus could spread to other areas of the body or to other people.
What Is The Treatment For Genital Herpes During Pregnancy
If you have genital herpes, you may be prescribed an oral antiviral medication, such as acyclovir, valacyclovir, or famciclovir starting at around 35 weeks to help reduce the chances that youll have an outbreak of genital herpes at the time of delivery. The drugs cant cure genital herpes, but they can help speed up healing if you have an outbreak of genital herpes and suppress future outbreaks while you get ready to have your baby.
As your labor begins, your doctor will carefully check for any genital herpes lesions blisters or sores. If you dont have any signs of an active outbreak of genital herpes when labor starts, you will probably be able to have a vaginal delivery.
If there are genital herpes lesions present during your labor, you will likely need to have a cesarean delivery to prevent tranmission of the herpes virus to the baby during delivery. Your doctor will discuss your options with you prior to your due date.
Your risk factors for contracting genital herpes are the same during pregnancy as they would normally be. Your risk factors for HSV are linked to being directly exposed to the virus. Risk factors include:
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What If I Am Pregnant
It is important to tell your obstetrician that you or a partner have had genital herpes, so that they can monitor you for symptoms and manage your pregnancy safely. There is a risk you can pass the virus on to your baby if you have a vaginal delivery during a first attack of genital herpes. If this happens you may be recommended to have a caesarean delivery.
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Prevalence Of Herpes During Pregnancy
Herpes infections are common during pregnancy. Research suggests that the prevalence of HSV-2 in reproductive-age females is almost 16%. Furthermore, that only represents a fraction of genital herpes infections, because many genital herpes infections are caused by HSV-1.
Most people with genital herpes do not know they are infected. The vast majority of herpes infections are asymptomaticmeaning they do not have recognizable symptoms.
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Do Natural Remedies Help
There are several options that can be tried to ease the pain. A73612 and Donnor52059 suggest dabbing cornstarch directly on the sores. I canât find any scientific studies that have researched this, but I canât see that it would do any harm.
A73612 also recommends squirting water from a bottle over the sores when you pee. This is a time-honoured method that will help to ease the pain.
Yolandayw mentioned taking a simple painkiller such as paracetamol during an outbreak. Feelbroken advised putting Vaseline on the sores. Lidocaine 5%, a local anaesthetic gel that numbs the area, is another option. Some people find it helpful to put on five minutes before passing urine. You need to get it on prescription and it doesnât suit everyone. Some people develop sensitivity to it which makes the symptoms worse.
Yolandayw also advised using ice as a home remedy. Simply wrap the ice in a tea towel and apply for 5-10 minutes. Never put ice directly on the skin as this can cause âice burnâ. Drinking plenty of water can also be helpful as it reduces the concentration of urine, making it less painful when you have to pee.
D91907 mentioned putting aloe vera gel on the sores. There is some scientific evidence that aloe vera is useful for both genital and oral herpes.
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Can Herpes Be Transmitted To An Infant During Pregnancy Or Delivery
When babies contract herpes, its known as neonatal herpes. Also called birth-acquired herpes, neonatal herpes can happen if your baby is exposed to genital herpes during vaginal delivery.
Neonatal herpes is considered rare, but when it does happen, there can be serious complications, such as permanent injury to the babys nervous system, developmental disabilities, and death.
The risk to your baby is greatest if you acquire HSV for the first time during the third trimester of pregnancy. Thats because the levels of the HSV in your system will be highest during that time, and youll have fewer protective antibodies to pass on to the baby prior to delivery.
If you contract a genital herpes infection during the third trimester, the risk of passing the virus to your baby during delivery is
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How Do Prior Herpes Outbreaks Affect My Pregnancy
If youve had previous herpes outbreaks, they wont necessarily affect your pregnancy. Unless you have an outbreak during pregnancy, no treatment is needed or recommended.
There is some limited evidence that suppressive therapy starting at 36 weeks of gestation may be helpful. However, in the absence of outbreaks, there is no need to change your pregnancy or delivery plans.
What Happens If Herpes Goes Untreated
The first outbreak of genital herpes can be the most severe and can cause complications such as vaginal yeast infections, urinating problems, and meningitis.
Treatment may not be necessary for subsequent outbreaks, but anyone experiencing very regular or severe outbreaks should speak with a doctor about preventive treatment.
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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
Clinical Considerations And Recommendations
Medical Management of Pregnant Women with Primary HSV Infection. Antiviral therapy is recommended for women with primary HSV infection during pregnancy to reduce viral shedding and help in the healing of lesions. Primary HSV infection cannot be distinguished from non-primary first-episode disease without serology. Primary infection poses a higher risk of vertical transmission than does recurrent infection.
Medical Management of Pregnant Women with Recurrent HSV Infection. A randomized trial of acyclovir given after 36 weeks of gestation in women with recurrent genital herpes infection showed a significant decrease in clinical recurrences. There was also a reduction in the number of cesarean deliveries performed for active infection, although this finding was not statistically significant.
Drug Treatment of HSV Infection During Pregnancy. Many antiviral compounds are available for the treatment of HSV infection however, none has received approval from the U.S. Food and Drug Administration for use in pregnancy. Oral acyclovir reduces viral shedding, reduces pain and heals lesions faster when compared with placebo. The drug is safe and has minimal side effects, but only 20 percent of each oral dose is absorbed.
