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    Lois McGuire, R.N., M.S.N., W.H.N.P.

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  • Jan. 23, 2009

    Herpes and pregnancy

    By Lois McGuire, R.N., M.S.N., W.H.N.P.

13 comments posted

Herpes and pregnancy is not to be taken lightly. Women with herpes have normal and healthy babies, but certain precautions need to be taken to protect the babies from contracting herpes. The likelihood of newborns contracting herpes is small if you and your provider use proper precautions. In women who have established herpes going into the pregnancy, the risk of neonatal herpes is about 1 in 5,500 deliveries.

Ideally, a blood test would be done at 20-24 weeks of gestation to see if either the mother or her partner has herpes. Screening for herpes is not part of the routine blood work in most obstetrical practices. You may need to request a blood test to protect your baby. Remember, approximately 1 in 5 women have herpes, but many are not aware that they have the virus.

I am going to address different scenarios so you know how to manage your situation if you or your partner has herpes simplex virus (HSV).

Scenario 1. The mother is positive for HSV-2, even if she has never had symptoms.

Babies who get HSV usually acquire it during the labor and delivery process. Contracting the disease while in the uterus is rare but can occur. Precautions would be taken at the end of pregnancy and at the time of delivery to protect the baby. These precautions include:

  • Mother would be on suppressive therapy from 36 weeks until delivery.
  • Scalp electrodes would be avoided to monitor the baby's heart rate.
  • Premature rupture of membranes would be avoided.
  • Caesarean section would be performed if the mother had an outbreak in the boxer shorts area of her body at the time of delivery.

Scenario 2. Mother is HSV negative and partner is HSV-2 positive.

Precautions should be taken so the mother isn't infected with HSV-2. A primary or first outbreak for the mother during the third trimester of pregnancy puts mother and baby at a greater risk for premature delivery. It also puts the baby at a much greater risk for becoming infected. Women that contract herpes during late pregnancy have not had an opportunity to make antibodies prior to delivery. These women have a 30 percent to 50 percent chance of infecting their baby. This is serious. Precautions should include:

  • Avoid intercourse in the third trimester or the last 3 months.
  • If this is not workable, then the partner should use daily suppression and a condom.

Scenario 3. Mother tests negative for HSV-1 and HSV-2, while partner tests positive for HSV-1 and only recalls a cold sore.

  • The partner should not give oral sex to the mother during the third trimester. A new HSV-1 genital infection at that time can result in transmission to the baby and be serious.
  • The partner should use suppressive therapy.

Scenario 4. Mother is HSV negative, while the partner is HSV-1 positive but has no history of an outbreak.

  • The site of the partner's HSV-1 infection is unknown. Abstaining from both oral sex and intercourse during the third trimester is the safest course of action.
  • Partner should be on suppressive therapy now and in the future to protect the mother and baby.

Scenario 5. Mother and/or partner are HSV-1 positive and have cold sores. Precautions include:

  • Avoid kissing your baby until the sore has healed.
  • Use suppressive therapy.
  • Avoid touching your cold sore.
  • Use good hand hygiene.
  • Do not share towels with baby.
  • Use liquid soap.

Scenario 6. Mother has HSV-1 or HSV-2 and wants to breast-feed. Precautions include:

  • If mother has no herpetic lesion on her breast, she may certainly feed her baby confidently.
  • If mother does have a herpetic lesion on her breast (this would be very unusual), then she should avoid breast-feeding.
  • Valcyclovir appears to be a safe suppressant therapy in breastfeeding mothers.

Newborns do not have an immune system that is capable of dealing with herpes. Babies can become very sick or die from herpes. If you or your partner have herpes, it is critical that you share this information with your provider! He or she can then take precautions to protect you and your baby.

13 comments posted

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  • June 12, 2009 12:23 a.m.

    I have a question...I am pregnant and have HSV1 & 2 can I breastfeed without passing HSV to my baby? Can I request a c-section and not be denied by my doctor?

    - Very concerned mom to be

  • May 7, 2009 10:16 a.m.

    this is a great article, but i do have another concern... with this new H1N1 swine flu, should i be more concerned about my immune system while pregnant? here is encouragement for some: i am the mother of 2 babies (2 and 8mos). i had had HSV2 for 6 yrs or so.... no one should be ashamed, unless they are purposely spreading it. it took a really long time for me to get over it. but i am married happily, and now have kids. i had both of mine via c-section. the first, i had an active outbreak, and the second i requested. they are both healthy, and free from herpes of any kind. you just need to know your body, and take hygiene seriously.

    - mom in NC

  • March 24, 2009 7:24 p.m.

