Herpes During Pregnancy: Signs, Symptoms, Risks And Treatment
Simple measures such as using a condom during intercourse can protect you from herpes.
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In This Article
Herpes simplex virus (HSV) is a common agent of the sexually transmitted disease (STD), herpes, which affects women of reproductive age, including pregnant women. Contracting herpes during pregnancy can be worrisome for mothers as the virus can spread to the fetus and adversely affect their health (1).
As per the Centers for Disease Control and Prevention (CDC), one in six persons between 14 and 19 years contracts herpes. Also, it is estimated that approximately 22% of pregnant women in the US have genital herpes, of which two% contract it in pregnancy (2).
Learn more about the herpes virus types and the symptoms, risk factors, and management of herpes during pregnancy.
Types Of Herpes
HSV is of two types, HSV-1 and HSV-2. Both viruses transmit through the skin and mucosal cells and then migrate to the nerve cells to persist in latency (3). HSV-1 causes oral herpes and cold sores. It infects the upper body, predominantly around the lips and mouth, and may infect the genital area. In contrast, HSV-2 frequently causes genital herpes (4).
Signs And Symptoms Of Herpes In Pregnancy
The symptoms of herpes are similar in pregnant and non-pregnant women. Most women are asymptomatic or have prodromal symptoms; hence, the infection goes undiagnosed in pregnancy. Inform your obstetrician or gynecologist if you experience the following symptoms (1) (5):
- Pain during urination and urinary retention
- Unusual vaginal discharge
- Tingling, itchiness, and tenderness in the genital tract
- Blisters or ulcers in the genital area (cervical and vulvar region), leading to open sores and pricking pain
- Fever, headache, muscle aches, and fatigue for two or more days
- Ulcerative lesions or rashes in the inner thigh, buttocks, and perineum skin.
Fetal Transmission Of Herpes During Pregnancy
Herpes infection is transmittable to the baby before or during labor, leading to a life-threatening viral infection called neonatal herpes (6). It is a rare but serious condition in infants with reportedly high mortality rates (7).
Risk Factors For Herpes In Pregnancy
You have an increased risk of contracting a herpes infection if you (1) (8)
- Are above 40 years – the prevalence of herpes increases with age
- Have a history of infections such as bacterial vaginosis or STIs
- Have a history of herpes infections
- Have a partner with a history of genital herpes infection
- Had earlier onset of sexual activity
- Have multiple sex partners.
Furthermore, certain social and lifestyle factors, such as poverty and drug abuse, may increase the risk of infection in pregnant women.
Diagnosis Of Herpes In Pregnancy
Herpes is diagnosed by a professional based on symptoms and certain laboratory tests, including (1) (3)
- Viral testing: Includes viral culture and HSV antigen testing by polymerase chain reaction (PCR).
- Antibody testing: Helps detect the presence of HSV-1 or HSV-2 antibodies and primary HSV infection.
- A type-specific blood test helps identify past or recurrent herpes infections.
Treatment For Herpes In Pregnancy
The widely used antiviral medications for herpes infection are acyclovir and valacyclovir. The recommended doses effectively reduce the severity and frequency of the symptoms of this infection.
However, acyclovir and valacyclovir are not licensed for use in pregnancy. The American College of Obstetricians and Gynecologists and the Society of Obstetricians and Gynecologists of Canada (SOGC) recommend pregnant women with active, recurrent herpes infections could be offered suppressive therapy with medications at or beyond 36 weeks of gestation (9).
Suppressive therapy for herpes in pregnancy is intended for
- Avoiding further spread and reducing the risk of asymptomatic viral shedding
- Reducing the rate of recurrence
- Opting out of cesarean delivery (may be required in case of a severe, active herpes infection).
Prevention And Management Of Genital Herpes In Pregnancy
Having genital herpes during pregnancy may cause embarrassment and fear about transmitting the virus to the developing fetus. Here are some ways to help prevent and manage genital herpes during pregnancy (10) (11) (12):
- Use condoms to reduce the risk of viral transmission and practice monogamy.
- Maintain proper genital hygiene.
- Avoid douching as it eliminates some protective bacteria from the vagina.
- If you or your partner have a history of genital herpes, undergo serological screening tests (or viral tests) for herpes infection.
- If you had a herpes infection earlier, talk with your primary care doctor (obstetrician or gynecologist) or counselor about medical interventions to prevent virus transmission in late pregnancy or chances of recurrence.
- If you acquire the infection later in pregnancy, speak to a specialist (maternal-fetal medicine or infectious disease specialist) about medications (antiviral therapy) and interventions to avoid further spread or future outbreaks during labor or delivery.
- Oral antiviral treatment can prevent perinatal transmission to the fetus and reduce the duration and severity of viral shedding.
