Pregnancy and Herpes
As a woman, if you suffer with genital herpes throughout life then it is, unfortunately, common to experience outbreaks of genital herpes during pregnancy. During the approximate 9 months of carrying a child the body goes through many changes and is pushed to the limits during this time. Therefore, the body can struggle to keep the herpes virus at bay during this time, as the immune system is focused on keeping mother and baby healthy. Juggling midwife visits, birth preparations and check-ups is stressful enough, but to be battling an outbreak of herpes at the same time adds an extra stress.
Many women are concerned about the affects an outbreak of herpes can have on their unborn child, and worrying about this only leads to further stress and as we have explained stress can cause even more outbreaks of herpes or lengthen the healing process. The below information is provided to help you avoid the stress, guiding you through the wealth of information surrounding herpes and pregnancy, and share advice and tips on how to manage herpes outbreaks during this time.
Did you know that?
- Your baby will be well protected by natural antibodies, if you are infected with herpes and have had previous outbreaks.
- If you are affected by herpes, you will most likely still give birth naturally, with no issues.
- You cannot transfer herpes to your baby through breast milk.
- Most people who carry the herpes virus are infected as children or adolescence.
Key Concepts – Herpes during Pregnancy
Primary Infection: is the first outbreak of herpes after infection of the herpes simplex virus.
Recurrent infection: recurring and frequent outbreaks of herpes are in medical terms called recurrent infections.
First, we will answer some of the most commonly asked questions about Herpes and Pregnancy.
Is Herpes Dangerous?
No! Herpes is not dangerous to you even if you have an outbreak during pregnancy. Herpes is also not dangerous for your unborn child. In the sections below we will explain why there is no reason to panic if you have an outbreak of herpes whilst pregnant.
Can I infect my baby with herpes?
It is very common to have outbreaks of herpes whilst pregnant. It is obvious and understandable to be concerned that you could possibly infect your child. In the next sections, we will give you the facts and information regarding herpes and pregnancy as well as the risk of infection that goes with these two things. We aim to provide useful and appropriate advice without adding to the already existing concerns.
Can I birth my baby naturally if I have repeated outbreaks of herpes?
In the majority of cases, Yes! Women who have suffered with outbreaks of herpes before pregnancy and during the first 2 trimesters can usually give birth naturally. This also applies if you suffer with an outbreak close to the due date. In the table below we show the periods of time during pregnancy that the risk of infection with the child is at its highest.
The most important question to ask is:
‘when did I become infected with herpes?
Answer ‘I was…’:
Infected with herpes before pregnancy:
This is good! You can rest easy with the knowledge that your baby will be protected from herpes by antibodies that are transferred from your blood to the foetus. Even if you are having an outbreak on the day of birth, there is virtually no danger of your baby becoming infected if you are suffering from recurrent outbreaks.
Infected with herpes within the first trimester of pregnancy:
Becoming infected with herpes within the first 0-12 weeks, can slightly increase the chances of transferring the virus to your baby and in rare cases miscarrying during this time. The risk of transmission of the herpes virus to the baby is also higher than if the mother was infected before pregnancy. However, cases of miscarrying and transferring the virus are still not in the majority, many women experience no negative effects on their pregnancy or foetus. Most babies in these cases are born strong and healthy with antibodies to protect against HSV.
Infected with herpes within the second trimester or at the beginning of the final trimester: During the 12-34 week of pregnancy there is very little cause for concern if you have become infected with herpes. Your baby will be protected by the antibodies that your body creates to protect itself and the risk of transmitting the virus to your unborn child is insignificant.
Infected with herpes within the last 6 weeks of my pregnancy:
if you experience your very first outbreak of herpes after the 34 week of pregnancy there is some reason to be alert and aware of the risks. The risk of transferring the virus to your baby increases to 30-40% if you are having an active outbreak of herpes when the baby passes through the birth canal. Therefore, it is most likely your doctor or midwife will suggest a caesarean section, if you are experiencing your first outbreak of genital herpes close to the due date.
As you can see in the above table there is only real cause for concern on primary infection (first outbreak) of the herpes simplex virus close to the term of your pregnancy. An outbreak of herpes at this late stage in the pregnancy is commonly called perinatal infection by doctors.
