Becoming a gestational surrogate requires a comprehensive medical and psychological evaluation to ensure a safe pregnancy for the carrier and the developing fetus. Fertility clinics implement rigorous medical screening protocols, including mandatory infectious disease testing, to protect the health of the child and intended parents by minimizing infection risk. When a potential surrogate has a history of Herpes Simplex Virus (HSV), eligibility depends on a detailed assessment of the infection’s status and manageability.
Initial Eligibility and Screening Criteria
A diagnosis of Herpes Simplex Virus (HSV) does not automatically disqualify an individual from serving as a gestational surrogate, but it requires careful evaluation. Eligibility is determined by the specific type of HSV and the history of outbreaks, focusing on whether the condition is well-controlled. All candidates undergo a thorough infectious disease panel, a standard requirement for third-party reproduction established by organizations like the American Society for Reproductive Medicine (ASRM).
Prior exposure to HSV-1, which commonly causes oral herpes or cold sores, is generally not a reason for rejection, provided the infection is disclosed and medically managed. The presence of HSV-2, typically associated with genital herpes, is subject to more scrutiny but also does not lead to automatic disqualification. The primary concern is the risk of transmission to the child during gestation or delivery, which is significantly lower with a chronic, well-documented infection.
The medical team must confirm the potential surrogate is currently asymptomatic and that the infection is stable before proceeding. While a history of recurring outbreaks is manageable, an active, primary (first-time) HSV infection identified during screening results in immediate deferral or rejection. This precautionary measure is in place because a newly acquired infection poses a substantially higher risk of transmission compared to a long-standing, recurrent infection.
Understanding the Risks of Herpes During Pregnancy
Strict screening and management protocols exist due to the potential for vertical transmission of the virus from the pregnant person to the fetus or newborn, leading to a severe condition known as neonatal herpes. Transmission risk is highly dependent on the timing of the maternal infection. A primary HSV infection acquired late in pregnancy, particularly in the third trimester, carries the highest risk of vertical transmission, estimated between 30 and 50% without intervention.
This elevated risk occurs because the pregnant person has not had sufficient time to develop and pass protective antibodies to the fetus before delivery. In contrast, a recurrent infection, where the body has pre-existing antibodies, poses a much lower risk of transmission, typically cited as 0% to 3% during a vaginal delivery. When transmission occurs, neonatal herpes can result in devastating outcomes, including skin, eye, and mouth disease, central nervous system involvement, or a disseminated infection affecting multiple organs.
The infection is most often acquired during the peripartum period when the newborn passes through the birth canal and contacts the virus shed from genital lesions or asymptomatic viral shedding. In-utero transmission is exceedingly rare. Therefore, the medical focus throughout the pregnancy is on preventing the virus from being active or shed at the time of labor and delivery.
Medical Management Protocols for HSV-Positive Surrogates
Once a gestational surrogate with a history of chronic HSV is medically cleared, the focus shifts to proactive risk mitigation throughout the pregnancy. The primary strategy involves using antiviral suppressive therapy to minimize the chance of a viral outbreak near the time of birth. Medications such as acyclovir or valacyclovir are typically prescribed to begin in the third trimester, generally around 36 weeks of gestation, and continue until delivery.
This prophylactic treatment reduces the frequency of symptomatic outbreaks and decreases the occurrence of asymptomatic viral shedding. Antiviral therapy is highly effective at lowering the amount of virus present in the genital tract, which significantly reduces the risk of transmission during birth. The surrogate is also instructed to immediately report any potential symptoms, such as the tingling or shooting pain that precedes an outbreak (known as a prodrome), or the appearance of any lesions.
The most critical decision point is determining the mode of delivery, which is made at the onset of labor. If the surrogate shows any signs of an active genital HSV lesion or reports prodromal symptoms when labor begins, a Cesarean section is mandated. This surgical delivery prevents the newborn from contacting the virus in the birth canal.
If the surrogate has been compliant with suppressive therapy and is completely asymptomatic (no active lesions or prodromal symptoms), a vaginal delivery is typically permitted. The effective use of suppressive antiviral medication is a primary reason that many gestational surrogates with a history of HSV can proceed with the surrogacy journey and deliver the child safely.