Transmitting Genital Herpes in Childbirth

By Jeffrey Ecker, M.D.
Content provided by the Faculty of the Harvard Medical School

Jeffrey Ecker, M.D. is an Associate Professor of obstetrics, gynecology and reproductive biology at Harvard Medical School and a member of the Department of Obstetrics and Gynecology at Massachusetts General Hospital, where he practices maternal-fetal medicine.

Question:

If you have genital herpes, is it possible to have children without them being infected?

Answer:

Although the herpes virus can be devastating to newborns, most women with genital herpes will have uninfected children. This happy reality is the result of both biology and careful medical care.

Women infected with herpes virus "shed" the virus from their genital tract from time to time. Some women have attacks many times a year, others just once or twice in a lifetime. Herpes outbreaks are marked by small ulcers or sores and symptoms of burning, itching, tingling or pain. Sometimes, however, the virus can be detected even when symptoms and sores are absent. Babies can be infected as they pass through the birth canal when the virus is present.

Usually, however, the virus is dormant and not being actively shed. So there is little risk of a baby becoming infected during labor and delivery. Also, women with a history of herpes usually have developed antibodies to the virus. These antibodies pass through the placenta to the baby, providing some degree of protection from infection during delivery.

The active virus is much more likely to be shed if the mother has symptoms or sores. Therefore, to minimize exposure to the newborn, most obstetricians recommend Caesarean delivery if:

  • There is evidence of herpes at the time of labor

  • The membranes have ruptured, or

  • The Caesarean delivery was previously planned.

Some doctors and pregnant women will choose to use medications in the weeks before the due date to reduce the likelihood of an outbreak when it is time to deliver.

If you have a history of genital herpes tell your doctor or midwife. It is especially important that you report any symptoms that make you think you might be having an outbreak at the time you come to deliver. If you have a history of genital herpes your provider will ask you about symptoms when it comes time to deliver and will do a careful examination of the vagina, cervix and surrounding tissues to be sure there is no evidence of an outbreak. Suspicious sores or symptoms may lead you to choose a Caesarean birth.

The greatest risk a baby faces in being infected is associated with a primary (first) herpes infection at the time of labor and delivery. The amount of virus shed is highest during the initial infections, partly because the mother has not yet made antibodies to protect the baby.

If you have concerns about new sores or pain in the vagina or surrounding skin, let your doctor know. Women who believe they are uninfected should be especially careful about having sex with men who have or have had herpes in order to avoid a primary infection during pregnancy.

Last Annual Review Date: 2008-01-14T00:00:00-07:00 Copyright: Copyright Harvard Health Publications

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Once you have herpes, an infection can recur at any time. Women typically endure longer and more severe recurrent infections than men.