Genital herpes in pregnancy [HSV 2 & HSV 1]

Last updated on January 23rd, 2023 at 05:22 pm

Genital Herpes in Pregnancy | HSV 2 positive in pregnancy

Genital herpes simplex virus [HSV 2] infection in pregnancy

Herpes is an infectious disease, which is caused by the herpes simplex viruses (HSV 1 and HSV 2). With genital herpes, which is caused by HSV 2, is already infected 32 percent of people. Because it is not a very rare disease in the childbearing period, it can occur in pregnancy too.

How does HSV 2 affect pregnant women and newborns? Genital herpes in pregnancy can cause pregnant women a few complications, but above all, it causes a big fear of fetal infection in the uterus.

Labial herpes (commonly known as cold sores, or facial herpes) and genital herpes are caused by two different viruses (HSV 1 and HSV 2). However, due to altered sexual habits, the first one (facial herpes) may cause genital infection too.

Genital herpes can be spread to an infant if the virus is present in the woman’s birth canal during the delivery. That causes neonatal herpes.
Neonatal herpes is a very rare, but severe and sometimes fatal condition. Most women with genital herpes give birth to healthy babies!

What is genital herpes?

Genital herpes is a chronic viral infection caused by the herpes virus (HSV). The most known HSV viruses are HSV type 1 and type 2.

Most genital herpes infections are caused by type 2 HSV. But, due to different sexual habits, HSV 1 has recently appeared as a cause of genital herpes too. Type HSV 1 has used to cause only labial herpes or so-called cold sore.

Genital herpes is a sexually transmitted disease that is, in many cases, not recognized. The patient can excrete viruses even when she or he does not have characteristic painful blisters and wounds.

The virus is transmitted through body fluids. It is in seminal fluid, and vaginal discharge, thus it is spread through sexual intercourse. The virus is present in the blisters’ fluid and saliva, so it also transmits through kissing.

Herpes infection manifests as a blistering rash around the lips, nostrils, genital area, inflammation of the cornea and eyelid, or in rare cases as an inflammation of the brain membrane (meningoencephalitis).

Signs of genital herpes in pregnancy

Signs of genital herpes in pregnancy are not the same if pregnant women have an initial infection called primary genital herpes, or recurrent infections called recurrent genital herpes.

Signs of the primary infection with genital herpes simplex in pregnancy include:

  • a change in the external genitalia in the form of tiny painful blisters
  • genital ulceration
  • transparent vaginal discharge

Other signs of genital herpes in pregnancy:

  • the affected area may experience itching, pain or irritation
  • the pregnant woman usually feels a burning sensation when urinating
  • fever
  • general malaise
  • enlarged lymph nodes in the groin
  • headache
  • muscle and joint pain

Recurrent genital herpes may occur several times a year. The clinical picture is milder, the changes are less intense, and there is usually no overall tiredness. Pregnant women experience less significant signs. For example, only a small pain in the external genital area may be present.

A check-up with a healthcare provider is essential for the diagnosis. She or he will confirm typical changes that occur in herpes infection. In case of any doubt, they will prove genital herpes with one of the available tests: with viral culture tests, by confirming the presence of viral DNA, or with the antibody test.

What happens if you get genital herpes while pregnant?

If you get genital herpes in pregnancy, talk to your gynecologist, obstetrician, or midwife! Your doctor will confirm the infection and prescribe antiviral treatment if needed.

1. Primary infection:

The most dangerous to the fetus is the primary herpes infection. That is because newly infected pregnant women don’t have antibodies against the virus, and there is no natural protection for the baby during birth.

2. Secondary infection:

Secondary infection is usually only treated if it occurs in the last weeks of pregnancy.

3. Active disease during delivery:

If the infection is active at the time of delivery, a Cesarean section is advised. It significantly reduces the possibility of transmission to the fetus during delivery and thus the disease in the newborn.

4. How should a pregnant woman care for her hygiene if HSV 2 restarts?

Hygiene in both pregnant and non-pregnant women is the same. Use warm water with occasional use of mild intimate or baby soap. Wear ordinary cotton linen that you can wash at high temperatures.

How do you treat genital herpes when pregnant?

For the infected pregnant women, therapy with antiviral medicines in the last month of pregnancy is more and more advised. That prevent the relapse of the disease until delivery.

HSV 2 risks for the baby

  • If a pregnant woman gets genital herpes for the first time in late pregnancy, the risk of transmission to the fetus during delivery is between 30% and 50%.
  • If the patient becomes ill before pregnancy or in early pregnancy, the risk of transmission to the fetus is only 1 percent!

The risk for the baby is the biggest if herpes simplex virus is excreting from vesicles or ulcers during the labor. That is why, in the case of a fresh infection or relapse at the time of delivery, where visible blisters on the vagina, cervix, and rectum are present, the birth with a Cesarean section is advised.

Is the Caesarean section the only efficient solution for preventing the HSV 2 transition on the baby?

In the case of visible blisters and wounds, the Cesarean section is the safest solution for the baby.

Can the genital herpes virus transmits to the baby at the time of vaginal delivery, if a pregnant woman is not in the process of relapse at that time?

When the pregnant woman has no visible herpes vesicles, the chance of transmission from mother to infant is very small (1 %).

Can herpes affect a baby in the womb?

Transmission of genital herpes infection via the placenta on the baby is extremely rare. 

So far, researches have shown “only” a slightly higher likelihood of miscarriages, birth defects, and premature births.

Signs of herpes simplex virus infection in the newborn

In a newborn, the disease manifests in different ways. Most often in the form of multiple herpetic vesicles, mainly in the mouth and on the eyes. But HSV 2 can also cause severe infections like meningoencephalitis and general systemic infections.

The least dangerous infection for a baby is, of course, herpes that is limited to the skin, eyes, and oral cavity. But it may repeat several times during the first year.

Unfortunately, even in this mildest form of infection, a central nervous system may be affected too. Baby with herpes can lose consciousness, has convulsions, or vomits frequently. This form of illness is associated with high mortality or subsequent disability (cerebral paralysis).

Frequently asked questions about genital herpes in pregnancy

Does genital herpes (HSV 2) cause miscarriage?

It can, but very rare. If a woman gets genital herpes in pregnancy for the first time, the possibility of miscarriage or premature birth is higher than with recurrent disease, but still very rare.

Is genital herpes curable?

No. Once a person gets the herpes simplex virus, he remains infected throughout the whole life. The immune system limits infection, but the virus stays in the body. After some time, it may erupt again, particularly with reduced immune resistance, increased stress, period, etc.

What are the chances of getting HSV 2 from protected sex?

Since the locations of herpetic changes may be outside the area covered by the condom, a genital herpes infection is possible despite the use of a condom.

Condoms, when used correctly and consistently, reduce the risk of virus transmission by 40-70 percent. Your partner is less infectious when he has no rashes.
There is no 100% protection against genital herpes transmission!

What happens if genital herpes is left untreated?

Genital herpes causes painful skin changes, but although rare, central nervous system infection can occur too.
Be careful that you don’t transmit blister’s discharge on the other body parts. If contact does occur, immediately and thoroughly wash your hands to avoid the transmission.

Are the chances to get genital herpes from my partner smaller over time?

The chance of infection does not decrease over time. More likely, both partners are already infected, so the number of visible relapses is lower.


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