The rightsholder did not grant rights to reproduce this item in electronic media. For the missing item, see the original print version of this publication.
Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.
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Risk Factors For Shingles
Reportedly, one in three people in the US will have shingles in their lifetime, making it a fairly common infection. Anyone whoâs had chickenpox before can get shingles. Thatâs because the virus that causes chickenpox becomes dormant in the body after treatment. It later reactivates to cause shingles.²
Several factors can increase the likelihood of the varicella-zoster virus reactivating. A weakened immune system is one risk factor, as your body is less able to fight off viruses, thus allowing the varicella-zoster virus to come alive.
Several factors can cause a weakened immune system, including:
-
Having another illness like cancer or HIV
What Are Possible Complications Of Herpes
Theres some research that a genital herpes infection may lead to miscarriage or result in the preterm delivery of your baby, which is why its important to discuss any symptoms you have with your physician so your case can be managed carefully.
If you have recurrent herpes , youre at an extremely low risk less than 1 percent of transmitting herpes to your unborn baby.
Same goes if a routine screening for sexually transmitted diseases at your first prenatal visit diagnoses HSV for the first time, or if youre infected during the first trimester of your pregnancy and are asymptomatic.
Only women who are infected for the first time in late pregnancy have a greater risk of infecting their unborn babies, because their bodies have not yet produced HSV antibodies. In the rare case that a newborn gets herpes, transmission most often occurs when the baby passes through the mothers infected birth canal.
To prevent this from happening, your health care provider may prescribe medication in your third trimester to decrease the chances of a herpes outbreak around the time you give birth. And if you have active sores or youre expecting a breakout near your due date, you might be advised to have a cesarean section to minimize the risk of infection.
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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.
What Are The Complications Of Having Herpes And Being Pregnant
Most people who have herpes when theyre pregnant will not have any complications. In rare cases, herpes infection during pregnancy can be transmitted to the newborn. This can potentially cause serious or even life-threatening disseminated neonatal herpes.
The more likely complication of having herpes when youre pregnant is that your doctor might recommend that you have a C-section instead of giving birth vaginally.
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Genital Herpes Treatment During Pregnancy
Women taking antiviral drugs for herpes — either daily suppressive therapy or occasional therapy for outbreaks — should consult their doctor about whether to take the drugs during pregnancy. The answer is not set in stone: You and your doctor have to discuss the risks and benefits to decide what’s right for you.
For pregnant women with a history of genital herpes, the doctor might recommend daily doses of an antiviral medication during the month before their due date.
Herpes infection in a newborn is also serious. Do not allow anyone with a cold sore on the mouth to kiss the baby. If you have a cold sore, don’t kiss the baby, and wash hands with soap and water before touching the baby.
Risks Of Herpes During Pregnancy
The major risk associated with herpes and pregnancy is neonatal herpes infections. These infections of the newborn are rare, but can be quite serious or even fatal. The biggest risk for neonatal herpes occurs for people who are newly infected during pregnancyparticularly near the time of delivery.
Cesarean section is recommended instead of vaginal delivery for people who have genital symptoms at the time of delivery. It is also recommended for people who are having prodromal symptoms that signal a likely outbreak. C-section has been shown to significantly reduce the risk of herpes transmission to the infant.
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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.
How Is Herpes Diagnosed In Pregnancy
If you or your partner experience any of the above symptoms, check in with your doctor. A health care provider may be able to identify your sores via an exam, but a lab test is necessary to diagnose a case of genital herpes.
A sample is taken from the fluid inside a sore and then tested to see if it contains the virus and, if it does, what type of HSV is present. A blood test can check for antibodies and therefore diagnose HSV and its type but it cant determine how the infection was contracted or how long youve had the virus.
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How Is Herpes Treated In Pregnancy
Its not clear whether all antiviral medications for genital herpes are safe during pregnancy, so follow your doctors lead when it comes to treatment.
Herpes symptoms may be managed with antivirals and during an outbreak, and they may reduce the length and severity of it. Daily medication, which is called suppressive therapy, can also reduce the number of outbreaks you experience.
How Common Is Genital Herpes
According to the Centers for Disease Control and Prevention, approximately 40 million to 50 million adults in the United States have genital herpes. HSV II infection is more common in women and in people who have had more than five sexual partners. Most people with HSV II do not know they have it, because it does not always cause symptoms.
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Suppressive Therapy For Recurrent Hsv
Suppressive therapy reduces frequency of genital herpes recurrences by 70%80% among patients who have frequent recurrences . Persons receiving such therapy often report having experienced no symptomatic outbreaks. Suppressive therapy also is effective for patients with less frequent recurrences. Long-term safety and efficacy have been documented among patients receiving daily acyclovir, valacyclovir, and famciclovir . Quality of life is improved for many patients with frequent recurrences who receive suppressive therapy rather than episodic treatment . Providers should discuss with patients on an annual basis whether they want to continue suppressive therapy because frequency of genital HSV-2 recurrence diminishes over time for many persons. However, neither treatment discontinuation nor laboratory monitoring is necessary because adverse events and development of HSV antiviral resistance related to long-term antiviral use are uncommon.
Valacyclovir 500 mg orally 2 times/day for 3 daysOR
Valacyclovir 1 gm orally once daily for 5 days
*Acyclovir 400 mg orally 3 times/day is also effective, but are not recommended because of frequency of dosing.