A woman with herpes can get pregnant and have a healthy baby. Herpes simplex virus (HSV), which includes both HSV-1 and HSV-2, is a common infection that does not interfere with a woman’s ability to conceive or sustain a pregnancy. The primary medical concern during gestation is preventing the transmission of the virus to the newborn during birth, a risk that is highly manageable with modern obstetrical care. Healthcare providers focus on a clear management strategy to ensure the safety of both the mother and the infant.
Conception and Pregnancy Planning
Having herpes simplex virus does not negatively impact a woman’s fertility or her ability to become pregnant naturally. The virus does not affect the reproductive organs, nor is it transmitted through the egg cells, meaning it poses no barrier to conception itself. Open communication with an obstetrician or midwife during pre-conception counseling is an important first step. This initial consultation allows the healthcare team to establish the woman’s specific risk profile. For women who acquired the infection prior to pregnancy, the body has already produced protective antibodies. These maternal antibodies cross the placenta, providing the developing fetus with protection. Herpes generally does not cause miscarriage or birth defects, as transplacental transmission of the virus to the fetus is exceedingly rare.
Managing Outbreaks During Gestation
The management of herpes during pregnancy centers on monitoring for outbreaks and minimizing the chance of viral shedding (when the virus is active on the skin surface). Recurrent outbreaks during the first and second trimesters are common and do not typically harm the baby. However, a primary infection acquired late in the third trimester poses the highest risk of transmission, as the mother has not yet developed a full antibody response to pass to the baby. Antiviral medications, such as acyclovir or valacyclovir, are commonly used and considered safe during pregnancy, classified as Category B drugs. These medications manage symptomatic recurrences at any point during pregnancy to reduce the severity and duration of an outbreak. The most common strategy involves suppressive antiviral therapy—a daily dose of medication starting at or beyond 36 weeks of gestation. This late-trimester regimen is highly effective, reducing the chance of an outbreak at delivery and decreasing the need for a Cesarean section.
Preventing Transmission During Childbirth
The primary goal during labor and delivery is preventing the newborn from coming into direct contact with the virus in the birth canal, as transmission most often happens during this intrapartum period. The decision on delivery method is based on the presence of active lesions or symptoms at the time labor begins. If a woman has no signs of an active outbreak, a vaginal delivery is considered safe and is the recommended option, even for women with a history of recurrent herpes who have been on suppressive therapy. A planned Cesarean section (C-section) is recommended for women who have active genital lesions or are experiencing prodromal symptoms (such as vulvar pain or tingling) when labor starts or if the membranes rupture. These symptoms suggest the virus is actively shedding, which raises the risk of transmission to the baby. This protocol is standard practice, guided by recommendations from organizations like the American College of Obstetricians and Gynecologists, and is designed to bypass the infected area. The risk of transmission for women with recurrent herpes is already low, estimated to be less than 4% even with a lesion present, but a C-section further minimizes this small risk.
Understanding Neonatal Herpes
Neonatal herpes is a rare but serious infection acquired by the baby, usually during passage through the birth canal. The infection is considered a medical emergency because it can lead to severe long-term disability or death if not treated promptly. This condition is classified into three main categories based on the extent of the infection in the newborn:
- Skin, Eye, and Mouth (SEM) disease, which is localized to the surface areas of the body. SEM can progress to more severe forms if left untreated.
- Central Nervous System (CNS) disease, which affects the brain and spinal cord.
- Disseminated disease, which is the most dangerous, involving multiple organs like the liver and lungs.
Neonatal herpes symptoms are often non-specific, such as lethargy, poor feeding, or fever, making a high index of suspicion vital for the healthcare team.