Key takeaways
- While genital herpes is common, affecting about 22% of pregnant people in the US, most individuals with the virus give birth to healthy babies without transmission.
- If a pregnant person has an active genital herpes outbreak during labor, a cesarean delivery is typically recommended to prevent the transmission of the virus to the baby.
- Antiviral medications, such as acyclovir or valacyclovir, can be prescribed around 35 weeks of pregnancy to reduce the likelihood of a herpes outbreak during delivery.
Herpes is one of the most common health conditions caused by the herpes simplex virus (HSV). Herpes symptoms can be inconvenient, but the virus doesn’t put your health in danger.
If you have genital herpes, it’s possible to transmit the HSV to your baby, so you’ll need to make a plan with your doctor to keep that from happening.
It’s estimated that 22% of pregnant people in the United States have HSV-2, and 2% acquire a genital herpes infection during pregnancy. That means you’re certainly not the first person to have questions. But rest assured, most people with genital herpes give birth to healthy babies and don’t pass on the virus.
Here’s what we know about having genital herpes when you’re pregnant.
There are two main categories or types of herpes simplex virus:
- HSV-1: Primarily transmitted orally, HSV-1 typically causes oral sores, often referred to as cold sores or fever blisters. However, HSV-1 can also cause genital blisters if transmitted during oral sex.
- HSV-2: Generally transmitted via sexual contact, HSV-2 most often causes genital herpes sores or blisters in the genital area. HSV-2 can also cause oral infections through exposure during oral sex, but it’s the genital sores that are a risk during delivery.
Genital herpes refers to herpes blisters or sores in the genital area. The herpes virus may be transmitted to an infant during a vaginal delivery if the baby comes into contact with genital herpes blisters or sores.
Transmission
Herpes is transmitted through direct contact with fluid, blood, or saliva from a person who has herpes. Genital herpes is transmitted through sexual contact, including oral sex. That’s why genital herpes is primarily thought of as a sexually transmitted virus.
You can get a herpes infection without knowing it. The virus can be asymptomatic, meaning that it may not produce any noticeable symptoms. The World Health Organization (WHO)
Management
While there is no cure for genital herpes, there are medications you can take to reduce symptoms, prevent future outbreaks, and reduce the risk of transmission.
After you’ve had an initial outbreak of herpes simplex, the virus remains present in your body. Future outbreaks of herpes sores are most likely to occur within the first few months or years after contracting the virus.
As time passes, your body develops increased antibody protection against the virus. These antibodies mean that the virus tends to be less active once you’ve had herpes for a while.
Symptoms of genital herpes during pregnancy are similar to symptoms when you aren’t pregnant.
Symptoms of a new outbreak of genital herpes include:
- painful sores on the genital area
- fever
- burning during urination
- swollen lymph nodes
- body aches
If you develop a herpes infection for the first time during pregnancy, your symptoms may present as more severe or noticeable than they would in a nonpregnant person.
The American College of Obstetricians and Gynecologists (ACOG) currently does not recommend that every pregnant person be screened for herpes during pregnancy. Your provider may recommend that you be tested for herpes if:
- You know or suspect that a sexual partner has genital herpes.
- You notice what could be symptoms of herpes.
- You have never been tested for herpes before.
Of course, you can also simply ask your doctor or healthcare professional for a herpes test if you are concerned that you might have it.
To diagnose herpes, a viral culture may be taken from your genitals using a cotton swab. The swab is sent to a lab to test for viruses and bacteria.
An antigen blood test may also be performed to see if you have the herpes virus in your system.
If you have genital herpes, you may be prescribed an oral antiviral medication, such as acyclovir, valacyclovir, or famciclovir, starting at around 35 weeks to help reduce the chances that you’ll have an outbreak of genital herpes at the time of delivery. The drugs can’t cure genital herpes, but they can help speed up healing if you have an outbreak of genital herpes and suppress future outbreaks while you get ready to have your baby.
As your labor begins, your doctor will carefully check for any genital herpes lesions – blisters or sores. If you don’t have any signs of an active outbreak of genital herpes when labor starts, you will probably be able to have a vaginal delivery.
If there are genital herpes lesions present during your labor, you will likely need to have a cesarean delivery to prevent transmission of the herpes virus to the baby during delivery. Your doctor will discuss your options with you prior to your due date.
Your risk factors for contracting genital herpes are the same during pregnancy as they would normally be. Your risk factors for HSV are linked to being directly exposed to the virus. Risk factors include:
- being female
- having a compromised or weakened immune system
- having multiple sex partners
When babies contract herpes, it’s known as neonatal herpes. Also called birth-acquired herpes, neonatal herpes can happen if your baby is exposed to genital herpes during vaginal delivery.
Neonatal herpes is considered rare, but when it does happen, there can be serious complications, such as permanent injury to the baby’s nervous system, developmental disabilities, and death.
The risk to your baby is greatest if you acquire HSV for the first time during the third trimester of pregnancy. That’s because the levels of the HSV in your system will be highest during that time, and you’ll have fewer protective antibodies to pass on to the baby prior to delivery.
If you contract a genital herpes infection during the third trimester, the risk of passing the virus to your baby during delivery is
Yes. Herpes can be transmitted to a baby during pregnancy, delivery, or shortly after delivery and can cause preterm birth or, rarely, miscarriage. If you contract herpes late in pregnancy, that may pose the greatest risk to an infant.
Herpes is not worse during pregnancy. Approximately 75% of people who have herpes during pregnancy will have outbreaks, which is similar to the rate in people who are not pregnant.
Yes. Though most people who have herpes during pregnancy give birth via cesarean delivery, it is possible to have a vaginal delivery if you had herpes before you became pregnant and have not had active lesions (sores) at the time of your delivery. If you have herpes before pregnancy, your antibodies may help protect your baby and prevent your baby from contracting herpes.
Genital herpes can present challenges during pregnancy. But, unless you’ve only recently acquired the virus and it’s late in your pregnancy, your chances of passing herpes to your baby are low.
It’s important to get a proper diagnosis if you’ve been exposed to genital herpes so that you and your doctor or healthcare professional can make a plan to avoid passing the herpes virus to your baby.