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Genital herpes is one of the most common sexually transmitted diseases which means that the risk of catching it for the first time or reappearing during pregnancy is on the rise. How should you best safeguard your baby from it?

Pregnancy can be of one of the most challenging experiences in a woman’s life. With the fluctuation of hormone levels and the physiological changes that the body undergoes, along with the regular stresses of everyday life, there is so much that can go wrong and so much to keep track of. Morning sickness, mood swings, doctor’s appointments, preparing your home for the arrival of your newborn, the list is endless. And then you start to notice strange symptoms; pain on urination, itching in your crotch, red spots on your crotch. Many are familiar with the symptoms of a urinary tract infection, but during pregnancy, it’s time to be extra cautious.

You head to the internet and discover that it could be herpes! What could all this mean for your child? Well, worry not, we’ll be discussing the most important points when it comes to this ailment.

What is Genital Herpes?

Genital herpes is an infection caused by the Herpes Simplex Virus (HSV) of which there are two types, HSV-1 and HSV-2. It is one of the most common sexually transmitted infections and is very prevalent in maternal populations.[1] This virus is typically transmitted via skin-to-skin contact during intercourse and can be transmitted during pregnancy to the child which can result in developmental abnormalities and other health issues. The risk of transmission is greatest when red sores are visible and come in contact with the skin of another person.[2]

Most instances of the disease can be asymptomatic and there is no way to eradicate the organism from the body; the virus lives in nerve cells and is able to replicate to produce infectious particles when the host's body is compromised. Treatment aims to stop the virus from replicating and prevent the outbreak of symptoms.

Which Signs and Symptoms Should I Watch Out For?

The most common symptoms associated with genital herpes are:

  • Pain and/or itching in the vaginal area
  • Pain when urinating
  • Atypical discharge from the vagina
  • Swollen lymph nodes around the groin

The initial (also known as primary) infection is often accompanied by fever, tiredness, headache and muscle pain. The formation of red sores that eventually become painful are characteristic of genital herpes. These symptoms typically last from 8 to 10 days.[3] However, the disappearance or absence of the symptoms does not mean the eradication of the virus. Even with treatment, the virus remains dormant in nerves near the groin, meaning that it can reactivate when the body is undergoing significant stress, such as during another illness. This is known as recurrent genital herpes. Approximately 60% of infections do not present with any symptoms, which can make it difficult to determine when the appearance of lesions, such as sores or ulcers, are due to a primary infection or a recurrence (a reactivation of disease).[2]

As mentioned earlier, there are two types of HSV and while both types can cause genital herpes, they tend to present differently. HSV-1 presents typically as sores around the mouth and lips, known more commonly as cold sores, while HSV-2 is associated mostly with the genital sores and is the most common cause of such lesions.

How can this affect my child?

If you notice symptoms of herpes it is important to contact your primary healthcare provider. This is because depending on which stage of the pregnancy the infection occurs, it can have serious consequences on the child due to a phenomenon known as vertical transmission. This involves the transfer of viral particles to the child, and depends on when the infection takes place during the pregnancy, whether there are lesions present on the skin (especially in the genital region) and whether it is the mother’s the first encounter with the disease or whether it is a recurrent infection. 

If the first time the mother is infected is during the first trimester, the risk of transmission of the infection to the child is relatively low, less than 1%. On the other hand, primary infection in the third trimester, increases the risk to 30% to 50 %. The risk of infection is highest at delivery, especially when sores are present near the birth canal. Recurrent outbreaks have lower rates of transmission at 1.3%.[4]

Herpes infection in a newborn typically results in infection of the eyes and skin, resulting in redness of the eyes and red vesicles appearing on the skin. It can progress to an infection of the tissues surrounding the brain of the child, resulting in herpes meningitis. [5]  This is a very serious condition! The mortality of neonatal herpes is high, at around 60%, if treatment is delayed; despite effective treatment the child might still end up with serious disabilities. [6]

How can I test for Genital Herpes?

We can diagnose genital herpes by swabbing either skin lesions (if any present) or vaginal/cervical secretions and look for the presence of HSV DNA in the laboratory. Alternatively, we can test the blood of the mother for the presence of antibodies that bind to HSV particles, which indicate that she has been infected and whether the virus is in the dormant phase, i.e. if no symptoms are present. To determine whether it’s been passed on to the child we can swab potential skin lesions, eyes, mouth, throat and rectum between 12 and 24 hours after birth if there is a suspected transmission of the virus. [7]

How can I treat it?

Treatment of genital herpes involves taking antiviral medications, such as acyclovir, at a dosing regime dependent on the infection is primary or recurrent. This aims to decrease the production of viral particles and minimize the symptoms of an outbreak. Don’t worry, it is very treatable with few side-effects in the fetus.[8]

Ideally, you would like to avoid being in such a situation in the first place, so if you or your partner have ever had herpes, be sure to inform your primary healthcare provider. As herpes tends to live on in the body past the initial infection, there exists a risk for recurrence of the viral symptoms. If your partner is suffering from an outbreak, avoid skin contact with the lesions, including avoiding sexual intercourse and it is advisable to use condoms for the duration of the pregnancy even if symptoms are absent; it should be noted that condom use wont protect against transmission via contact with lesions not covered by the condom. Antiviral medication is not recommended for prevention as they act only as a means to decrease the replicative ability of the virus and not kill it outright. [9]

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