Herpes simplex virus (HSV) is a common viral infection, primarily categorized into two types: HSV-1 and HSV-2. HSV-1 is typically associated with oral herpes, often presenting as cold sores, while HSV-2 is most commonly linked to genital herpes, though both types can infect either area. Many pregnant individuals with herpes have concerns about its impact on pregnancy. Effective medical management strategies can significantly reduce potential risks to both the pregnant person and the baby.
Understanding Potential Risks During Pregnancy
Herpes during pregnancy can pose risks, particularly to the developing baby. The main concern is neonatal herpes, a serious condition that can occur if the virus transmits to the newborn. Neonatal herpes can manifest in various ways, including localized infections affecting the skin, eyes, or mouth, or more severe forms involving the central nervous system or disseminated disease affecting multiple organs. Untreated, neonatal herpes can lead to significant neurological problems, developmental delays, or even be fatal. The risk of transmission varies depending on the timing and type of maternal infection.
If a pregnant person has a history of recurrent genital herpes, the body has produced antibodies that can offer some protection to the baby through the placenta. In these cases, the risk of transmission to the baby during labor is relatively low, typically between 1% and 3% even with active lesions. However, the risk may be slightly higher with HSV-1 recurrences compared to HSV-2. A primary, or first-time, herpes infection acquired during pregnancy carries a substantially higher risk of transmission to the baby. This is because the pregnant person has not yet developed protective antibodies. The risk is particularly elevated if this primary infection occurs in the third trimester, with transmission rates potentially ranging from 30% to 50%.
Medical Management Throughout Pregnancy
Informing healthcare providers about a herpes diagnosis is important for managing the condition during pregnancy. This allows the medical team to implement strategies tailored to the individual’s history and status. Antiviral medications are used to manage herpes during pregnancy, particularly in later stages. Medications such as acyclovir and valacyclovir are commonly prescribed and are generally considered safe for use during pregnancy. These antivirals work to suppress viral replication, reducing the frequency and severity of outbreaks. They also prevent viral shedding, which is the release of the virus from the body, even in the absence of visible lesions.
Suppressive antiviral therapy is often recommended starting around 36 weeks of gestation and continuing until delivery. This treatment aims to prevent herpes recurrences and minimize viral shedding near birth. For example, acyclovir might be prescribed at 400 mg three times daily, or valacyclovir at 500 mg twice daily. This regimen lowers the likelihood of an active lesion being present at delivery, reducing transmission risk to the newborn and decreasing the need for a Cesarean section.
Strategies for Labor and Delivery
Herpes transmission to the baby typically occurs during vaginal birth if active genital lesions are present or if viral shedding is occurring in the birth canal. Direct contact with these infected secretions as the baby passes through the birth canal is the most common route for neonatal herpes, accounting for approximately 85% of cases. For individuals with active genital lesions or symptoms indicating an impending outbreak, such as tingling or pain, at the onset of labor, a Cesarean section (C-section) is generally recommended. This surgical delivery method bypasses the birth canal, significantly reducing the baby’s exposure to the virus. A C-section can lower the risk of transmission by approximately 85% compared to vaginal delivery in such scenarios, making it a crucial preventative measure.
Conversely, a vaginal delivery can be considered safe for individuals with a history of herpes who do not have active lesions or prodromal symptoms at the time of labor. In these cases, the risk of transmission is very low, particularly if suppressive therapy was used in late pregnancy to reduce viral shedding. Healthcare providers will conduct a thorough examination to confirm the absence of lesions before proceeding with a vaginal birth. Additionally, avoiding invasive procedures like fetal scalp electrodes during labor can further minimize any potential risk of transmission.
Contracting Herpes During Pregnancy
Contracting a primary herpes infection for the first time during pregnancy represents a distinct and often more concerning scenario. This situation carries a significantly higher risk of transmission to the baby compared to recurrent outbreaks. This elevated risk occurs because the pregnant person’s immune system has not yet developed protective antibodies, which would normally pass to the fetus and offer some defense. The risk is particularly acute if this primary infection occurs late in pregnancy, especially within the last six weeks before delivery. Without sufficient time for maternal antibodies to develop, the baby is left highly vulnerable to infection during birth. In such cases, immediate medical interventions are initiated, which may include antiviral therapy and close monitoring of both the pregnant person and the fetus. A Cesarean section is often recommended for primary infections occurring in the third trimester to prevent transmission.