Pregnant women experiencing their first outbreak
There are not many cases of women becoming infected with herpes in the late second and third trimester of their pregnancy. Should you be one of these unfortunate women to experience their first outbreak in the late stages of pregnancy, you may have to prepare that you may not be able to have the natural birth you had dreamed of. However, if you opt for a caesarean section, the risk of transmission of the herpes virus is eliminated.
Babies with Antibodies to herpes
A perinatal infection or outbreak with the herpes simplex virus, is no cause for concern if you have experienced outbreaks of herpes earlier in life or even during your pregnancy up to the 34-week mark. In these cases, the risk of transmission is insignificant as the baby will be protected by the antibodies in the mother’s blood. With recurring (recurrent outbreaks) herpes outbreaks there is only a minimal risk (0-3%) of transferring the virus to the baby. This is also the case if the mother is experiencing an active outbreak of genital herpes during birth.
It is in extremely rare cases that a child is born with herpes, that has been transmitted to it whilst still in the womb. This rare phenomenon is called transplacental infection. However, it is always better to be safe than sorry, so always inform your doctor or midwife if either you or your partner are infected with herpes, so they can test whether there is a real risk of infection to the unborn child.
Pregnancy – herpes and caesarean sections
Once your doctor has been informed of a genital herpes outbreak they will investigate to see whether the mother is experiencing the primary infection outbreak or if the virus has been dormant in the body for a while. In the majority of cases, it will be uncovered that the mother was infected with herpes before pregnancy without experiencing any symptoms, in these cases a caesarean section will not be necessary.
It is common for the primary infection and initial outbreak of herpes to be asymptomatic (without symptoms). However, this does not mean the virus is inactive, it can be excreted and be seen as a risk of infection even without symptoms.
Experiencing your first outbreak after week 34 of your pregnancy or during the third trimester means your body may not have started to produce antibodies, which would usually be transmitted to the baby if you have experienced herpes outbreaks earlier in life. Therefore, in these cases, your doctor will most likely recommend a caesarean section, as giving birth naturally can be dangerous for the baby if herpes is transmitted to it at this early stage.
Is herpes dangerous for a new-born baby?
Herpes in new-borns, also known as neonatal herpes or herpes neonatorum, can unfortunately be dangerous and in some cases fatal, but fortunately examples of this virus in new-borns are extremely rare. UK infant mortality in general is at 1% in the first year of life, but Herpes is the cause of only 0.0016 of these babies, read more.
When looking at the risks of transmission of the herpes virus, HSV-2 or genital herpes is commonly riskiest during the pregnancy up to the point of giving birth, once the baby is born the HSV-1 or cold sores virus is the riskiest when it comes to transmitting the infection and HSV-1 is the most common source of infection for new-borns.
Are cold sores dangerous for my baby?
In some cases, Yes! Those new-borns whose mothers already carry the Herpes virus will already be protected by the antibodies. But for those whose mothers were not already infected, battling the herpes simplex virus can be dangerous and even fatal for a baby (see information below). So, if you are displaying symptoms of an oncoming cold sore outbreak or if you have an active outbreak, you must avoid kissing your baby at all times, no matter how irresistible they are. This is the same for any family member or friend, if they are suffering from an active outbreak of HSV-1 you must insist they do not kiss your baby until it is completely healed. It is also extremely important if you or any others around your baby is having an outbreak, you ensure that you and others thoroughly wash their hands. In many cases, there is no need to worry as your baby will be protected by antibodies, but it is always better to be safe than sorry.
Regardless of which herpes simplex virus your baby contracts, in a worst case scenario the virus can attack the babies central nervous system or cause inflammation in the brain, which is why it is so important to avoid transmitting the virus to your baby at all costs. Therefore, it is best to be informed of the risks of infection during and after birth.
Transmission of herpes to new-borns can be classified into 3 categories:
- Transmission to the skin, mouth or eyes (45% of cases)
- Transmission to the Central Nervous system (Encephalitis)
- Transmission to the organs (Meningitis)
The last two forms of Herpes in new-born’s are the most severe infections. We have explained more about these last two below.
