|
GENITAL HERPES AND PREGNANCY
by Dr. H., Medical Director
www.herpes.org
updated December 1, 2006
Managing genital herpes during pregnancy is very important to the health of
the soon-to-be-born infant. Infants exposed to the herpes simplex can experience
brain infection, seizures, prolonged hospitalization, mental retardation, and
death if the infection takes hold. With such a frightening prospect for
potential harmful or fatal effects on the baby, then persons who have genital
herpes must give careful thought to the risks associated with childbearing when
one or both future parents have genital herpes.
With that caution, though, the reader should be assured that the risk can be
limited and virtually eliminated through careful family planning and thoughtful
monitoring by a knowledgeable obstetrician. Estimates range that as many
as 50 million Americans, and possibly more, harbor herpes simplex virus in the
genital area. Yet, the actual incidence of herpes infection in the newborn
is exceedingly low.
Approximately 1 in 2000 births in America in which the mother is infected with
genital herpes may result in herpes simplex virus transmission to the infant1,2,
with the potential for effects on the baby as mentioned above. Results in other countries
such as England reveal a much lower rate of transmission of the virus to the
infant, as low as 1 in 65,000 births, and the rate is estimated to be 1 in 15,000
births in Japan2. The reasons for these differences are not clear.
The greatest risk to the infant is in those pregnancies in which the mother
develops her first genital herpes infection ever while pregnant2.
In those pregnancies the risk to the baby of catching herpes simplex while in the womb is as high
as 30 to 50% if the mother has the first outbreak of genital herpes during the final three months
of pregnancy. This presents a very high risk to the baby, and it is a risk that can be avoided
with careful attention.
Partners in which one of the partners has genital (or oral) herpes, who are planning to have children, and in which the future mother does not have genital herpes must be especially careful not to place
the future mother in a situation in which she might develop a first infection
with genital herpes while pregnant. For example, if the future father
has genital herpes but the pregnant mother does not, it would be very wise to
consult with the obstetrician prior to engaging in sexual relations during the
pregnancy. Even condoms might not give satisfactory protection, as discussed
elsewhere on this web site. It is also well documented that a pregnant
woman having sexual contact with a new intimate partner during her pregnancy
puts herself at a much higher risk of contracting primary genital herpes, and
thus seriously endangering the child2.
The reasons for the increased risk to the newborn if the
mother has the new onset of primary genital herpes are threefold.
First, the patient sheds virus for a much longer period during
primary herpes infections. Second, more viral particles
are excreted during a primary infection as opposed to a recurrent
infection. Finally, less antibody is transmitted from
the mother to the baby during a primary infection as opposed
to during a recurrent outbreak (this is called transferring
“passive immunity” to the baby, which involves the
transmission of antibody through the placenta from the mother
to the baby)2.
Elsewhere on this website discussion is found concerning
how often patients who have genital herpes experience symptoms.
It is now known that as many as 80% of patients contract genital
herpes in an “asymptomatic” manner. This means
that the patient does not realize that he or she has contracted
the disease. Very often patients can be infected with
genital herpes and never have symptoms.
When this fact is translated to the situation of a pregnant patient, this means
that very often a woman who is pregnant does not realize that she has genital
herpes. Thus, between 50-70% of infants who do develop herpes simplex
infections shortly after birth are born to women who are asymptomatic at the
time of delivery2.
Historically the traditional way to protect the infant against catching herpes
simplex during pregnancy is to deliver the mother by Caesarian section.
This is an operation in which the baby is removed from the mother’s womb
by surgery on the abdomen. This surgery of course bears the usual risks
and recovery period of major surgery to the mother, including infection, responses
to anesthesia, and blood clots. However, given those concerns, using this
surgery to protect the newborn from the risk of herpes infection seems a useful
tradeoff.
In a small percentage of cases, though, it appears that the herpes virus is
actually transmitted to the baby while the baby is still in the womb.
However, very few cases of “in utero” transmission have been documented.
