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Top Tips for Pregnant Women with Herpes Simplex Virus

Elizabeth Stein, CNM, MSN, MPH
Midwife & Leading Women's Health Expert
  1. A pregnant woman and her partner should be tested for the presence of Herpes Simplex Virus 1 and Herpes Simplex 2 IgG antibodies (HSV 1 and HSV 2 IgG Ab). This is a blood test. This test should be done at first prenatal visit. If you have been exposed to herpes virus or have had an outbreak, the virus is still in your body. In response to this virus, your immune system will produce antibodies which are found in your blood. These antibodies last for life.

    Antibodies are good - they usually prevent the virus from attacking your baby. The lack of antibodies means you can catch herpes. It takes your body approximately 8-12 weeks to develop antibodies (known as seroconversion) that could prevent herpes transmission to your fetus or newborn. Therefore, first infection during the last trimester of pregnancy (28-40 weeks) poses the greatest risk for your baby to become infected with neonatal herpes.

  2. A pregnant woman should do everything she can to prevent infection in her newborn. If the woman does not have antibodies but her partner does, then the risk of first infection exists. First herpes infection during pregnancy (especially the third trimester) poses a significant risk of infection of the fetus while in the womb as well as during delivery. Preventing transmission of the virus from the partner to the pregnant woman can include not having sex (vaginal or oral), having protected sex (condoms) when not having an outbreak as well as her partner taking antiviral medication such as Valtrex, Famvir or Zovarix (antiviral medication). All come in generic form. These medications are treatments, not cures. Currently, there is no vaccine or cure for herpes infection.
  3. A pregnant woman with a history of herpes outbreaks (cold sores on her mouth or blisters on genital tissue) or the presence of HSV 1 or 2 IgG antibodies should be offered Valtrex in the last month of pregnancy (starting at 36 weeks). The goal is to prevent a herpes outbreak during the end of pregnancy or during labor. This antiviral medication is Category B (safe during pregnancy) and only works on cells with active virus in them. It will not hurt your fetus or newborn. Discuss with your physician or midwife that you prefer less interventions during labor: not to rupture the membranes, place an internal scalp electrode, use forceps or vacuum unless absolutely necessary since any break in the fetal skin could increase the risk of infection.
  4. A herpes outbreak during labor should be treated with a cesarean delivery, to prevent infection of the newborn passing through the birth canal (vagina). How common is this infection in a newborn? Depending on when the herpes infection occurred and if it is first infection or a recurrent outbreak -- from 1/3000 births to 40% chance.
  5. There is no stigma with infection or treatment-just the need to prevent infection in your newborn. Share your concerns with your provider. Moms with cold sores on their mouth should not kiss their baby, but should take medication to help the outbreak heal quickly and reduce the risk of transmission. You may breast feed while taking antiviral medication as well as during a herpes outbreak. Pay close attention to hygiene.
  6. Hygiene is very important. Herpes virus prefer the corners of wet to dry skin- the corners of your mouth, genital tissue, eyes and nipples wet with breast milk. Hand washing is vital. Herpes virus may live on inanimate objects such as towels, toothbrushes, forks, spoons, toilet seats and telephones for several hours. Although the chance of herpes transmission is low, it is probably not zero! Sharing towels, toothbrushes, forks and spoons are discouraged. Toilet seats and telephones can be cleaned with Purell.

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