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Genital herpes during pregnancy is often uncomfortable, especially as the delivery date draws near. We will discuss the likelihood of transmitting herpes during birth and what steps can be taken to reduce that risk.

Hearing that you have genital herpes is never a good thing. And as the due date for your child draws near, the thought of hearing such a diagnosis weighs heavy on one's mind. By learning more about it, you hope that you may allay some fears that you may bear concerning the risks that genital herpes during pregnancy may pose to your child. 

Genital herpes is most commonly caused by type 2 of the Herpes Simplex Virus (HSV-2) where the classic presentation consists of a burning sensation on urination and the appearance of painful, red sores on genitalia. It is one of the most prevalent sexually transmitted infections, especially among women, and is spread through direct contact of infectious sources, such as sores, with skin. [1]

Risks of transmission of genital herpes

The risk of passing an HSV-2 infection to an unborn child is dependent at what stage of the pregnancy the infection takes place and whether it is the mother’s first encounter with the disease or whether it is a recurrent infection. If the first time the mother is infected (also known as the primary infection) is during pregnancy in the first trimester, the risk of transmission of the infection to the child is relatively low, at less than 1%. These infections, while quite rare, carry very serious consequences for the child as they can result in poor development of the brain, premature birth, restriction of growth and even miscarriage. [2] However it's quite a different picture if the primary infection arises in the third trimester, where 30% to 50% of newborns are infected; however the majority (85%) of these infections arise during the birthing process. [3]

This is because the mother has not had the time required to produce antibodies that neutralize the viral particles, which normally stifle the spread of the disease. These antibodies are passed on to the child which helps prevent them from becoming infected by HSV-2. If a mother is infected in the third trimester however, this is too short a period to produce the antibodies, which can take up to 8 weeks, and transfer them to the child, leaving it defenseless. The resulting infection of the newborn can result in symptoms such as the distinct blisters that tend to form around the mouth, to non-specific symptoms such as increased tiredness and difficulty feeding which raise alarms as they could indicate that the disease involves important organs. [4]

In the case women who acquired genital herpes acquired prior to pregnancy have a 75% chance of at least one recurrence of the disease, and 14% will experience minor symptoms and sores at the time of delivery, with a trend of a decreasing number of outbreaks over time. [5] The risk of transmission is much lower, at 1.3%, if you have already suffered from the disease.

How to lower the risk of transmission

The use of antiviral medications, such as acyclovir or Valacyclovir, can be used to decrease the transmission risk in late pregnancy primary infections with genital herpes, as these drugs work by suppressing the replicative processes of the virus, preventing the development of outbreaks and shortening the duration of any symptoms present. These medications are safe for use in all stages of pregnancy and are used for the treatment of HSV-2 infection in the newborn if deemed necessary. [6]

If traces of an outbreak are present or symptoms that precede an outbreak develop, such as itchiness of the groin or discomfort with urination, a cesarean section is recommended. This is a surgical procedure where the baby is delivered through a cut made in the abdomen and the uterus of the mother, reducing the risk of transmission by avoiding contact with a potentially virus-rich birth canal. [7] The mother may proceed with a vaginal birth if no signs of an outbreak are present and antiviral medication is taken to reduce the chances of an outbreak. The healthcare professionals delivering the baby may want to avoid the use of tools that may cause small breaks in the baby's skin in this case, such as forceps, as they may provide access for the virus to enter. [8

What if the herpes is transmitted?

You should be prepared to watch out for potential signs of herpes infection in your child for up to three weeks, as this is the time required for symptoms to manifest. At this point, urgent treatment is required in the form of hospitalization and treatment with antiviral medication. While the treatment cannot reverse any damage done by the virus, it can potentially save the life of your child. [9]

Be aware!

Remember to be able to recognize the initial symptoms of genital herpes during pregnancy so that you can inform your primary healthcare professional as soon as possible and negotiate the best treatment plan for both you and your baby to proceed with, in order the minimize the risk of transmission during the delivery process. [10]

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