Herpes simplex virus (HSV) is a common viral infection with unique considerations during pregnancy. Understanding its implications and management strategies is important for positive outcomes for both parent and baby. Awareness of how the virus behaves during gestation and delivery is key for a healthy pregnancy journey.
Understanding Herpes in Pregnancy
The herpes simplex virus exists in two primary types: HSV-1 and HSV-2. HSV-1 is most commonly associated with oral herpes (cold sores), while HSV-2 is typically linked to genital herpes. Both types can cause genital infections. Many individuals experience no symptoms or very mild ones, leading to unawareness of their infection.
During pregnancy, a distinction is made between a primary herpes infection and recurrent outbreaks. A primary infection occurs when an individual contracts the virus for the first time, often resulting in more severe symptoms and higher viral shedding. Recurrent outbreaks are reactivations of the latent virus, which tend to be milder and shorter in duration. The Centers for Disease Control and Prevention (CDC) estimates that about one in every six people aged 14 to 49 years in the United States has genital herpes, indicating its widespread prevalence.
How Herpes Can Be Transmitted to the Infant
Herpes transmission from parent to infant most commonly occurs during vaginal delivery. This occurs when the baby passes through the birth canal and contacts active genital lesions or viral particles, even without visible sores. This peripartum transmission accounts for most neonatal herpes cases.
Less common, but more severe, transmission can occur in utero, known as congenital herpes. This rare event typically happens when a pregnant individual acquires a primary herpes infection early in pregnancy, allowing the virus to cross the placenta and infect the fetus. Postpartum transmission is another possibility, though less frequent, where the infant acquires the virus after birth, for example, from a caregiver’s cold sore. The risk of transmission is significantly higher if the pregnant individual experiences a primary genital herpes infection late in pregnancy, especially during the third trimester, compared to recurrent outbreaks.
Consequences for the Infant
Neonatal herpes is a serious condition that can result from transmission during pregnancy or around the time of birth. Although rare, occurring in approximately 1 in 3,000 to 1 in 20,000 live births, it can lead to significant health complications if not promptly diagnosed and treated. The effects on the infant can range in severity and are typically categorized into three main forms.
Localized Skin, Eye, and Mouth (SEM) Disease
This is the least severe form. Infants with SEM disease may develop blisters on their skin, inflammation of the eyes (conjunctivitis or keratitis), or sores inside their mouth. While generally having a good prognosis with antiviral treatment, SEM disease can progress to more serious forms if left untreated.
Central Nervous System (CNS) Disease
This form affects the brain and spinal cord. Symptoms can include lethargy, irritability, seizures, and poor feeding. Even with treatment, CNS disease carries a risk of long-term neurological damage, such as developmental delays, intellectual disability, or recurrent seizures.
Disseminated Disease
This is the most severe form, which occurs when the virus spreads throughout the infant’s body, affecting multiple organs like the liver, lungs, and adrenal glands. Infants with disseminated herpes often present with fever, poor feeding, lethargy, and may experience respiratory distress or jaundice. This form has the highest mortality rate, reaching up to 25-30% even with antiviral therapy, underscoring the importance of early diagnosis and immediate treatment to improve survival and reduce long-term morbidity.
Managing Herpes for a Healthy Pregnancy
Managing herpes during pregnancy involves strategies aimed at preventing transmission to the infant. Antiviral medication plays a significant role in this prevention. Healthcare providers often prescribe suppressive antiviral therapy, such as acyclovir, valacyclovir, or famciclovir, starting around 36 weeks of gestation. This late-pregnancy regimen helps to reduce the frequency of outbreaks and minimize viral shedding at the time of delivery, thereby lowering the risk of transmission.
Delivery considerations are also crucial. It is important for pregnant individuals to inform their healthcare providers about any history of herpes. If active genital lesions or symptoms indicating an impending outbreak (prodromal symptoms like tingling or itching) are present at the onset of labor, a Cesarean section (C-section) is typically recommended. This surgical delivery method helps to prevent the baby from coming into contact with the virus in the birth canal.
After birth, continued vigilance is important to prevent any potential postnatal transmission. Caregivers with active cold sores should avoid kissing the newborn and practice meticulous hand hygiene to prevent accidental spread. Maintaining open communication with healthcare providers throughout pregnancy is important. This ensures appropriate screening, monitoring, and management strategies are implemented, maximizing a healthy outcome for both parent and baby.