Having herpes during pregnancy is a cause for caution but definitely not for alarm. Here’s how your doctor will treat this common infection during pregnancy and birth.
If you’re a mom-to-be with herpes, you’re not alone: Approximately one in every six adults in the U.S. is infected with genital herpes. That means there’s a better-than-average chance that your doctor has treated many expectant mamas with herpes before you and is well-equipped to ensure your baby is delivered safe, sound and completely unaffected by this common virus — especially if you and your practitioner take protective steps during pregnancy and delivery.
WHAT IT IS
There are two types of herpes simplex virus (HSV), the viral infection that causes genital herpes:
HSV-1 usually causes cold sores or blisters around the mouth, though it can be spread to the genital area during oral sex
HSV-2 more commonly causes genital herpes, which can also be spread to the mouth during oral sex
Both are spread through skin-to-skin contact and are actually most often transmitted by someone who has no visible sores or blisters. It’s a lifelong infection, and there is no cure — though medications can help manage symptoms and outbreaks, even during pregnancy.
SYMPTOMS
Many people infected with the herpes virus never experience symptoms. However within two to 10 days after initially contracting the virus, a person might experience flu-like symptoms including:
Chills, fatigue, fever, headache, achiness and general malaise for two or more days
Accompanying genital pain, itching, pain when urinating, vaginal and urethral discharge, tenderness in the groin
Small, painful, fluid-filled blisters or sores that often occur in clusters which blister and then crust over
The first bout with herpes can last from two to four weeks, during which time it can still be transmitted. Since it’s during a first episode that genital herpes is most likely to be passed on to a fetus, call your practitioner if you experience the above symptoms.
Note that subsequent outbreaks are less severe, as the immune system develops antibodies. You may experience tingling, burning or itching where the infection initially occurred a few hours before sores appear, but usually no fever or swelling. The outbreak will likely be less painful and last less time — three to seven days.
WHAT HAPPENS DURING PREGNANCY
If you have recurrent herpes (that is, you’ve experienced an outbreak before), you’re at an extremely low risk — less than 1 percent — of transmitting herpes to your unborn baby. Same goes if a routine screening for sexually transmitted diseases at your first prenatal visit diagnoses HSV for the first time, or if you’re infected any time during the first half of your pregnancy and are asymptomatic. Only women who are infected for the first time in late pregnancy have a greater risk (30 to 60 percent) of infecting their unborn babies, because their bodies have not yet produced HSV antibodies.
In the rare case a newborn is infected, transmission most often occurs when the baby passes through the mother’s infected birth canal. To prevent this from happening, your health care provider may prescribe medication in your third trimester to decrease the chances of a herpes outbreak around the time you give birth.
TREATING HERPES
The symptoms of herpes can be managed with medication. The Centers for Disease Control and Prevention (CDC) recommends Zovirax (the generic name is acyclovir) during pregnancy, which can lessen symptoms and reduce discomfort. While the safety of acyclovir during pregnancy is not definitively established, it’s routinely used to suppress herpes in pregnant women.
COMPLICATIONS
Remember, herpes is rarely transmitted to a baby during pregnancy — 80 to 90 percent of newborns with HSV are infected when they pass through an infected birth canal. If the amniotic sac breaks before birth, very rarely the fluid in an infected birth canal can infect a baby who has not yet passed through the birth canal. In the unlikely event a baby is exposed to herpes during birth, because infection can cause severe problems including brain and eye damage he will be treated with antiviral medications.
WHAT HAPPENS AT BIRTH
When you go into labor, your doctor should carefully examine you for herpetic lesions. If you aren’t experiencing sores or symptoms at delivery time, a vaginal birth may be possible. If, however, you are experiencing sores or early symptoms of a herpes outbreak (such as vulvar pain and itching), a cesarean delivery is recommended to reduce the chance the baby will come in contact with the virus.
Once your baby arrives, you’re free to breastfeed; the virus can’t be passed through breast milk. But be on the lookout for sores and lesions on your breasts, which can spread the virus to your baby.
There are two types of herpes simplex virus (HSV), the viral infection that causes genital herpes:
HSV-1 usually causes cold sores or blisters around the mouth, though it can be spread to the genital area during oral sex
HSV-2 more commonly causes genital herpes, which can also be spread to the mouth during oral sex
Both are spread through skin-to-skin contact and are actually most often transmitted by someone who has no visible sores or blisters. It’s a lifelong infection, and there is no cure — though medications can help manage symptoms and outbreaks, even during pregnancy.
SYMPTOMS
Many people infected with the herpes virus never experience symptoms. However within two to 10 days after initially contracting the virus, a person might experience flu-like symptoms including:
Chills, fatigue, fever, headache, achiness and general malaise for two or more days
Accompanying genital pain, itching, pain when urinating, vaginal and urethral discharge, tenderness in the groin
Small, painful, fluid-filled blisters or sores that often occur in clusters which blister and then crust over
The first bout with herpes can last from two to four weeks, during which time it can still be transmitted. Since it’s during a first episode that genital herpes is most likely to be passed on to a fetus, call your practitioner if you experience the above symptoms.
Note that subsequent outbreaks are less severe, as the immune system develops antibodies. You may experience tingling, burning or itching where the infection initially occurred a few hours before sores appear, but usually no fever or swelling. The outbreak will likely be less painful and last less time — three to seven days.
WHAT HAPPENS DURING PREGNANCY
If you have recurrent herpes (that is, you’ve experienced an outbreak before), you’re at an extremely low risk — less than 1 percent — of transmitting herpes to your unborn baby. Same goes if a routine screening for sexually transmitted diseases at your first prenatal visit diagnoses HSV for the first time, or if you’re infected any time during the first half of your pregnancy and are asymptomatic. Only women who are infected for the first time in late pregnancy have a greater risk (30 to 60 percent) of infecting their unborn babies, because their bodies have not yet produced HSV antibodies.
In the rare case a newborn is infected, transmission most often occurs when the baby passes through the mother’s infected birth canal. To prevent this from happening, your health care provider may prescribe medication in your third trimester to decrease the chances of a herpes outbreak around the time you give birth.
TREATING HERPES
The symptoms of herpes can be managed with medication. The Centers for Disease Control and Prevention (CDC) recommends Zovirax (the generic name is acyclovir) during pregnancy, which can lessen symptoms and reduce discomfort. While the safety of acyclovir during pregnancy is not definitively established, it’s routinely used to suppress herpes in pregnant women.
COMPLICATIONS
Remember, herpes is rarely transmitted to a baby during pregnancy — 80 to 90 percent of newborns with HSV are infected when they pass through an infected birth canal. If the amniotic sac breaks before birth, very rarely the fluid in an infected birth canal can infect a baby who has not yet passed through the birth canal. In the unlikely event a baby is exposed to herpes during birth, because infection can cause severe problems including brain and eye damage he will be treated with antiviral medications.
WHAT HAPPENS AT BIRTH
When you go into labor, your doctor should carefully examine you for herpetic lesions. If you aren’t experiencing sores or symptoms at delivery time, a vaginal birth may be possible. If, however, you are experiencing sores or early symptoms of a herpes outbreak (such as vulvar pain and itching), a cesarean delivery is recommended to reduce the chance the baby will come in contact with the virus.
Once your baby arrives, you’re free to breastfeed; the virus can’t be passed through breast milk. But be on the lookout for sores and lesions on your breasts, which can spread the virus to your baby.
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