Herpes simplex virus (HSV) is a common viral infection, often recognized by cold sores or genital lesions. While typically a mild condition for adults, it can present specific considerations during pregnancy. Understanding how herpes testing is approached during pregnancy helps to ensure both maternal and infant well-being.
Why Herpes is a Concern in Pregnancy
Herpes simplex virus is a concern during pregnancy primarily due to vertical transmission from the pregnant individual to the baby. This transmission usually occurs during vaginal delivery if the baby comes into contact with active lesions in the birth canal. Neonatal herpes, a rare but serious condition, can lead to severe health issues, including central nervous system damage, developmental problems, or even be fatal. Both HSV-1, commonly associated with oral herpes, and HSV-2, often linked to genital herpes, can cause neonatal herpes. The risk of transmission is significantly higher if a pregnant individual acquires a new genital herpes infection late in pregnancy, particularly during the third trimester, because their body has not had enough time to develop protective antibodies to pass to the baby.
Current Guidelines for Herpes Testing During Pregnancy
Major health organizations, including the American College of Obstetricians and Gynecologists (ACOG) and the U.S. Preventive Services Task Force (USPSTF), do not recommend routine screening for herpes in asymptomatic pregnant individuals. This approach is due to potential false-positive results and lack of evidence that routine screening improves newborn outcomes. Testing is typically recommended in specific situations, such as when the pregnant individual experiences symptoms like sores or blisters. Furthermore, testing may be advised if a partner has a known herpes infection or if there is a history of herpes, even without current symptoms, to help guide management.
In these targeted scenarios, different tests confirm a herpes infection. Viral culture or polymerase chain reaction (PCR) tests involve swabbing an active lesion to detect the virus; PCR is more sensitive. Blood tests for HSV-1 and HSV-2 antibodies indicate past exposure, even if there are no current symptoms. These type-specific antibody tests help differentiate between the two HSV types and can inform counseling regarding transmission risks.
Managing Herpes Infection During Pregnancy
If a pregnant individual is diagnosed with herpes or has a history of the infection, healthcare providers implement management strategies to reduce transmission risk to the baby. Antiviral medications, such as acyclovir and valacyclovir, are commonly used during pregnancy. These medications are considered safe for use during pregnancy and are prescribed, particularly in the third trimester. Suppressive therapy, typically started at or beyond 36 weeks of gestation, helps to prevent outbreaks and reduce the likelihood of viral shedding at the time of delivery. This proactive approach significantly lowers the chance of active lesions being present during labor, which is a key factor in preventing neonatal herpes.
Minimizing Risks to the Newborn
Preventative measures around birth protect the newborn from herpes infection. A Cesarean section (C-section) is recommended if active genital herpes lesions or prodromal symptoms are present at labor onset. This surgical delivery method helps to avoid the baby’s contact with the virus in the birth canal, significantly reducing the transmission risk. If no active lesions are present at the time of labor, a vaginal delivery is considered safe. Beyond delivery, careful hygiene is important; individuals with active lesions should avoid direct contact with the newborn and practice hand hygiene to prevent postnatal transmission.