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With HSV-2 being the one of the most common sexually transmitted diseases, the chances are you know somebody who has been infected. But with symptoms often being ambiguous, many expectant mothers are unaware of this. Should they consider testing?

Suffering from genital herpes is never an easy task to deal with. Symptoms can be quite painful, from the burning during urination to the aching sores that arise. Adding pregnancy to the mix just makes the situation so much more stressful. However, what many people do not realize is that infection with the herpes simplex virus (HSV) that causes genital herpes can be asymptomatic, meaning that you could have been infected and not known about it!

This can be especially stressful when a mother unknowingly passes on to her child, which can have grave consequences. Newborns who are infected with HSV may not necessarily receive the treatment that they require as the symptoms might not be specific enough to consider a herpes infection especially if the mother denies having the disease. This can lead to an infection of the blood in what is called sepsis which may ultimately cause the death of the child. This is why the mortality rate associated with herpes in newborns is as high as 50%. [1]

Natural history of genital herpes

But how can genital herpes during pregnancy go undetected? Genital herpes is caused by two types of HSV, type 1 (HSV-1) and type 2 (HSV-2). HSV-1 presents with “cold sores” around the mouth and lips, while HSV-2 causes genital sores and is the most common cause of what we call genital herpes. The time between transmission of the virus to a new host and the onset of symptoms is between 2 to 14 days. However, most infections with HSV-2 occur with some mild tingling or itching in the genital area or without the presentation of any symptoms at all, resulting in many being unaware that they have contracted the illness. To make matters worse, the disease lives on indefinitely in the body, regardless of whether a person received any treatment for it. This means that the distinctive symptoms of red sores may arise at any time when your immune system is weakened, be through illness or stress. [2] Be aware though that while this may sound frightening, many already live with virus in their body, such as people who have suffered from chicken pox.

How do we detect herpes?

Due to the ambiguous nature of its presentation, studies show an increase in the number of people testing positive for HSV, especially women. [3] This poses a potential risk to their children, especially since the majority of infections are passed on during delivery. So how can one test if they are carriers for the herpes virus? Traditionally an infection is diagnosed by swabbing areas where symptoms appear, such as the vagina and cervix in women and areas where sores are present and sending the samples to a laboratory to test for the presence of viral DNA. [4] This is trickier in asymptomatic patients as they might not have enough viral particles being produced to be able to be detected by this method, which leads us to a more precise means of detecting HSV. By collecting a blood sample from a patient, we can perform a test to detect the presence of specific markers to herpes virus, which would indicate a prior infection. [5]

Should we check every expecting mother for herpes?

Does this mean that we should test expecting mothers for HSV-2 DNA? As we mentioned earlier, many women are infected with HSV-2 without being aware of it and yet, the majority of births proceed without any complications and no signs of genital herpes infection among their children. This is due to the fact that the risk of transmission of mothers who became infected with HSV-2 prior to pregnancy is very low. [6] The situation is quite different in mothers who are infected with genital herpes during pregnancy for the first time, as they lack the antibodies to fight the disease resulting in a much higher risk of transmission to the child. These cases result in the mother taking antiviral medications to decrease the replication ability of the virus and reduce the likelihood of an outbreak and it may result in them delivery their child via a surgery known as a cesarean section (i.e. through a cut in the abdomen and uterus) which also decreases the risk of infection. [7]

How should we treat mothers who are herpes positive?

Antiviral therapy in cases of mothers with a prior infection in the absence of outbreaks is not recommended as there is little evidence to suggest that it has an impact on the risk of transmission. [8] Thus it is not recommended to test for the presence of HSV-2 in asymptomatic pregnant women as the approach to the mother's care would not differ than if she was not a carrier of HSV-2. Evidently, the costs involved far exceed the potential benefits in uncovering potential carriers. Currently, research is underway into the development of a vaccine for herpes. Other preventative measures should also be considered to stem the spread of the virus among the populace, as it results in an increasing burden on healthcare costs. [9]

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