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Suffering from genital herpes for the first time while pregnant is can be very taxing both physically and mentally on an expectant mother. Here is we will talk about the potential risks to your child and how best to minimize them.

The last thing anyone expects to contract when they are pregnant is a sexually transmitted disease. Unfortunately, the incidence of diseases like genital herpes during pregnancy on the rise and with women at greater risk of being infected, [1] pregnant mothers have to be more vigilant than ever especially as their pregnancies come to term. [2]

What causes genital herpes?

Genital herpes is a sexually transmitted infection that is caused by the Herpes Simplex Virus (HSV). 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.

A primary genital herpes outbreak means that this is the first time the patient has been exposed to the disease. This can be accompanied by fever, tiredness, headache and muscle pain. The formation of red sores that eventually become painful are characteristic of genital herpes. These symptoms last approximately 10 days.[3]

The other form of the disease, known as recurrent genital herpes, can follow the primary outbreak. After the disappearance of symptoms the virus continues to live in spinal nerves of the lower back, meaning that it can reactivate when the body's immune capabilities are compromised, such as during another illness or stress. The symptoms during an outbreak tend to be milder and last for a shorter period of time.

It is difficult to determine clinically whether an outbreak is due to primary or recurrent genital herpes as most infections tend to present with mild symptoms, such as itching or discomfort, or even no symptoms at all. This is very important as the type of infection can give an insight into the potential risk of transmission to the child. 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%. The resulting infection could result in premature delivery, altered growth of the baby, severe brain development abnormalities or even miscarriage. [4]

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. The reason behind this dramatic increase in transmission risk is due to the lack of antibodies against the viral particles in the mother's bloodstream. It takes the human body approximately 4 to 8 weeks to produce antibodies against a specific disease and during pregnancy these antibodies are transferred to the child's circulation. By the time delivery arrives, there has not been time for the antibodies to be produced and the baby's immune system is practically defenseless against the virus. [5]

How can I treat genital herpes?

Expectant mothers will be provided with antiviral medications to help decrease the symptoms of outbreaks (especially red lesions in the birth canal) and decrease the production of viral particles in the host. Mothers will be then given a choice of a cesarean section as a method of delivery, especially if she has herpetic lesions present. This method is a surgical procedure where the baby is delivered through incisions in the abdomen and uterus, thereby avoiding exposure of the newborns' skin to virus-rich areas in the birth canal, such as the lesions and genital secretions. [6]

How will I know if my baby is infected?

An infection in a newborn can be difficult to spot as symptoms take up to 3 weeks to appear and can present with very non-specific symptoms such as increased tiredness and difficulty feeding. 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, especially around the mouth. It can eventually progress to an infection of the tissues surrounding the brain of the child, and even the brain itself, causing severe neurological damage. More serious infections can involve major organs of the child, including the lungs, liver, and kidneys. 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. The compromise of these systems can lead to the death of the child if not treated in a timely manner. [7] That is why it is important that mothers share any knowledge of prior genital herpes infections with healthcare providers so that they can immediately apply the appropriate treatment protocol. Treatment of herpes in newborns involves the use of the same antiviral medications used to treat genital herpes in adults. [8]

How can we prevent a herpes infection?

If the child was lucky enough to have not been infected by HSV, the mother should take precautions to avoid herpes infection in her pregnancy. This includes taking medications if she is positive for HSV antibodies to reduce the production of viral particles of genital herpes during the pregnancy and the chance of outbreaks; the mother can continue breastfeeding with these medications. Pregnant women with a known history of genital herpes can be given antiviral medications approximately 3 weeks before their due date to prevent potential outbreaks during delivery. 

The newborn should avoid contact with people with active herpetic lesions, as lesions may be present on the mouth and hands; this logic also applies to lesions that may be present on the breast, so the mother should avoid feeding with the affected breast and use the unaffected breast instead. [9]

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