If you’re a mom-to-be with herpes, you’re not alone: About 1 in 6 reproductive-age adults in the U.S. is infected with genital herpes.
That means there’s a good chance your doctor has treated many expectant moms with herpes before you and is well-equipped to ensure your baby is delivered safely. It’s important that you and your doctor take early, protective steps to safeguard your health and the health of your baby.
When you have herpes and you're pregnant, you’ll want to be sure to stay on top of making and keeping appointments — attending your prenatal care visits is more important than ever to keep your case under control.
While it’s known that herpes can be passed to a baby during delivery, your doctor will likely inform you about medication that can reduce your risk of an outbreak before your baby arrives.
Here’s what else pregnant women need to know about herpes symptoms, as well as possible pregnancy complications and the ways you can manage a case of herpes when you’re expecting.[1]
What is herpes?
Herpes is a sexually transmitted infection (STI) caused by one of two types of herpes simplex viruses (HSV), the viral infection that causes genital herpes. Both are spread through skin-to-skin contact and are often transmitted by someone who has no visible sores or blisters.[2]
It’s estimated that at least 50 million people in the U.S. are living with the herpes virus, and cases of genital herpes are more common in women than men. Herpes is a lifelong infection with no known cure — though fortunately medications can help manage symptoms and outbreaks, even during pregnancy.
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What causes herpes?
Herpes is caused by two types of the herpes simplex viruses (HSV):
- HSV-1, which usually causes cold sores or blisters around the mouth and can be spread to the genital area during oral sex
- HSV-2, which commonly causes genital herpes and can be spread via vaginal or anal sex. It can also be transmitted by the mouth during oral sex
Herpes symptoms
Herpes symptoms often appear about two to 10 days after the virus infects the body, but many people who contract herpes never experience symptoms at all.
In fact, you may mistake herpes for a run-of-the-mill pimple or even an ingrown hair. If you do have a case of herpes, you might experience flu-like symptoms, including:
- Chills, fatigue, fever, headache, achiness, nausea and general malaise for two or more days
- Accompanying genital pain, itching, pain when urinating, vaginal and urethral discharge, and tenderness in the groin
- Small, painful, fluid-filled blisters or sores that often occur in clusters on genitals and buttocks, 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 the first episode that genital herpes is most likely to be passed on to a fetus, it's crucial that you call your practitioner if you experience any of the above symptoms.
Subsequent outbreaks may be less severe, less painful and subside more quickly — within three to seven days (as the immune system develops antibodies). You may feel tingling, burning or itching where the infection initially occurred just before a sore appears, but you usually won’t experience a fever or swelling.
How is herpes diagnosed in pregnancy?
Check in with your doctor if you or your partner experience any of the above symptoms. A health care provider may be able to identify any sores via an exam, but a lab test is necessary to accurately diagnose a case of genital herpes.
During testing, a sample is taken from the fluid inside a sore and then examined to see if it contains the virus. If it does, the test determines what type of HSV is present. A blood test can check for antibodies and therefore diagnose HSV and its type, but it can’t determine how the infection was contracted or how long you’ve had the virus.
What are possible herpes complications?
There’s some research that a genital herpes infection may lead to miscarriage or result in the preterm delivery of your baby, which is why it’s so important to discuss any symptoms you have with your physician as soon as possible so that your case can be managed carefully.
If you’ve experienced an outbreak before or find out you have herpes after a routine first prenatal visit, you’re at an extremely low risk of transmitting herpes to your unborn baby.
However, women who contract herpes for the first time late in pregnancy haven’t yet developed the necessary antibodies to protect their unborn babies. In fact a new infection is frequently active, and with it, there’s an increased possibility that the virus will be present in the birth canal during delivery. This exposes your baby to the virus as she’s born.
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. And if you have active sores around your vagina or you’re expecting a breakout near your due date, your doctor will likely recommend that you have a cesarean section to minimize the risk of infection.
How is herpes treated in pregnancy?
Follow your doctor’s lead when it comes to treatment for genital herpes. Your practitioner will prescribe an appropriate antiviral.
Herpes symptoms may be managed with antivirals during an outbreak, and they may reduce the length and severity of it. Daily suppressive medication therapy can also reduce the number of outbreaks you experience.
How can you manage herpes in pregnancy?
Fortunately, herpes is rarely transmitted to a baby during pregnancy, since most newborns with HSV get it when they pass through an infected birth canal. If the amniotic sac breaks before birth, the fluid in an infected birth canal can, in very rare cases, infect a baby who has not yet passed through it.
But the infection can cause severe problems for your baby, including skin lesions, eye disease (such as inflammation of the retina) and brain damage. Your doctor will treat her with antiviral medications in the unlikely event she’s exposed to herpes during birth. This treatment is safe and may be given over a period of several weeks
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 have sores or early symptoms of a herpes outbreak (such as vulvar pain and itching), a cesarean delivery may be recommended to reduce the chance the baby will come into contact with the virus.
Can you pass herpes to your child?
Yes, since cold sores are extremely contagious, HSV can be passed to babies and toddlers. Transmission commonly occurs via fluid from blisters, skin-to-skin contact or when touching something that’s been handled by a person who’s having an active herpes outbreak.
It’s also possible for HSV from cold sores to spread to a child’s eye and infect the cornea. This type of outbreak usually heals on its own, but more severe cases can lead to corneal scarring or blindness. HSV is of great concern to babies under 6 months old, as their immune systems are still immature. As hard as it can be, it’s best to nix kissing and close cuddles from parents or relatives with cold sores.
Can you breastfeed if you have herpes?
Yes, most women can breastfeed their babies even when infected with herpes, as 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, and always wash your hands with soap and water before and after each feeding session. If you spot a sore, don’t feed your infant from that breast.
And as for milk that’s been pumped or expressed by hand from a breast that has an active lesion, it’s a no-go for your infant. This milk may be contaminated and must be discarded since it may have come into contact with the sore during the process. But if your other breast is sore-free, you can pump and feed from that side, though be sure both your hands and the pump parts are super clean to avoid any transmission (from the lesion on the other side).
It may seem like herpes is a big bump in the road when you’re trying to have a baby. But if you’re proactive with your health care, gather helpful information to offset any stress, and seek out the best possible pre- and postnatal care, your baby can be delivered infection-free, and you should be able nurture and feed her safely.
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