One would expect that active disease would be present at the time of delivery,
and this is very rare. Apparently the infection usually occurs at the
time of labor and delivery in the vast majority of deliveries. Sadly,
though, neither blood tests nor viral cultures performed shortly prior to delivery
are reliable enough to always prevent infection of the baby2.
Infection of the newborn immediately after delivery and not by the vaginal
delivery itself is apparently very uncommon. However, cases have been
documented of the transmission of herpes to the baby from an infected nipple
area on the mother as well as from a cold sore on one of the parents or other
family members2. In this small percentage of cases due to transmission
shortly after delivery, persons with cold sores on their mouths or herpes lesions
on their hands have apparently played a part in transmitting the infection to
babies3. Obviously it is wise for concerned parents, as well
as hospital personnel and family members, to take reasonable steps to be sure
that they don’t have any herpes lesions that are active or dormant that
might come in contact with the baby.
Herpes simplex infections are treated with acyclovir, or with one of its related
drugs such as Valtrex or Famvir. Evidence has emerged that acyclovir, and Valtrex (which turns into acyclovir in the bloodstream),
are very safe during pregnancy. It has not been associated with birth defects
in excess of those found in mothers who are not taking acyclovir during pregnancy4.
Acyclovir has been shown to reduce viral shedding in excess of 50% in some patients4.
Likewise its efficacy in reducing herpes recurrences during pregnancy has been
documented4.
Thus, some real hope is now on the horizon that in cases in which the pregnant
mother’s status of having genital herpes is known, use of acyclovir may
carry real benefit in preventing the virus from being transmitted to the developing.
In no circumstances, however, should a pregnant patient EVER medicate herself
with any drug without the consideration and consent from her obstetrician.
Concerned parents in concert with a knowledgeable obstetrician reasonably should
seek appropriate testing to determine whether either parent is a carrier of
the herpes simplex virus. If appropriate testing is not available locally,
concerned parents or physicians can find resources available through this and
other websites.
We strongly suggest that any persons who have genital herpes and who are considering
childbearing should make careful plans in advance as to how to manage the disease
during pregnancy. Using good education, adequate testing, and appropriate
medications where indicated, parents can rest certain in the knowledge that
they too can join the millions of other parents who have genital herpes and
who have safely and successfully delivered a healthy baby.
1 Authors' experience with
medical therapy of herpes genitalis in pregnancy, Zarcone R, Fortuna G, Castagnolo
A, Vicinanza G, Bellini P, Carfora E, Lizza R, “Minerva Ginecol” 1998
Mar;50(3):105-7, Istituto di Ostetricia e Ginecologia, II Universita degli Studi,
Napoli.
2 Neonatal Herpes University
of Washington Academic Medical Center, Children's Hospital and Regional Medical
Center, 1998
3 Neonatal herpes: diagnosis
and management, Kohl S., presented at the American Academy of Dermatology. Mar.
21-26, 1997, San Francisco.
4 Prevention of perinatal herpes:
prophylactic antiviral therapy? Scott LL, Clin Obstet Gynecol 1999 Mar;42(1):134-48
University of Miami School of Medicine, Department of Obstetrics and Gynecology
If this website has helped you in any way,
then please support our work with a donation of any size by
clicking here. Your donation
is a tax deductible charitable contribution.
THIS PAPER WILL BE UPDATED AT PERIODIC INTERVALS
AS SCIENTIFIC LITERATURE, APPROVED THERAPIES, AND FEEDBACK
FROM USERS OF THIS SITE SUGGEST NEW INFORMATION THAT SHOULD
BE CIRCULATED.
HERPES.ORG DOES NOT PURPORT
TO ESTABLISH A PHYSICIAN-PATIENT RELATIONSHIP. ALL TREATMENT
DECISIONS SHOULD BE MADE BETWEEN A PATIENT AND HIS/HER PRIVATE
PHYSICIAN. NO TREATMENTS SHOULD BE ATTEMPTED WITHOUT A FIRM
AND CONVINCING DIAGNOSIS OF THE CONDITION BEING TREATED.
|
HERPES
& PREGNANCY
