Genital herpes is a sexually transmitted infection caused by the herpes simplex virus (HSV).
It’s a chronic condition that can reoccur throughout your lifetime.
Some people with the virus experience a herpes infection only once.
However, others may develop genital lesions frequently.
There are two types of herpes simplex virus that can cause genital herpes:
- Herpes simplex virus type 1 (HSV1) is mostly responsible for what we call cold sores or oral herpes
- Herpes simplex virus type 2 (HSV2) is a sexually transmitted infection that causes genital herpes.
A person can contract both herpes viruses through bodily fluids, including genital fluids and saliva.
Once people have the virus, the symptoms can flare up from time to time for the rest of their lives.
Symptoms of genital herpes for pregnant women
Women who have the herpes virus might have no outbreaks or signs of infection such as cold sores. Many don’t even know they have the virus. Once you’re infected, the virus stays in your nerve cells for life.
When the virus isn’t active, there’s no sign of infection. When the virus becomes active, a herpes outbreak occurs.
Some women might have no outbreaks or possibly only one, while others could have multiple outbreaks.
General symptoms of genital herpes infection can include:
- Tingling or itching on or around the genital area
- Painful blisters or ulcers on the genitals
- Pain when passing urine or inability to pass urine
- A warning tingling sensation just before a sore appears (in some sufferers)
- Fatigue and feeling generally unwell.
Contact your GP for an appointment if you have any of these signs of genital herpes.
Does pregnancy make herpes worse?
Genital herpes during pregnancy is quite common. Even if people show no symptoms of the infection, they can still transmit the disease to others through sexual contact.
During pregnancy, the immune system is suppressed and becomes less effective. This can trigger a first outbreak.
Pregnant women previously infected with herpes will have an average of three outbreaks during pregnancy.
Can genital herpes affect pregnancy?
If you or your partner have ever been diagnosed with the herpes simplex virus, let your midwife or doctor know.
If a woman caught the infection pre-pregnancy, it’s likely that her immune system will protect her baby during pregnancy. If a previously diagnosed herpes infection flares up during pregnancy, this should not affect the baby.
If you contract herpes in the last six weeks of pregnancy, however, your immune system won’t have time to produce antibodies to protect the baby.
If the baby hasn’t received protection via your immune system, the virus could be transmitted to the baby during childbirth.
For more information, please read Genital Herpes And Pregnancy – Everything You Need To Know.
Can I still have a healthy baby if I have herpes?
A HSV infection can be devastating to an infant. Most of these infections are caused by HSV2, but 15-30% are found to be caused by HSV1.
Most cases occur in during labor and birth. But they can also occur during pregnancy or after birth, through contact with oral or skin lesions.
Although herpes is a serious condition for newborns, it’s also very rare. Less than 0.1% of babies born in the United States each year get neonatal herpes.
By contrast, some 20-25% of pregnant women have genital herpes. This means most women with genital herpes give birth to healthy babies.
For more information, please read Why Visitors Shouldn’t Kiss Your Newborn On The Lips.
Will I need to have a c-section if I have genital herpes?
If you have herpes, it doesn’t mean you automatically need a c-section.
The American College of Obstetricians and Gynecologists (ACOG) currently recommends only women with active herpes lesions or symptoms that suggest a lesion is about to erupt should be offered a c-section to prevent the virus from infecting the baby during a vaginal birth.
In the weeks leading up to your birth, your ob-gyn or doctor might prescribe medication to prevent an outbreak of herpes.
Giving birth with genital herpes
With proper health care, most women with genital herpes can have a healthy baby vaginally.
The exceptions to this rule are women who have a first episode of genital herpes during the last six weeks of the third trimester, or women with active sores at the time of delivery.
Certain steps can be taken to reduce the risk of genital herpes infection affecting your baby and birth:
- At the time of early labor you might need an examination to detect any sores or signs of outbreaks
- Your doctor will avoid breaking the bag of waters around the baby unless necessary. This can help protect the baby against any virus in the birth canal
- The doctor will avoid the use of a fetal scalp monitor to monitor the baby’s heart rate unless medically necessary. This instrument makes tiny punctures in the baby’s scalp, which could allow transmission of HSV. An external monitor such as a Doppler will be used instead
- Ask that a vacuum or forceps not be used unless medically necessary. These instruments can also cause breaks in the baby’s scalp, allowing the transmission of HSV
- You might be offered a c-section.
In most cases of a newborn having HSV, the mother wasn’t diagnosed before birth. This is a very rare occurrence.
After birth, the doctor will monitor your baby closely for about three weeks, for symptoms such as:
- Skin rash
- Lack of appetite.
Although these can be symptoms of several mild illnesses, check in with your doctor if you have any concerns.
Reducing the risk of herpes in pregnancy
HSV is spread by sexual contact and leads to a herpes infection.
The risk of passing on a recently caught infection during birth is around 40%. Neonatal (newborn) herpes is a serious but rare condition that causes infection of the skin, eyes, and mouth.
Some things you can do to reduce the risk:
- It’s recommended you and your partner abstain from oral sex in pregnancy if you have been diagnosed
- Make sure your health care provider knows you or your partner have genital herpes
- To increase the chance of women with recurrent genital herpes being able to birth vaginally, many experts advise they take antiviral medication from 36 weeks. This reduces the likelihood of developing an outbreak at the time of birth.
Speak to your healthcare provider if you would like to find out more about how to reduce your risk of herpes in pregnancy.
Will I be tested for herpes while pregnant?
Currently, across the world, there’s no routine testing of women for HSV in pregnancy. This is because testing women with no symptoms makes little difference, as the infection has no cure.
Women who have active symptoms, or know they have HSV, should speak to their doctor or midwife for information about treatment during pregnancy.
Can herpes kill my unborn baby?
If you contact HSV for the first time during the first trimester, there’s a possibility the baby will be infected via the placenta. If this is the case, there’s an increased risk of miscarriage.
There is also a slightly increased risk that your baby will develop birth defects in the womb.
How do you treat genital herpes when pregnant?
If you’re unsure you have HSV, a swab of an open sore will be taken by your doctor and sent to a lab. If the results confirm a HSV infection, you may be offered medication to reduce how active the virus is.
Medication also speeds up the healing of lesions and can reduce the chance of having active sores at the time of labor.
Medications you might be offered include:
- Acyclovir (Zovirax) and valacyclovir (Valtrex) – antiviral medication most commonly used for herpes in pregnancy
- Paracetamol – pain relief
- Lignocaine Topical Gel – pain relief for open sores
- Salt baths – to help sores heal
Can I breastfeed if I have herpes?
You can breastfeed with some precautions.
If you have herpes sores on one or both of your breasts:
- You can keep breastfeeding as long as your baby or pumping equipment doesn’t touch a herpes sore
- Don’t breastfeed from the breast with sores. Herpes is spread through contact with sores and can be dangerous to a newborn baby
- Breast milk can be contaminated if it comes in contact with active herpes lesions, either from touching the breast during hand expression or via the pump
- Discard expressed breast milk from the affected side until the lesions have healed
Talk to your care provider or a lactation consultant for more advice.
Can I have a water birth if I have genital herpes?
If you have an active herpes outbreak, a water birth isn’t recommended. It’s also important no one is in the water with you if they suspect a herpes outbreak.