Herpes during pregnancy is a big concern for women and must be taken seriously. Pregnant women who have herpes stand the risk of transmitting the infection to their baby and it is estimated that as much as 1,500 to 2,000 newborns are affected with neonatal herpes every year. Yet despite the numbers, cases of neonatal herpes are extremely rare with the right medical care.
Therefore it is important for a woman to be knowledgeable about the risks, complications and what to do during pregnancy in order to protect her unborn baby from infection as well as to ensure a happy outcome to the delivery of her child.
Herpes Testing During Pregnancy
In many incidences of neonatal herpes, it has been found that 90% of the women are not aware that they have herpes or did not disclose their condition to their obstetric provider (OB).
Note: 90% of neonatal herpes happens during labor when the baby is exposed to the virus in the birth canal during vaginal delivery.
While it is now common practice for hospitals to conduct a mandatory routine STD test on women who are looking to become pregnant or are already pregnant, most of these tests only screen for chlamydia, gonorrhea, syphilis and HIV but not herpes. There are no accepted guidelines or recommendations from the American College of Obstetricians and Gynecologists for compulsory herpes screening in pregnancy.
To get a diagnosis, a woman should speak to her obstetrician and request for a herpes blood antibody test before or early in the pregnancy. This will help identify whether it was an old or new infection before the beginning of the third trimester where the risks of infection to the baby is 30 to 50 percent.
That said, pregnant women who already know of their infection should not be embarrassed to speak to their OB about their condition as with the appropriate medical care, the risks of infecting the baby during pregnancy or delivery can be greatly reduced.
Risks And Complications For Pregnant Women With Herpes
There are some evidences to suggest that women who had a bad herpes outbreak (either primary or recurrent) during their first trimester may suffer a miscarriage. While it is rare, herpes can also cause congenital birth defects to the baby if there is a direct infection to the womb like a primary outbreak during the early months of the gestation period. As a precaution, antiviral therapy should be started immediately once a women feels any prodromal symptoms to prevent a bad attack.
Viral shedding may happen late in the pregnancy, during labor or delivery. Most pregnant women are advised to start taking daily antiviral medications such as Valacyclovir (Valtrex) as a form of suppressive therapy during the last few weeks of pregnancy to reduce viral shedding as well as to prevent an outbreak during delivery.
Women are also advised to abstain from any sexual activity with their partner in the third trimester of their pregnancy as there are increased risks of reactivation of the herpes virus to cause an outbreak.
During the pregnancy, the obstetrician will also avoid using a fetal scalp monitor to monitor the baby’s heartbeat and health as the instrument makes a tiny break in the unborn baby’s scalp that may allow the transmission of the virus. However the herpes condition of the woman needs to be make known to the OB provider so an external monitor will be used.
Herpes Outbreaks During Pregnancy – What To Do?
Women who previously already had a primary outbreak before her pregnancy or experience recurrent outbreaks before the third trimester should not be overly worried as her body would have already develop some antibodies against the herpes virus and has passed on the antibodies to the unborn child. If there is a recurring outbreak, antiviral medication can offer some protection to you as well as to your baby.
Also, women who have no outbreak symptoms during the period of labor may attempt a natural birth. If there are no active outbreaks, the risk of the baby contracting neonatal herpes also drops to less than 1%.
To improve the protection of the child during vaginal birth, doctors may place women with recurrent herpes on oral antiviral drugs for the final few weeks of the pregnancy. This reduces the risk of an outbreak occurring during labor.
However if a woman experience her first herpes infection late in the pregnancy especially in the third trimester, the risk of infection to the baby is a lot higher than for women with recurrent infections. In a first infection, a pregnant woman usually has a weak immune system and has no antibodies to help fight the virus or protect the baby. Viral shedding is also more frequent during and after a primary infection.
If a woman does has an ‘active’ outbreak less than 10 days to her delivery time or if the water has been broken for a long period of time, herpes can be transmitted to the baby during labor. In cases like this, your obstetrician will recommend a C-section to reduce the odds of viral transmission to the baby.
Herpes Treatment During Pregnancy
Antiviral drugs are commonly administered for genital herpes during pregnancy. The following guidelines, recommended by the Centers for Disease Control and Prevention, are commonly used in treating herpes during pregnancy;
- Acyclovir (Zovirax) is given to pregnant women during the last 4 weeks of pregnancy. This is done to reduce the risk of a recurrent outbreak emerging during the period of delivery.
- Acyclovir may be given to women during the first or second trimester.
- Women with severe HSV infections may be given intravenous acyclovir medication.
- For women with primary herpes infections, acyclovir may be prescribed to reduce the severity of the symptoms and delay or prevent recurrent herpes outbreaks during pregnancy.