Herpes simplex virus (HSV), encompassing both HSV-1 (oral herpes) and HSV-2 (genital herpes), is a widespread viral infection. For pregnant individuals, understanding how herpes is managed during pregnancy can help alleviate concerns about its implications for their baby.
Current Testing Guidelines
Routine screening for herpes in pregnant individuals who do not show symptoms is generally not recommended by major medical organizations, including the American College of Obstetricians and Gynecologists (ACOG) and the U.S. Preventive Services Task Force (USPSTF). This approach is due to factors like potential false-positive test results and the psychological distress a positive, asymptomatic diagnosis might cause. The USPSTF found no evidence that routine screening improves health outcomes or reduces transmission in asymptomatic individuals.
Despite the lack of routine screening, testing is performed in specific situations. A healthcare provider may recommend testing if a pregnant person exhibits symptoms like sores or lesions, reports a partner with herpes, or has a personal history of the infection. Tests used to detect herpes include viral cultures from active sores, polymerase chain reaction (PCR) tests for viral genetic material, and blood tests that detect herpes antibodies. Blood tests are especially useful if there are no active symptoms but an exposure is suspected.
Potential Risks to the Baby
Herpes can pose significant risks to a newborn if transmitted during pregnancy or birth, though transmission is rare. The most common route of transmission is during a vaginal birth if the birthing parent has active genital lesions or is shedding the virus in the birth canal. While less common, transmission can also occur in the uterus or shortly after birth through contact with an active cold sore.
The consequences of neonatal herpes can be severe. This infection can manifest in various forms, including skin, eye, and mouth infections, which may appear as fluid-filled blisters. More serious forms involve the central nervous system, leading to conditions like encephalitis (brain infection), or disseminated disease, affecting multiple organs. Neonatal herpes can result in lasting neurological disability, developmental delays, or even be fatal. The risk to the baby is highest if the pregnant person acquires a new genital herpes infection late in pregnancy, particularly in the third trimester. This is because a newly infected individual has not yet developed protective antibodies that could be passed to the baby.
Managing Herpes During Pregnancy
Management of herpes during pregnancy focuses on minimizing the risk of transmission to the baby. Antiviral medications, such as acyclovir, valacyclovir, and famciclovir, are commonly used for this purpose. These medications may be prescribed, particularly from around 36 weeks of gestation, as suppressive therapy. This aims to reduce the likelihood of an outbreak occurring around the time of delivery and decrease viral shedding.
The mode of delivery is carefully considered based on the presence of active herpes. If a pregnant person has active genital lesions or experiences prodromal symptoms (like tingling or itching) at the onset of labor, a Cesarean section (C-section) is typically recommended. This surgical delivery helps prevent the baby from coming into contact with the virus in the birth canal, significantly reducing transmission risk. If there are no active lesions or symptoms, a vaginal birth is generally considered safe. Consistent communication with the healthcare provider throughout pregnancy is important for developing an individualized management plan.
Protecting Your Baby
It is important to inform your obstetrician or midwife about any history of herpes, or if you have concerns about potential exposure, early in your pregnancy. This allows your healthcare provider to monitor your condition and plan for a safe delivery.
Avoiding contact with active herpes lesions is crucial. This includes lesions on yourself, your partner, or others, as the virus is most contagious when sores are present. If a partner has oral herpes (cold sores), avoiding oral sex, especially during the late stages of pregnancy, can prevent acquiring genital herpes. Informing the delivery team about your herpes status is also advisable so they can take appropriate precautions during labor and delivery. Certain medical interventions, such as fetal scalp monitors, forceps, or vacuum extractors, may be avoided unless medically necessary, as they could potentially create small breaks in the baby’s skin where the virus could enter.