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You are faced with an important decision in light of recent genital herpes infection; how will my baby be delivered? Here we will examine the pro and cons between our two options.

You called your doctor the minute the symptoms appeared; the painful urination, the stinging red spots. You are already in the last few weeks of your pregnancy and you are not willing to take any risks with the health of your child. Thankfully you were admitted to the hospital and the doctors have started giving you medication to help with your symptoms; they have determined it to be genital herpes during pregnancy. With the delivery day looming, you are presented with the option of a delivery via cesarean section instead of the vaginal birth you expected.

But first, a little background information on genital herpes. It is one of the most common sexually transmitted diseases that is caused by the Herpes Simplex Virus (HSV). It is most commonly caused by the HSV-2 subtype, which results in the characteristic pain on urination, blisters and eventual red sores, however the HSV-1 subtype, which normally causes sores around the mouth, can also cause genital sores. What most do not realize is that most infections result in very mild symptoms or even no symptoms at all, and the virus continues to live on in the body for the rest of the host's life. This means that the virus can reactivate later on when the host's immune system, such as during illness or stress. [1]

Why a cesarean section?

In the case of an outbreak of genital herpes, a cesarean section can help protect your baby from the risk of infection that may occur during the birthing process. As the risk of transmission of the herpes virus is highest during delivery, due to the contact of the baby's skin with lesions and sores in the birth canal, being able to avoid this contact is of utmost importance. [2] HSV is spread via skin contact with viral particles, which are most concentrated in active lesions seen in sores, which explains the spread of the disease through sexual intercourse in adults and through vaginal birth in newborns. While cesarean section does not totally eliminate the risk of transmission, it is recommended for all women to undergo a cesarean section with clear symptoms of genital herpes such the red sores or early signs like itching or pain in the crotch. [3]

What is a cesarean section?

A cesarean section is a surgery where the baby is delivered via an incision made in the abdomen and the uterus. It is typically performed under regional anesthesia, meaning that the mother is awake during the procedure. Following the delivery of the baby and the placenta, the mother will spend a few days at the hospital to recover and monitor the site of incision for signs of potential infection. The baby will also be monitored to determine if there are no complications following the delivery. 

What are the risks involved?

Major risks to the baby include injury incurred during the operation and breathing issues where the baby breathes faster than usual for the first few days of birth. The mother has an increased risk of infection of the uterus and the site of the incision, heavy bleeding during and after the delivery, potential reactions to anesthetics used. Complications may occur during the surgery which could result in damage to structures surrounding the uterus such as the bladder, which may require additional surgery. It is also worth noting that a cesarean section brings the potential for complications in future pregnancies and multiple cesarean sections may prevent you from being able to deliver vaginally. [4]

How will I know if my baby is infected?

A herpes infection in a newborn (known as neonatal herpes) can be difficult to spot as symptoms take 5 to 21 days to appear and can range from the characteristic blisters that can burst and form sores, to very non-specific symptoms such as increased tiredness and difficulty feeding. Providing treatment at this point can be too late as it cannot reverse potential damage done by the virus, which can include brain damage resulting in severe neurological impairment. That is why it is important that mothers share any knowledge of prior herpes infections with healthcare providers so that they can immediately apply the appropriate treatment protocol. In neonatal herpes, this can often be the difference between life and death as delayed treatment carries a mortality rate of up to 60%! [5]

How to protect your child from HSV infection

The best way to protect your child is to prevent infection in the first place. Assuming your child is healthy at birth, you will want to avoid contact between the child's skin and herpetic lesions.

For example, if you have a cold sore on your mouth, you should refrain from kissing the baby. This can extend to breastfeeding; if you suspect any lesions on a breast, it is recommended to feed using the other unaffected breast. [6]

Is vaginal birth still an option?

If no herpetic lesions are present in the birth canal and there are no early symptoms of genital herpes during the pregnancy in the last trimester, you may be able to proceed with a vaginal birth while taking some antiviral medication to help further minimize the risk of transmission and outbreaks. Remember, the transmission risk is approximately 50% via vaginal birth with lesions present. You can consult with your primary healthcare professional as to which option is the best for you. [7]

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