Herpes simplex virus (HSV) is a widespread viral infection, primarily known as HSV-1 (oral herpes/cold sores) and HSV-2 (genital herpes). Many individuals with herpes are concerned about its impact on family planning and pregnancy. This article provides information on managing herpes for a healthy pregnancy and the well-being of both parent and baby.
Herpes and Conception
A herpes diagnosis generally does not affect an individual’s ability to conceive. The virus does not typically impair fertility in women or men. For women, herpes does not directly affect reproductive organs or egg quality. While some studies suggest an association between HSV infection and reduced sperm count or motility in men, it does not necessarily cause infertility. Individuals with genital herpes can pursue pregnancy without unique conception challenges, whether through natural means or assisted reproductive technologies. The focus shifts to managing the virus during pregnancy to prevent transmission to the baby.
Protecting Your Baby During Pregnancy
Managing herpes during pregnancy minimizes the risk of transmission to the developing baby. A first-time (primary) herpes infection acquired during pregnancy, especially in the third trimester, carries the highest risk of transmission to the fetus or newborn. This is because the birthing parent has not yet developed protective antibodies. Such an infection can lead to complications like miscarriage or preterm birth, and rarely, congenital herpes if the virus crosses the placenta. If a primary infection occurs near term, the transmission risk can be as high as 30-50%.
Recurrent herpes outbreaks, where the birthing parent has pre-existing antibodies, pose a much lower risk of transmission to the fetus during gestation. These antibodies pass to the baby through the placenta, offering some protection. Antiviral medications, such as acyclovir or valacyclovir, are often prescribed from 36 weeks of gestation until delivery. This suppressive therapy helps reduce the frequency of outbreaks and the likelihood of active lesions around the time of labor, lowering the risk of transmission to the baby.
Delivery Choices and Preventing Transmission at Birth
The method of delivery is an important decision for pregnant individuals with herpes to prevent transmission to the newborn. Neonatal herpes, a serious and potentially life-threatening condition, is most commonly transmitted (85% of cases) during vaginal delivery if the virus is present in the birth canal. This can occur even without visible symptoms, as the virus can be shed asymptomatically.
A vaginal birth is generally safe if no active herpes lesions or symptoms (like tingling or itching) are present at the onset of labor. If active lesions or prodromal symptoms are present when labor begins, a Cesarean section (C-section) is typically recommended. This surgical delivery bypasses the birth canal, significantly reducing the baby’s exposure to the virus. A C-section protects the newborn from the severe consequences of neonatal herpes, which can affect the baby’s brain, skin, eyes, and other organs, potentially leading to lasting neurological disabilities or even death.
Caring for Your Newborn with Herpes
Parents with herpes can safely care for their newborn by following simple hygiene practices. Handwashing before touching the baby helps prevent viral transfer. If a parent has oral herpes (cold sores), avoid kissing the baby, especially around the mouth or face, while an active lesion is present. Covering any active cold sores also adds protection.
Breastfeeding is generally safe for mothers with genital herpes, as the virus is not transmitted through breast milk. However, if a mother has an active herpes lesion on her breast or nipple, she should avoid breastfeeding from that affected breast until the lesion has healed. Milk expressed from an affected breast should be discarded. Parents should watch for any signs of illness in their newborn, such as lethargy, poor feeding, fever, or skin blisters, and seek immediate medical attention if these symptoms appear. Early treatment is important for neonatal herpes.