Encephalitis caused by a herpes infection
Inflammation of the brain also known as Encephalitis, can be caused by the Herpes Simplex Virus and it is not only new-born’s that can be affected. If you carry the Herpes virus you can suffer from encephalitis at any stage of life. In infants and young children encephalitis is usually caused by the HSV-2 virus, whereas in older children, adolescents and adults it is more likely to be HSV-1 that causes encephalitis. Encephalitis caused by herpes, if not caught and treated in time has a mortality rate of 70-80% and even with specific antiviral medication it has a mortality rate of 30%, read more.
The common symptoms of Encephalitis are flu like symptoms such as a high temperature, headaches, aches and muscle weakness and sickness, the more severe symptoms can be disorientation, seizures, hallucinations, vision and hearing problems and altered behavior. Always seek medical advice if you experience any of these symptoms, but also be mindful that this disease is not a commonly seen phenomenon, not in babies, children or adults. There is a small risk for all those who carry the herpes simplex virus of experiencing encephalitis but it is extremely small.
Meningitis caused by a herpes infection
Meningitis and encephalitis are different diseases, meningitis does not cause inflammation of the actual brain itself but in the brain membrane. However, they are both caused by the same HSV-2 virus. Most people who suffer from meningitis will recover without medication, but it can also become serious if not treated quickly. The common signs and symptoms of meningitis are drowsiness, headaches, sickness, a rash that does not disappear when a cool glass is rolled over it, sensitivity to bright lights and high temperatures, 38C and above.
You should always seek the advice of a medical professional if you believe you or your child have meningitis.
How to prevent herpes during pregnancy
We all know the common behaviors associated with pregnancy such as food cravings for a specific snack or food, at all times of the day and night. But if you carry the herpes simplex virus and wish to avoid outbreaks during pregnancy there are certain foods you should refrain from eating, as much as you can you should avoid corn, rice, nuts and chocolate – no matter how hard it may be. These foods contain arginine, there is some evidence that suggests a large intake of this can worsen the symptoms of herpes and can lead to more frequent outbreaks.
Consuming the foods above can cause and in balance between your arginine and lysine amino acids. Lysine acts in the complete opposite way to arginine and can help prevent outbreaks of herpes. So, if you really can’t avoid that nutty chocolate bar it may be a good idea to take lysine supplements to restore balance and avoid herpes outbreaks. Read more about the risks and benefits of arginine versus lysine here.
Medication to treat herpes during pregnancy
Many doctors would prescribe the same antiviral medication (Aciclovir) to women experiencing herpes during pregnancy as those who suffer whilst not pregnant. However, this is not something we recommend, there are many natural alternatives that could be substituted and it is always important to ensure the body is not exposed to a stressful environment during pregnancy, as stressful situations are proven to trigger outbreaks of the herpes simplex virus. Read more about genital herpes and pregnancy here.
Children and Herpes
Now that we have covered herpes outbreaks and how it links with pregnancy and babies, we must now focus on how herpes can affect toddlers and older children. It is common for children between the ages of 3-5 to experience their first outbreak of cold sores or HSV-1. These first cold sores look and feel the same as outbreaks of HSV-1 in adults, appearing as blisters, sores and scabs, normally on or around the lips. Usually lasting from a week to 10 days, these outbreaks heal by themselves leaving no scars.
Many children are infected with HSV-1, without experiencing any symptoms. These cases are more common than those children that do experience their first outbreaks during childhood. Those children infected with HSV-1 that don’t experience outbreaks will usually have their first cold sores appear when they hit puberty.
Breastfeeding if infected with herpes
If you are experiencing an outbreak of cold sores on the mouth or face it is still safe to breastfeed your baby, there is no risk of transmitting the herpes virus via breastfeeding or in breast milk. Some women may suffer from outbreaks of herpes on their chest, if this is the case then we recommend using a breast pump to produce milk for your baby. Once the blisters and sores have scabbed over it is safe to feed your baby again.
Herpes virus eye infections in babies & children
If there are any signs your baby or child has a herpes virus infection in or around the eye, always contact your doctor. Usual signs are redness, pain, swelling or watering in or around the eye, sensitivity to bright light and sometimes blurred vision. In most cases herpes infections in the eye are not serious and will usually heal between 1-2 weeks, but if they last longer, it can result in further eye infections caused by bacteria, glaucoma , permanent blurred vision or complete loss of sight. Many children who experience herpes eye infections will have recurring outbreaks. Therefore, if you notice any symptoms of an infection in the eye caused by herpes be cautious to keep yours, your baby’s or child’s hand clean and away from their eyes.
