Genital herpes is a common viral infection that impacts millions of pregnancies worldwide. While many worry about the impact herpes could have on their pregnancy and baby, this is a common infection and something ObGyns and midwives deal with all the time. Let’s talk about what you need to know about managing herpes during pregnancy.
What is Herpes?
Herpes is a common viral infection that many adults have – in fact, about 1 in 6 women carry the virus. There are two types: HSV-1 (which traditionally causes cold sores) and HSV-2 (which traditionally causes genital herpes), though either type can affect either location. Many people who have herpes don’t know they have it because symptoms can be mild or absent.
How Can It Affect Pregnancy?
The main concern during pregnancy is preventing transmission to the baby during delivery. The risk of transmission is highest if a mother gets a new herpes infection late in pregnancy and has active lesions during birth. For this reason, we typically recommend a cesarean birth for individuals with lesions or the symptoms that typically precede an outbreak (known as prodromal symptoms) such as itching, tingling or burning. The good news is that there are steps you can take to prevent outbreaks at the end of pregnancy. Rest assured, for individuals who have had herpes before pregnancy, the risk to the baby is very low, especially with proper medical care.
Managing Herpes During Pregnancy
Outbreaks of genital herpes, both primary infections and recurrent outbreaks, are typically treated with antiviral medications such as acyclovir* or valacyclovir. These medications are usually taken orally though in severe cases can be given through an IV.
Individuals with a history of genital herpes outbreak(s) should be offered suppressive therapy starting at 36 weeks, or earlier if a preterm vaginal birth is planned. Acyclovir 400mg orally three times daily until delivery is most commonly prescribed for suppressive therapy, though valacyclovir 500mg orally twice a day until delivery is another option.
*Acyclovir is the most well-studied in pregnancy, and animal and human data suggest that it is safe in pregnancy, including in the first trimester, and can effectively reduce viral shedding and persistence of lesions. Valacyclovir is rapidly converted to acyclovir after metabolism in the liver. Therefore, valacyclovir is presumed to have a safety profile that is similar to acyclovir.
In the final weeks of pregnancy your OB provider will likely ask you about symptoms and perform an exam to look for signs of an outbreak.
When Would a C-Section Be Recommended?
A cesarean delivery is typically only recommended if you have active herpes sores or early warning symptoms when labor begins. If you have no active symptoms during labor, a vaginal delivery is usually safe.
After Delivery
Unless you have sores on your breasts, it’s safe to breastfeed your baby. The most important thing is practicing good hand hygiene and avoiding direct contact between any active sores and your baby.
Important Things to Remember:
- Having herpes does not mean you can’t have a healthy pregnancy and baby
- Be open with your healthcare provider about your history or concerns
- Take prescribed medications as directed
- Know the signs of an outbreak so you can alert your healthcare team
- Don’t be afraid to ask questions or seek support
When to Contact Your OB Provider:
- If you think you’ve been exposed to herpes during pregnancy
- If you develop any new symptoms
- If you have concerns about delivery
Remember, millions of women with genital herpes have successful pregnancies and healthy babies every year. The key is working closely with your OB provider and following their recommended precautions. You’re not alone, and there’s no shame in having herpes – it’s a common condition that can be managed effectively during pregnancy.
