It is possible for a woman with herpes to become pregnant and have a healthy baby. While herpes simplex virus (HSV) infection can present considerations during pregnancy, proactive management and open communication with healthcare providers can help mitigate potential risks. This guide explores the various aspects of pregnancy with herpes, covering conception, potential risks to the baby, management strategies, and pre-conception planning.
Conception and Pregnancy with Herpes
Herpes does not affect a woman’s fertility or ability to conceive. Unlike some other sexually transmitted infections (STIs) such as gonorrhea or chlamydia, herpes does not directly impact the reproductive organs or biological fertility levels. This means a herpes diagnosis does not hinder getting pregnant.
If an active herpes outbreak occurs, it is recommended to abstain from sexual intercourse to prevent transmission. Once the outbreak has resolved, normal sexual activity can resume, allowing for conception. Informing a healthcare provider about herpes status is a necessary first step for women who are pregnant or planning to become pregnant, ensuring appropriate monitoring and care.
Risks to the Baby
The primary concern regarding herpes during pregnancy is potential transmission of the herpes simplex virus (HSV) to the infant, resulting in neonatal herpes. Transmission most commonly occurs during vaginal delivery if active lesions or viral shedding are present in the birth canal. While less common, transmission can also occur in the uterus or shortly after birth through direct contact with a cold sore or other active lesions.
Neonatal herpes can have severe health consequences for the baby, including widespread infection affecting organs like the liver and lungs, or central nervous system disease affecting the brain. Even with prompt antiviral treatment, outcomes such as lasting neurological damage, developmental problems, or death can occur. The risk of transmission is significantly higher (30-50%) if a mother acquires genital herpes for the first time late in pregnancy, especially during the third trimester, because her immune system has not yet developed protective antibodies to pass to the baby. Conversely, if a woman had genital herpes before pregnancy or acquired it early in pregnancy, the risk of transmission to the baby is very low (less than 1%), due to maternal antibodies that offer some protection.
Managing Herpes During Pregnancy
Managing herpes throughout pregnancy focuses on minimizing the risk of transmission to the baby. Healthcare providers recommend antiviral medications, such as acyclovir or valacyclovir, particularly in the third trimester. This suppressive therapy, started around 36 weeks of gestation and continued until delivery, aims to prevent or reduce herpes outbreaks, lowering the risk of active lesions at birth.
The choice of delivery method, whether vaginal or Cesarean section (C-section), depends on the presence of active herpes lesions at the onset of labor. If a woman has active genital herpes sores or prodromal symptoms (like tingling or itching signaling an impending outbreak), a C-section is recommended. This surgical delivery method helps prevent the baby from coming into contact with the virus in the birth canal, significantly reducing the risk of neonatal herpes. If no active lesions or symptoms are present, a vaginal delivery is considered safe.
Planning for Pregnancy
For women with herpes planning to conceive, open and honest communication with a healthcare provider before conception is highly recommended. This pre-conception discussion allows for a personalized assessment of herpes status and the development of a proactive management plan. Understanding one’s own herpes type (HSV-1 or HSV-2) and recurrence patterns can help inform this plan.
Healthcare providers may discuss testing, especially if there is uncertainty about previous exposure or if a partner has herpes. They can also provide guidance on safe sexual practices during conception, such as abstaining from intercourse during outbreaks and consistent condom use between outbreaks, even when no symptoms are visible, as the virus can still shed. Taking daily antiviral medication before and during pregnancy can further reduce the risk of transmission to a partner and help prevent outbreaks during pregnancy.