Herpes Simplex Virus (HSV) is a highly prevalent infection. Genital herpes (HSV-1 or HSV-2) is a common, lifelong condition managed effectively with medical care. Many people experience anxiety about discussing this diagnosis with their healthcare providers, especially their obstetrician-gynecologist (OBGYN). Disclosure is a fundamental step in ensuring you receive the safest and most effective care for your general health and during pregnancy. Medical management of HSV depends entirely on a complete and accurate health history provided by the patient.
The Necessity of Disclosure and Confidentiality
Full disclosure of your HSV status to your OBGYN is a professional expectation for providing comprehensive medical care. A complete medical history allows the provider to accurately assess your health risks and tailor prevention strategies specific to your needs. This open communication forms the foundation of the patient-provider relationship, enabling a collaborative approach to managing a chronic condition.
Your healthcare provider is bound by professional ethics and federal law to protect the privacy of your health information. The Health Insurance Portability and Accountability Act (HIPAA) establishes national standards for the protection of sensitive patient data. This means your diagnosis, as part of your protected health information, cannot be shared with your employer, family, or the public without your express permission, except in very narrow, legally defined circumstances.
The primary purpose of disclosing this information is not to judge or stigmatize, but to inform clinical decision-making. Physicians use this knowledge to ensure patient safety, especially when considering potential interactions with other conditions or planning invasive procedures. Understanding these strong legal and ethical safeguards can help alleviate the fear that information will be misused or shared inappropriately.
Managing HSV During Routine Gynecological Visits
For the non-pregnant patient, the knowledge of an HSV diagnosis significantly influences the approach to routine gynecological care. During the annual physical examination, the physician can perform a more focused assessment of the genital area to look for any subtle or atypical lesions. This heightened awareness helps to confirm a diagnosis or to recognize a recurrence early, allowing for prompt treatment.
Disclosing your HSV status also facilitates appropriate counseling regarding transmission and outbreak management. Your doctor can discuss strategies to reduce the risk of passing the virus to a sexual partner, even during periods when no symptoms are present. For patients experiencing frequent or severe outbreaks, suppressive therapy with antiviral medication can be prescribed to reduce the number of recurrences.
The OBGYN visit is also an appropriate time to discuss prescription refills for episodic therapy, which shortens the duration and severity of an outbreak if taken immediately upon noticing prodromal symptoms. Having a full sexual health history, including an HSV diagnosis, guides the provider in determining the need for screening for other sexually transmitted infections (STIs). While HSV does not increase the risk of acquiring other STIs, a history of one infection often prompts a thorough check for co-existing conditions.
Protecting the Infant During Pregnancy and Delivery
HSV disclosure is particularly important due to the risk of vertical transmission to the newborn, a rare but serious event known as neonatal herpes. The risk of the infant acquiring the virus depends heavily on the timing of the mother’s infection. A mother who acquires a primary genital herpes infection near the time of delivery has the highest risk of transmission (25% to 60%) because her body has not yet produced protective antibodies to pass to the fetus.
In contrast, if the mother had the infection before pregnancy, or acquired it early in gestation, the transmission risk to the baby is significantly lower, typically less than 2%, even if an outbreak occurs at delivery. This reduced risk is due to the transfer of maternal antibodies across the placenta, which helps protect the newborn. The most common and dangerous route of transmission is when the infant passes through the birth canal during an active maternal outbreak.
To minimize this risk, medical guidelines recommend prophylactic suppressive therapy for all pregnant patients with a history of recurrent genital herpes. This typically involves starting an oral antiviral medication, such as acyclovir or valacyclovir, at 36 weeks of gestation and continuing until delivery. This late-term suppression significantly reduces the likelihood of a recurrence or asymptomatic viral shedding at the time of birth.
Antiviral suppression can decrease the chance of having a recurrence at delivery by approximately 75% and reduces the need for a Cesarean delivery. The delivery plan is determined by the presence of symptoms at the onset of labor. If the patient has active genital lesions or is experiencing prodromal symptoms, such as vulvar pain or tingling, a Cesarean delivery is recommended to prevent the newborn from contacting the virus in the birth canal. If the patient has a history of HSV but has no active lesions or symptoms at the time of labor, a vaginal delivery is considered safe and appropriate.