Genital herpes and pregnancy: Understanding the risks
August 4, 2020
Genital herpes is one of the most common health conditions in the U.S. The Centers for Disease Control and Prevention (CDC) estimates that 1 in 6 people between the ages of 14 and 49 have it. Approximately 22% of pregnant women in the U.S. have genital herpes. Two percent contract it during pregnancy – that's 1 in 50 pregnant women.
Two viral strains can cause genital herpes. HSV-2 (herpes simplex virus) is the most common and typically spreads through sexual contact. HSV-1, which is best known for causing cold sores, can also produce genital lesions (blisters or open sores). More than half of adults in America get HSV-1 at some point in their lives.
Herpes is generally manageable in adults. However, it can cause serious health problems in newborns. During delivery, your baby may be exposed to the virus, even if you are not having an outbreak.
Herpes infection occurs in less than 1% of births, but it can cause severe illness in newborns, such as:
- Serious infections, such as viral meningitis
- Recurrent sores on the skin, eyes, genitals, or mouth
- organ damage, including to the liver, lungs, and heart
Tell your doctor if you or your partner have herpes or if you may have been exposed. By knowing, we can take extra precautions to reduce your baby's risk of infection during delivery and in their first few weeks at home. If you’re not certain but think you may have had herpes in the past, we can do a blood test to determine whether you have had the infection.
If you are concerned about privacy, we will note in your chart not to discuss the condition in front of anyone at your appointments – we are happy to accommodate this common request.
"Tell your doctor if you or your partner have herpes or if you may have been exposed. By knowing, we can take extra precautions to reduce your baby's risk of infection during delivery and in their first few weeks at home."
How can I manage herpes during pregnancy?
There is no evidence to suggest pregnancy causes flare-ups. The American College of Obstetricians and Gynecologists says 75% of pregnant women who have herpes, however, can expect to have an outbreak during pregnancy.
During pregnancy, you should watch for symptoms of the virus becoming active, such as tingling, itching, or burning around where the sore will eventually appear.
If you have a history of herpes (or your blood test is positive), your provider may prescribe an antiviral medication such as acyclovir (Valtrex) to reduce the risk of spreading the virus or having an outbreak around the time of your delivery.
We typically recommend starting an antiviral at 36 weeks or sooner if you are at risk for preterm birth. The antiviral medications are safe during pregnancy. In fact, we can give the same medications to your baby if needed.
Will I need a C-section if I have herpes?
A cesarean (C-section) can’t completely prevent herpes transmission. But it does substantially decrease the risk to your baby if you have a lesion or report typical symptoms by bypassing contact with the vagina and labia.
Once you go into labor, we’ll carefully examine you for genital lesions. If we see something suspicious, we will recommend a C-section.
If you have no symptoms and no sores in the genital region, a vaginal delivery may be safe. Lesions can sometimes appear in other areas, such as the legs or back. If this is the case, we’ll cover them to make sure the baby doesn’t come into contact with them.
How can I protect my newborn from getting herpes?
If your partner has herpes and you don’t, do not have sex and oral sex the last few weeks of pregnancy. Condoms can reduce the risk of transmission but aren’t 100% effective. There’s no reason to risk a new infection close to delivery.
In the unlikely event your baby has been exposed, we’ll treat the baby with antiviral medications. HSV can’t be passed through breast milk, so unless you have sores or lesion on your breasts, breastfeeding is safe.
With visitors, do not allow anyone who has a cold sore or has had one recently to hold your baby. Same goes for people who have a cold or virus. Insist that anyone who wants to hold or touch your newborn wash their hands first – this should be the norm anyway due to COVID-19.
Genital herpes is a common condition, and we are well-equipped to help reduce your baby's risks. If you or your partner has a history of herpes, talk with your Ob/Gyn. We are eager to help you have a safe pregnancy and delivery.