First, the risk of your baby getting herpes is almost certainly very, very low. Women with genital herpes most often have normal pregnancies and deliver healthy babies, especially if the infection is long-standing: the mother’s immune system responds to the virus and helps protect the baby. The risk of transmission is highest among women who are infected with genital HSV close to the time of delivery. The lack of an immune response to share with the baby—and the large amounts of virus shed during first outbreaks—combine to put the baby at risk.

The important thing is to make sure your healthcare provider(s) are aware that you have a history of genital herpes, so they can examine you closely when you deliver your baby, to see if any genital lesions are present.

Experts debate whether or not pregnant women should use medications for herpes. There’s no indication that using these medications during pregnancy causes problems or birth defects, but their safety in pregnant women isn’t really well understood. Women with severe outbreaks can be treated with the drug acyclovir. Ask your healthcare provider what he or she recommends.

One other note: experts recommend that if at all possible, it’s best not to use fetal scalp monitors with babies born to mothers with genital herpes. This is because the monitors can cause small cuts in the infant’s scalp, which might provide HSV a way to enter if the baby is exposed.

Visit the HRC online for a detailed discussion of herpes and pregnancy.

–The STI Resource Center Staff

---

Hi Helen,
I understand that you are worried - that's pretty normal.  However, the numbers are definitely on your side.  For women with established herpes infection, the rate of transmission to the newborn are about 0.3%.  There are several things you can do to minimize this risk.  First, make your OB provider aware of your herpes infection so they know what to look for at delivery.  Second, consider the use of daily antiviral therapy at the end of pregnancy.  The dose recommended in various research studies is more than the usual dose, so be sure to talk with your provider about this important difference. The daily therapy is normally started around 34 weeks of gestation, assuming everything is normal in the pregnancy.  If it looks like the delivery might happen sooner, it would be wise to start sooner.  it is optimal to have a week to 10 days on therapy before the delivery.  Normally, it takes five days for antiviral therapy to kick in fully, but in the case of pregnancy, because pregnancy is a somewhat immunoompromised state in itself, it can take longer to be fully effective in the pregnant woman.  Third, you can be fully aware of any lesions that come up during the late pregnancy and make your OB provider aware of these.  If you have a lesion at the time of delivery, in the boxer shorts area, you may be delivered by c-section.  Fourth, when you water breaks, it is important that you go to the delivery location right away or at least call in right away.  The time from rupture of membranes to delivery in a mom with herpes is important to watch. 

During the second half of your pregnancy, you will pass immune responses to your baby that will help protect him/her.  So even if you happen to be shedding virus at the time of delivery, these immune responses will help keep the baby safe.

If you think that 1 in 4 women between 14 and 49 in the US are infected with HSV 2, and neonatal herpes only happens about 1500 times in a year, that's a very low number indeed.  And most cases are in women who do not know they have herpes or women who get infected in the third trimester.  You are so on top of this, I know you will do whatever you can to have this be a safe and wonderful pregnancy.

Terri
---