Last Updated on June 4, 2020 by Valinda Riggins Nwadike, MD, MPH
This guest post was written by one of our contributors, Internist, Dr. Marina Gafanovich, MD.
Women who have been diagnosed with genital herpes (HSV1 or HSV2) often have some concerns about how the condition will affect their pregnancy and their unborn baby. While it is possible for a baby to become infected with herpes during delivery, which can be fatal, this only occurs in about 1% of cases when the woman was infected either before pregnancy or very early in the pregnancy.
However, if a woman becomes infected with herpes late in the pregnancy, the risk of infecting the baby increases to 30-50% due to the body not having time to develop antibodies that can protect the baby. Overall, though, only about 1,500 cases of newborn herpes are reported each year, making it quite rare, and there are ways to reduce the risk of transmission, regardless of when the mother contracts the herpes virus.
Is a Cesarean Section Necessary to Prevent Newborn Herpes?
Not all women infected with the herpes virus will need a cesarean section (c-section), but this will depend upon many factors. Women who were infected prior to pregnancy and those infected in the first and second trimesters can usually deliver vaginally with minimal risk, as long as they are not having a current outbreak (visual symptoms) when their water breaks.
To reduce risk of transmission, women who are having symptoms of an outbreak will need to have a cesarean section immediately after their water breaks or when labor begins. Unfortunately, there is no test that can definitively tell if you are shedding the virus, so if there are any symptoms present, such as tingling, pain, burning, or sores on the vagina, cervix or external genitals, most doctors will recommend a c-section as a precaution.
If you prefer a water birth, that is possible as long as you are not experiencing a current outbreak. Talk to your doctor or midwife, in advance, if you want to plan a water birth, so that precautions can be taken to reduce your risk of an outbreak as much as possible.
Can a Baby Get Herpes After Birth?
Approximately 5% of newborn herpes cases are contracted after birth, and that is just as serious as herpes that is contracted during labor. However, simple precautions can usually prevent that from happening:
- Wash your hands completely before interacting with your baby.
- Do not touch the baby if you have a herpatic whitlow sore on your hand or finger.
- Do not allow any lesions on your body to come in contact with your baby.
Is Breastfeeding Safe With Herpes?
It is generally safe to breastfeed when you have the herpes virus, including when you are experiencing an outbreak.
Although, if an outbreak is causing lesions on or near your breasts, you will need to abstain from breastfeeding. If the lesion is on one breast, completely covering the lesion and only nursing with the other breast is generally acceptable.
Can I Take Antiviral Medications During Pregnancy?
Being treated with antiviral medications during pregnancy can decrease the risk of passing herpes to your baby by reducing the risk of recurrent herpes lesions.
Whether you have had a recent outbreak or not, your doctor will likely encourage you to use a suppressive treatment all throughout your pregnancy. Many herpes drugs are taken at the first sign of outbreak and then taken for a short period of time to heal the outbreak (intermittent therapy). However, suppressive therapy is usually recommended while pregnant, because frequent recurrences can occur during pregnancy.
It is safe to use suppressive therapy indefinitely during pregnancy, and it can greatly reduce the amount of recurrences experienced. In fact, the majority of patients on long-term suppressive therapy do not experience any recurrences.
Both valacyclovir (Valtrex) and acyclovir (Zovirax) can be used during pregnancy to promote lesion healing and decrease viral activity. Famciclovir (Famvir) can also be prescribed, but due to the fact that it is more expensive than the other two drugs, it is not used as much.
All three drugs can be used as part of a suppressive therapy regimen. While the dose will be determined on a per patient basis, the general dosage guidelines include:
- Acyclovir: 400mg taken two times per day
- Famciclovir: 250mg taken two times per day
- Valacyclovir: 500mg taken one time per day
Typically, these drugs are also considered to be safe during breastfeeding, but always make sure to talk to your doctor before using any medications while breastfeeding.
Who Will Know That I Have Herpes?
It is important that your primary healthcare provider and your obstetrician know that you have the virus, because they are the ones that will be directing your healthcare during pregnancy.
When you are giving birth to your baby, the only people who will know are those directly involved in your care and the care of your newborn, and this is done to ensure optimal health for the both of you.
It is your choice if you inform anyone else.
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An acclaimed researcher and medical practitioner and rated the #1 internist in New York, Dr. Gafanovich holds a medical degree from the Sackler School of Medicine and works as a private medical practitioner on the Upper East Side. Affiliated with Weill Cornell Medical Center in Manhattan and New York Presbyterian Hospital, she believes quality of care is particularly imperative when handling issues encompassing sexually transmitted infections and diseases, and it is important to her that her patients are not only treated for the physical appearances of an ailment but the demonstrative characteristics of it too. For more about Dr. Marina Gafanovich, you can read her full bio, along with links to her recent posts, on our contributors page, or visit her website My NYC Doctor, and/or check out her Manhattan-based STD testing clinic. You can also find her directly on Twitter, Facebook or LinkedIn.
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