Herpes Simplex Virus (HSV), either type 1 or type 2, can infect the skin of the breast, nipple, or areola, though this is rare. This infection, sometimes referred to as herpetic mastitis, is often underrecognized. It is of particular concern for individuals who are nursing.
Recognizing Herpes Simplex Lesions
The onset of a herpes infection often begins with localized discomfort, such as itching, tingling, burning, or pain. This prodrome phase is rapidly followed by small, red bumps that quickly develop into characteristic fluid-filled blisters (vesicles), typically grouped in a cluster on a reddish base. The lesions are painful and may be accompanied by swelling of the lymph nodes in the armpit on the same side of the body.
Over several days, these blisters rupture, leaving behind shallow, painful ulcers that may weep. The final stage involves the sores drying out and forming crusts or scabs, after which the skin heals without scarring. Herpes must be distinguished from other issues like bacterial mastitis or candidiasis (thrush). Unlike the deep, generalized pain of bacterial mastitis, herpes presents with superficial, clustered blisters, characterized by their painful, fluid-filled nature.
Routes of Infection and Contagion
Herpes Simplex Virus requires direct skin-to-skin contact with an area of active viral shedding. The virus must enter the body through a break in the skin, which can happen easily on the nipple or areola. A primary route of infection is contact with a partner’s oral cold sore (HSV-1) or a genital lesion (HSV-2) during intimate contact involving the breast area.
Another route is through a process called auto-inoculation, where an individual transfers the virus from an infected site on their own body, such as the lip or genitals, to the breast via their hands. During nursing, an infant with oral herpes can transmit the virus to the mother’s nipple during feeding. While the infection can be acquired when no visible sores are present, the risk is highest when active lesions are shedding the virus.
Managing Herpes While Breastfeeding
An active herpes infection on the nipple or areola presents a risk to an infant, especially a newborn, due to the potential for neonatal herpes. Neonatal herpes is rare but can cause severe, life-threatening complications, including damage to the central nervous system. Specific precautions are necessary because transmission risk is high with direct contact between the baby’s mouth and an active lesion.
If active lesions are present on the nipple or areola, breastfeeding from that affected breast must be temporarily stopped. The mother can safely continue to nurse from the unaffected breast, provided no lesions are present there and strict hygiene measures are followed. The herpes virus is not transmitted through the breast milk itself, but through direct contact with the active sore.
To maintain the milk supply, the mother should pump or express milk from the affected breast, but this milk must be discarded until the lesions are completely healed. Pump parts that contact the lesion should be cleaned thoroughly to prevent spreading the virus. Direct breastfeeding from the affected breast is safe only once the lesions have fully dried, scabbed, and healed.
Medical Treatment and Recovery
The standard medical approach for treating a Herpes Simplex Virus outbreak on the breast involves antiviral medications. Oral medication is typically prescribed to shorten the duration and lessen the severity of the outbreak. Antiviral drugs such as acyclovir or valacyclovir are commonly used and are compatible with breastfeeding.
These medications inhibit the virus’s ability to replicate, speeding up the healing process. Initiating antiviral treatment as soon as the first symptoms appear is beneficial. In addition to prescription medication, comfort measures such as pain relievers help manage the pain associated with the lesions. Maintaining strict hand hygiene after touching the lesions is necessary to prevent the virus from spreading to other parts of the body or to the infant.