    I have 3 grown children. 2 of them were born by C-section for other reasons than Herpes. I recently had my doctor run a blood test on me for Herpes since the man I am dating now does have the virus. It turns out I too am positive, but think that the virus likely came from my late husband who I remember having tiny lesions that we never checked out. Hearing that C-sections are recommended for some scenarios is interesting especially since that is how my children were born. I think that option is the one to go with so the child is not exposed even accidently.

    - *

  • March 10, 2009 9:48 p.m.

    Thank you Cata for the encouragement. - Hoping for a Baby

    - No name given

  • February 11, 2009 7:52 a.m.

    A woman I met on "HerpesLoving. com" who infected by Herpes for 5 years, her husband he met on this site living with Herpes too. But they have a very healthy baby now.

    - cala

  • February 7, 2009 8:37 p.m.

    Both my husband and I have been diagnosed with HSV 1 and HSV 2. Neither one of us has ever had a cold sore. I believe that we have had it for years. I have recently been getting genital symptoms of HSV, outbreaks, etc. 2 ob in the last 1 and 1/2 months. We are trying to get pregnant, but I am very scared. He has no concerns, that he expresses, I am really afraid inside. Is there more of a chance that my baby will contract HSV because I have HSV 1 and 2? Can I request a c-section? I am so ashamed. I pray that if we get pregnant that my baby will be healthy. Has anyone here who has HSV 1 and 2 had a baby? Please help!

    - Hoping for a Baby

  • February 5, 2009 7:53 p.m.

    Thank you for writing this article. After being diagnosed I thought that motherhood was out of the question. I was diagnosed with gential herpes 3yrs ago and have been on daily treatments for 2yrs. I recently got engaged and we are blessed that he did not contract the disease. We want to have children but we have a few concerns. Will my daily treatments effect me getting pregnant? Do I need to get off daily treatments while I pregnant? What are the risk of the baby contracting it before/during birth even if there is no sores present? What are the risk of me passing it to the baby if I have a C-section? Also, I saw you said to not share towels or bar soap so can my family contract the disease by sharing these items with me while having a outbreak? Or what about if Im not having an outbreak?

    - Worried

  • February 3, 2009 8:49 p.m.

    Many women are asking this problem, especially singles living with herpes. I want to post this article to the singles site pozcupid.com. I was diagnosed of herpes 6 months ago.OMG. What a bad news.I felt so lonely and I had to date singles living with herpes on pozcupid.com. Thank god, I finally met someone!! I am not alone this Valentines Day. Oh yeah!! Take care

    - Rebecca

  • January 30, 2009 6:14 p.m.

    Ms. McGuire, Thank you for the article. After recently being diagnosed, I am quite surprised to learn that testing during pregnancy is not standard. Especially considering the likelihood a woman (or man) has HSV without even knowing it. I found that after my diagnosis, it has taken several conversations with several MDs to get a full picture on my diagnosis and what to expect for me & any future children. Between the information on the web, I was finding it a bit scary to even think about having more children. Today in fact I had a conversation with my child’s pediatrician, because I was worried that a diaper rash was possibly herpes related. Like your article, she did a great job of explaining the risks and precautions that would need to be taken should we decide to have more children and just as importantly, put me at ease by truly explaining neo-natal herpes. This is still very new and sensitive topic for me, and with a 1 in 5 ratio, I am surprised there isn’t more information out there on HSV. Let me rephrase – there is information, however for me, I had (and still do) some fears as how to live day to day and whether to be concerned with the other members of my household etc. Thank you for the clear & concise information. I’ll be sure to check out any other articles/blogs you may have on or off the subject. Regards.

    - Heather

  • January 28, 2009 8:33 p.m.

    Dear Concerned, A mother with HSV 1 of the genital area has the same concerns as outlined in Scenario 1. It does not matter if it is HSV 1 or 2 of the genital area.

    - Lois McGuire

  • January 27, 2009 2:37 p.m.

    What about scenario 7 - mother is positive for HSV-1 in the genital region? What concerns should be addressed during pregnancy and birth?

    - Concerned

  • January 26, 2009 1:34 p.m.

    that is very interesting i did not know that.

    - Miya

  • January 23, 2009 9:35 a.m.

    Terrific article! How nice to have someone talking about testing during pregnancy and presenting scenarios where those test results may be utilized for a safer delivery. Dr. Zane Brown and the University of Wisconsin would love this article - it's been his life's work to protect babies from herpes, and your article, if taken seriously by the OB community, will support Zane's goal.

    - Terri Warren, nurse practitioner

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