Herpes simplex in pregnancy: what it is and what are the risks to the fetus

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Herpes simplex can be of great concern if it occurs in a pregnant woman, but it does not always pose a danger to the fetus. If the expectant mother contracts cold sores, for example, there is no risk for the little one. Different, however, is the case ofgenital herpes, a less common infection than that though it can be passed on to the newborn at the time of childbirth. When a woman has a genital Herpes Simplex infection during pregnancy, a caesarean section should be considered to avoid putting the baby's health at risk.

In this article

  • what is herpes simplex
  • cold sores
  • genital herpes
  • how it is transmitted to the newborn
  • how to prevent transmission
  • simple herpes from a gas caesarean
  • the treatment of genital herpes
  • after the birth of the child

Herpes simplex: what it is

Herpes simplex is a contagious infectious disease that can also be particularly annoying, and many have experienced it on their skin. Characterized by the presence of itchy blisters, HSV (herpes simplex virus) infection can occur on the lips and mouth (cold sores) or on the genitals (genital herpes) and is caused respectively by virus HSV-1 and the virus HSV-2. In fact, although HSV-1 occurs more frequently in the labial area and HSV-2 occurs in the genital area, both viruses can affect both the genital and lip areas.

Primary infection

Herpes simplex infection it can present asymptomatically or with more or less severe manifestations. Usually, when for the first time there is contact between the virus and the mucous membranes (or skin) of the host, the primary infection occurs and itchy blisters appear that we are all familiar with and which can sometimes be painful. Lesions appear 2 to 14 days after exposure to the virus and generally the symptoms heal within a few days or at most a few weeks. After healing, however, the virus does not go away from our body, it goes into "stand-by" (a state of latency) for an indefinite time.

Recurring infections

Just why the virus never completely leaves our body, when the immune system weakens a little due to stress, flu or just because of pregnancy, herpes can recur with a new flowering of vesicles or in a completely asymptomatic way.

Depending on the area of ​​the body where it occurs, herpes simplex infection can be more or less dangerous for the baby that the woman is carrying.

Also Read: 13 Tips To Boost Your Immune System

Herpes labialis

Herpes simplex lip infection is very common indeed, so much so that it is estimated that the 68% of the adult population has manifested it at least once. It manifests itself with small bubbles and blisters that surround the lips and cause itching and burning. Generally the bubbles dry up within a few days and form yellow crusts, until they disappear completely within 10 days.

counteract the symptoms of herpes simplex you can use drugs for local use, ointments or patches with anti-inflammatory or anesthetic action. In any case, if the cold sore occurs in pregnancy there is no risk to the fetus.

On the other hand, genital herpes, which could be transmitted to the newborn, is much more risky.

Read also: Cold sores, 10 photos to recognize it

L'herpes genitalia

Genital herpes, caused by the herpes simplex virus, is fortunately less common than cold sores, but it is estimated that around 10% of the adult population has contracted it. The typical symptom of the disease is the presence of small injuries on the vulvar mucosa of women (or at the level of the penis in men) and, occasionally, they can also occur at the level of the anus. As we mentioned earlier, the HSV-2 virus is the main cause of genital herpes, but it can also be triggered by HSV-1, albeit in a smaller number of cases.

How do you get genital herpes

Genital herpes, as the National Institute of Health recalls, is highly contagious and is mainly transmitted during sexual intercourse of all kinds (vaginal, oral and anal) through body fluids or direct contact of the vesicles with the genitals. In recent years, genital herpes caused by HSV-1 has become increasingly common and is transmitted during oral intercourse through direct contact of the genitals with the vesicles present on the lips or in the oral cavity of an infected person.

Read also: Sex and adolescents: the infection warning

How is the diagnosis made

As indicated by the National Institute of Health, for the diagnosis of herpes simplex infection the visit to the specialist doctor which recognizes the disease by observing the lesions present at the genital level. The clinical diagnosis can be confirmed by lab test whether or not they confirm the infection. The diagnosis can also be made with serology, that is, with the search for specific antibodies anti-HSV-1 and HSV-2 in the blood. In the symptomatic patient, both virological and serological tests are able to determine whether it is a primary infection or a relapse.

How genital herpes is prevented

The risk of transmission of genital herpes can be reduced thanks touse of condoms correctly and consistently. However, condoms do not cover all areas that may be affected by the virus and therefore do not fully protect against infection. People with genital herpes should therefore refrain from sexual activity when blisters or other symptoms are present.

It is important to pay attention to genital herpes simplex infection if the woman wishes to become pregnant or if she is already pregnant because the disease could be transmitted to the newborn with serious consequences.

