Herpes simplex virus (HSV) is a common infection caused by two types, HSV-1 and HSV-2, both of which can lead to genital lesions. Many individuals carry the virus, often without realizing it, as symptoms can be mild or absent. For those planning a family, a history of this infection raises concerns about conception and the safety of a developing baby. Understanding the virus’s influence on fertility and established medical protocols is important for a safe path to parenthood.
Herpes Simplex Virus and Fertility
For women, a diagnosis of genital herpes does not affect the biological ability to become pregnant. The herpes simplex virus does not impact ovarian function, disrupt ovulation, or interfere with egg implantation in the uterus. The physical presence of the virus does not impair the reproductive organs necessary for natural conception or success rates in assisted reproductive technologies like in vitro fertilization (IVF).
An active outbreak can indirectly affect conception efforts, as healthcare providers recommend abstaining from sexual intercourse during this time to prevent transmission. For couples trying to conceive, this temporary pause may delay the process but does not cause infertility. Some studies have suggested that HSV-related inflammation could theoretically affect the reproductive tract, but this is not a generally accepted cause of female infertility.
The effect of HSV on fertility is more recognized in men, where the virus can be detected in semen. Research suggests that the presence of herpes simplex virus DNA in seminal fluid may be associated with diminished semen quality. Specifically, studies have noted a correlation between the virus and a reduced sperm count and decreased sperm motility.
This reduction in sperm parameters can impact the likelihood of conception, but it does not typically cause absolute male infertility. The virus may cause inflammation in the reproductive tract, which can contribute to these changes in sperm health. Men concerned about this factor can discuss treatment options with a fertility specialist, as managing the viral load may help optimize sperm parameters for conception.
Antiviral Management During Pregnancy
Antiviral medications are used for managing herpes during pregnancy and preventing transmission. The medications, such as acyclovir and valacyclovir, have been studied extensively and do not appear to increase the risk of major birth defects. These drugs are considered safe for use throughout all trimesters of pregnancy.
Management involves two approaches: episodic treatment and suppressive therapy. Episodic treatment is a short course of medication taken at the first sign of an outbreak to reduce the duration and severity of symptoms. Suppressive therapy is taken daily for a longer period to prevent outbreaks entirely.
For women with a history of genital herpes, suppressive therapy is typically initiated around the 36th week of pregnancy. This late-trimester regimen minimizes the chance of a recurrent outbreak or asymptomatic viral shedding near delivery. Reducing viral activity in the genital tract is the primary method for protecting the newborn from infection.
Risks of Neonatal Herpes Transmission
The primary concern for an HSV-positive mother is transmitting the virus to the baby during delivery, which can lead to neonatal herpes. Transmission occurs when the infant passes through the birth canal and contacts the virus in maternal genital secretions. Neonatal herpes is rare, but it can be devastating, causing lasting damage to the central nervous system or even death.
The risk of transmission is highest if a mother acquires a primary herpes infection late in the third trimester, especially within six weeks of delivery. In this scenario, the mother has not had time to develop and pass protective antibodies across the placenta, and the transmission rate can be as high as 33%. Conversely, a mother who had the infection prior to pregnancy has a very low transmission risk, often less than 3%, because her antibodies protect the baby.
The mode of delivery is determined by the presence of active lesions at the onset of labor. If a mother has visible genital lesions or prodromal symptoms, such as tingling or vulvar pain, a Cesarean section is recommended. This surgical delivery bypasses the infected birth canal, significantly lowering the risk of transmission. If no active lesions are present and the mother has been on suppressive therapy since 36 weeks, a vaginal delivery is considered safe.
Planning and Communication with Healthcare Providers
Communication with your healthcare team is important when planning a pregnancy and throughout gestation. You should disclose your HSV status to your obstetrician or fertility specialist as soon as you begin trying to conceive. This allows the provider to tailor a management plan specific to your history.
In some cases, specific testing, such as type-specific serology, may be advised to clarify if the infection is primary or recurrent if you have an outbreak during pregnancy. This distinction is important because the risk level for the baby is affected by the timing of the infection. Your physician will work with you to create a birth plan that includes suppressive antiviral therapy starting at 36 weeks gestation. This proactive approach ensures safety and preparedness for a healthy delivery.