Westover Heights Clinic - Pregnancy

    Genital herpes is of particular concern to pregnant women. Certainly, women with herpes can have healthy, normal children. However, some special problems may arise with pregnancy and genital herpes.

    Ideally, type-specific antibody testing is done during the pregnancy to determine who in the relationship has herpes and who does not.  Blood is drawn around 20 weeks of gestation.  If the mother is positive for HSV 2, even if she has never had symptoms, precautions should be taken at the end of pregnancy and at the time of delivery to protect the baby.  These precautions include suppressive therapy from 36 weeks until delivery, avoiding the use of scalp electrodes for fetal monitoring during labor, avoiding premature rupture of membranes, and performing a c-section if an outbreak is present in the boxer shorts area at the time of delivery. The likelihood of a newborn contracting herpes in these circumstances is very small.  For the woman with established genital herpes going into the pregnancy, the risk of neonatal herpes is about 1 in 5,500 deliveries.

    If the mother’s blood test shows that she is antibody negative for HSV 2, then optimally, her partner is tested for antibody.  If the father of the baby is HSV 2 positive and the mother is HSV 2 negative, precautions should be taken so the mother doesn’t get infected with HSV 2 in the third trimester of the pregnancy.  A primary outbreak in the last trimester of pregnancy puts mother and baby at a greater risk for a premature delivery and at much greater risk of infecting the baby at birth.  Women who contract herpes during late pregnancy who have NOT had an opportunity to make antibody before delivery have a 30-50% chance of infecting their babies.  Couples in this situation should avoid intercourse in the third trimester.  If that is not workable, then the infected male partner should be placed on daily suppression and condoms should be used without exception during intercourse.

    If the mother’s blood test shows that she is antibody negative for HSV 1 and 2, and her partner’s blood test shows infection with HSV 1 only, and the partner has ever had a cold sore, then the partner should not give oral sex to the mother during the third trimester.  New HSV 1 genital infection during the third trimester can result in transmission to the baby and is very serious.  If the partner tests positive for HSV 1, the mother is negative for HSV 1 and 2, and 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. 

    The major concern about herpes and pregnancy is that a baby may become infected with herpes virus if it passes through the birth canal when herpes virus is there.  Even if antibodies to the herpes virus are transferred from mother to baby during pregnancy, the antibodies are not adequate to completely protect all babies against infection. Newborns do not have an immune system that is capable of dealing with herpes, and they can become very sick or die from herpes infections.

    A woman who falls into one of the following categories should be followed carefully during her pregnancy and delivery:

    1) A woman who has a history of having genital herpes or who recently acquired the disease, or
    2) A woman whose sexual partner has herpes infection (genital or oral herpes, if the partner gives oral sex to the mother).

    This information can be scary for all pregnant women and especially for women who have known genital herpes.  But sharing information openly with OB clinicians will almost always result in safe deliveries and healthy babies. 

    Newborns should not be exposed directly to cold sores. If the mother has a cold sore at the time of delivery, she should avoid kissing her baby until the cold sore has healed. The same is true for all other people with cold sores who are around a newborn. Some women are concerned about breast-feeding and herpes.  If the mother has no breast herpes lesions, she may certainly breast feed the baby.