The transmission of herpes simplex infection to the newborn

When herpes simplex infection occurs at the genital level it can be transmitted to the fetus by contact at the time of delivery. In fact, if the little one comes into contact with herpetic lesions of the genitals, the risk of contagion is high. According to the guidelines of the American Centers for Disease Control and Prevention (CDC), the risk of transmission to the newborn from an infected mother is high (approximately 30-50%) among women who contract genital herpes near the time of delivery and low () among women who contracted herpes simplex in the first half of pregnancy or who have recurrent manifestations near the end of pregnancy.

La transmission to the fetus through the placenta on the other hand, it is quite rare as is the possibility of infection of the newborn after birth.

How neonatal transmission is prevented

The prevention of neonatal herpes, again according to the guidelines of the American CDC, is based on two fundamental aspects:

  • prevent primary infection in women during the last trimester of pregnancy;
  • avoid that the newborn is exposed to herpetic lesions during delivery.

To prevent primary infection it is important that pregnant women refrain from sexual activity with infected partners, or suspected such, during the last trimester of gestation. If during pregnancy the partner presents a manifestation of herpes simplex (labial or genital), according to the indications of the Royal College of Obstetricians and Gynaecologists, it is advisable for the woman to avoid skin-to-skin contact with the affected area.

To avoid exposure of the baby to herpetic lesions, however, in some cases it will be necessary to consider a caesarean section.

Read also: Infections in pregnancy: symptoms, prevention and treatment

Caesarean section and herpes simplex: when is it necessary?

Caesarean section According to the guidelines of the Royal College of Obstetricians and Gynaecologists NOT recommended:

  • in case of primary infection contracted in the first or second trimester of pregnancy;
  • in case of recurring relapses during pregnancy but without active lesions or prodromal symptoms at delivery due to the very low risk of transmission to the newborn.

Therefore, a woman with a past history of genital herpes and without herpetic lesions, i.e. vesicles, in the third trimester of pregnancy can be more peaceful because the risk for the baby is low and no therapies are needed after birth.

Also according to the guidelines of the Royal College of Obstetricians and Gynaecologists, the cesarean delivery is instead recommended When:

  • are present herpetic lesions (primary or not) at the level of the genitals at the time of delivery or within 6 weeks of the term of pregnancy;
  • if they are present prodromal syndrome such as vulvar pain or burning which may then indicate the presence of infection;
  • the woman contracted the infection in the third trimester.

A caesarean section is recommended in these situations although it does not completely eliminate the possibility of the infection being transmitted to the newborn because the benefits for the newborn still outweigh the risks.

Furthermore, the caesarean section does not have to be routinely proposed, but the specific situation of each woman must be evaluated. The choice to perform a caesarean section may also depend on theeffectiveness of the treatment against genital herpes simplex.

Read also: WHO: Caesarean section should only be done if necessary The ideal rate at 10%

How is genital herpes treated in pregnancy?

Currently there is no definitive cure genital herpes infections because the virus remains dormant in the body. However, the active phase of the infection can be effectively treated with antiviral drugs.

During pregnancy, all scientific societies agree on the use ofacyclovir orally, a drug that is safe for the mother and also for the baby she is carrying.

Treatment with aciclovir is indicated for women who:

  • have recurring manifestations herpes simplex during pregnancy (initiation of therapy from week 36);
  • have a clinical history of genital herpes (always starting from the 36th week);
  • present a primary manifestation of genital herpes simplex in the third trimester.

Antiviral treatment does not prevent relapses, but in a woman with recurrent infection it does avoid caesarean section if herpetic lesions are not present at the time of delivery or in the preceding weeks.

Read also: Drugs in pregnancy: which are allowed and which are forbidden

What to do after the baby is born

If, during delivery, the newborn comes into contact with herpetic lesions of the maternal genitals, the risk of infection is high. Neonatal herpes can manifest itself with:

  • lesions affecting the mucous membrane of the nose and mouth, conjunctivitis and diffuse rash (45% of cases);
  • encephalitis with or without skin lesions (30% of cases);
  • disseminated infection (25% of cases).

The consequences of neonatal herpes can also be very serious and irreversible therefore the newborn must be promptly subjected to antiviral therapy. Unfortunately, when there is involvement of the central nervous system the mortality it is equal to 15% while for disseminated disease it reaches 57%.

Even the child born apparently healthy should be observed carefully for the first six weeks of life as symptoms may appear late. If suspicious bubbles or fever appear, the pediatrician should be alerted immediately.

Read also: Neonatal herpes: what it is, what it entails, how it is prevented, how it is treated

Sources used:

  • National Institute of Health, Genital Herpes;
  • Centers for Disease Control and Prevention (CDC), Genital HSV infection, Sexually Transmitted Diseases Treatment Guidelines, 2022;
  • Royal College of Obstetricians and Gynaecologists, Genital herpes and pregnancy, 2022;
  • Royal College of Obstetricians and Gynaecologists, Management of Genital Herpes in Pregnancy, 2022.

  • neonatal herpes
  • herpes in pregnancy
  • herpes virus
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