The risk of infection of herpes in children
As the herpes virus is transmitted through contact and can be passed even if the carrier is not having an active outbreak of cold sores, it is extremely difficult to prevent your child from becoming infected.
As all parents know young children or toddlers put almost everything in their mouths, so there are many risks of transmission from toys, books, clothing, utensils etc. This behaviour means that it is common for children to be infected by putting a previously used toy, by another child who carries the herpes virus, into their mouths. Therefore, it is extremely difficult if not impossible for parents to prevent infection in their child with the herpes virus.
If your child experiences an outbreak of cold sores whilst they are at school or a club it is essential the child remains away from school or clubs until the outbreak has completely healed to avoid transmitting the virus to other children at the same school or club.
Remember…always wash yours and your child’s hands frequently during an outbreak!
During an active outbreak of cold sores of HSV-1 it is important to keep hand hygiene at a high standard and wash your own hands and your child’s frequently. Parents may also find it is very difficult to stop your child from itching and scratching at the sores and wounds created by the herpes virus. But be aware that if your child touches the outbreak and then touches another part of the body they can spread the virus to other areas on their own body. Therefore, always make sure all hands are washed after any contact with the cold sore.
Treatment for herpes outbreaks in children
As the herpes simplex virus will remain with the carrier for their entire life there are no treatments, at this moment in time, that can cure the virus as it remains dormant in the body until it is triggered and an outbreak occurs. There are treatments that can help ease the pain of an outbreak and suppress further outbreaks such as Moringa, Aloe Vera and CBD oil. If you experience frequent, recurrent outbreaks of cold sores there are medications that can help, however we do not recommend these medications for children as there can be many negative side effects associated with them.
Oral herpes in children
For those children that experience outbreaks inside the mouth, we recommend focusing on a healthy diet and extra rest, but if this is not a viable option for your child there are medicinal solutions that can be taken orally to ease the pain of these outbreaks. This is also a good option for children as it can be taken in a juice drink. However, we always recommend reading the internal leaflets for these solutions and if still wary of giving this to your child, try this treatment on yourself first to gage the side effects that could be experienced. Each parent will know their own child’s tolerance for medications so trust your own judgement but if still unsure always seek the advice of your local GP.
True or false
Outbreaks of cold sores in children means they have an STD
False! Cold sores and the HSV-1 virus are most often transmitted through contact with a person or object that carries the virus, and most people carry HSV-1 or cold sores. As HSV-1 appears mostly around the mouth it cannot be a sexually transmitted disease.
Impetigo and cold sores are the same thing.
False! Impetigo looks and can feel like a cold sore at first and is easily confused with herpes as it commonly occurs around the nose, mouth. However, as impetigo is caused by bacteria rather than a virus, it can easily spread and new sores will appear turning the single red wound into a rash of sores.
All children can sometimes experience outbreaks of cold sores
False! Roughly 60% of the UK’s adult population carry the HSV-1 virus that forms cold sores, the majority of these carriers would have been infected as a child.
You must have a caesarean section if you have herpes
False! It is only if you experience an outbreak of genital herpes after the 34th week of your pregnancy that your doctor may suggest a caesarean section to minimize risk of transmission to your baby when giving birth.
Women often get herpes once they become pregnant
True-ish! Those women who carry the HSV-2 virus or outbreaks of genital herpes could experience more frequent outbreaks of the virus during pregnancy. During pregnancy as your body is focused on protecting and growing the life inside of you, your immune system can become weakened allowing the virus to become active and cause outbreaks. However, it is also common for women to experience frequent, recurring outbreaks in the weeks leading up to menstruation and these women may find that pregnancy keeps their frequent outbreaks at bay as they will not be menstruating during this time.
Women who suffer from herpes should avoid getting pregnant
False! If this was the case the fate of the human population would be at risk. However, if you are planning to have a child or are pregnant always discuss your concerns regarding the herpes virus and pregnancy with your doctor or midwife.