Frequently Asked Questions
1. Can I give birth naturally if I have herpes?
Vaginal delivery is possible if you have herpes before delivery only if you don’t have the signs of a virus outbreak during labor or delivery. Also, the presence of HSV in the infected mother’s birth canal can infect the baby. Therefore, the duration and severity of the infection in pregnancy are major factors to consider before and during delivery (13).
2. What are the complications of herpes infection in pregnancy?
Some studies suggest that pregnant women with a herpes infection are at risk of having a preterm delivery, and neonatal herpes (14).
3. Can herpes cause a miscarriage?
No studies have found herpes infection to be associated with miscarriage, so far. However, it still poses a threat to the baby’s health and the pregnancy (5) (15).
4. Is herpes worse during pregnancy?
Yes, about 75% of pregnant women with herpes experience an outbreak of the symptoms during pregnancy. These symptoms include itchiness, burning, and tingling sensation before the sore appears (2).
5. Can herpes cause infertility in females?
No, herpes does not cause infertility in females, unlike bacterial infections such as chlamydia and gonorrhea (16).
6. Do they test us for herpes while pregnant?
Currently, herpes is not part of routine pregnancy test checkups and tests. While some experts state that herpes should not be tested due to the lack of cost-effectiveness and negative psychological impact, others argue that herpes serologic testing should be included in pregnancy tests (17).
Genital herpes infection during pregnancy has a substantial prevalence. Hence, implementing safety measures at the time of delivery is essential to avoid adverse pregnancy outcomes. Additionally, awareness should be provided to expectant mothers and their partners. Altogether, conducting screenings during prenatal visits, early diagnosis, personalized interventions, and counseling sessions is key for effective infection management and control.
Key Pointers
- Blisters or ulcers in the genital area, unusual vaginal discharge, and pain during urination could indicate herpes infection during pregnancy.
- Laboratory tests for herpes infection include viral testing, antibody testing, and a type-specific blood test.
- Suppressive therapy with medications at or after 36 weeks of pregnancy may be recommended as a treatment.
- If you are infected later in pregnancy, talk to your doctor about interventions to prevent the spread or further outbreaks during labor and delivery.
References
- Gianluca Straface, et al.; (2012); Herpes Simplex Virus Infection in Pregnancy.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3332182/ - Genital herpes and pregnancy: Understanding the risks.
https://utswmed.org/medblog/genital-herpes-pregnancy-faqs/ - Herpes simplex in pregnancy.
https://www.kemh.health.wa.gov.au/~/media/Files/Hospitals/WNHS/For%20health%20professionals/Clinical%20guidelines/OG/WNHS.OG.SexuallyTransmittedInfections-HerpesSimplex.pdf - Genital Herpes and Pregnancy.
http://conditions.health.qld.gov.au/HealthCondition/condition/14/217/61/genital-herpes-and-pregnancy - Genital herpes and pregnancy: your questions answered.
https://www.nct.org.uk/pregnancy/worries-and-discomforts/symptoms-watch-out-for/genital-herpes-and-pregnancy-your-questions-answered - Genital Herpes – CDC Fact Sheet.
https://www.cdc.gov/std/herpes/stdfact-herpes.htm#a5 - Management of Genital Herpes in Pregnancy.
https://www.rcog.org.uk/globalassets/documents/guidelines/management-genital-herpes.pdf - Zane A. Brown, et al.; (1985); Genital herpes in pregnancy: risk factors associated with recurrences and asymptomatic viral shedding.
https://pubmed.ncbi.nlm.nih.gov/2994477/ - Cindy W. and Becky McKay; (2012); Treatment of HSV Infection in Late Pregnancy.
https://www.aafp.org/afp/2012/0215/p390.html - Genital Herpes: What You Should Know About Sex And Pregnancy.
https://www.aad.org/public/diseases/a-z/genital-herpes-pregnancy - ACOG Releases Guidelines on Managing Herpes in Pregnancy.
https://www.aafp.org/afp/2008/0201/p369.html - Genital herpes.
https://www.womenshealth.gov/a-z-topics/genital-herpes - Genital herpes in pregnancy.
https://www.ncbi.nlm.nih.gov/books/NBK525779/ - Zane A. Brown, et al.; (1997); The acquisition of herpes simplex virus during pregnancy.
https://pubmed.ncbi.nlm.nih.gov/9262493/ - Javad Charostad et al.; (2020); Detection of human herpes viruses 1-5 in miscarriage: A case-control study.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7385915/ - Herpes could lead to infertility.
https://www.figo.org/news/herpes-could-lead-infertility - David A. Baker et al.; (2011); HSV Serologic Testing for Pregnant Women: Willingness to Be Tested and Factors Affecting Testing.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3094703/
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