Herpes simplex virus with pregnancy

You can talk to your healthcare provider about testing for genital herpes. If you test negative for genital herpes, but your partner has genital or oral herpes, you may acquire it unless you take steps to prevent transmission. The following steps can help protect you from getting an infection during pregnancy:. CNN and other outlets have run articles on a paper linking high levels of antibody to herpes simplex virus type 2 HSV-2, the main cause of genital herpes in pregnant women with an increased risk their baby will later be found to have autism.

Bottom line: most pregnant women with HSV-2 have normal pregnancies and deliver healthy babies. As always, talk to your health care provider if you have questions. You can read more about herpes and pregnancy from the University of Washington Virology Research Clinic. Skip to content. Herpes and Pregnancy If you are pregnant and you have genital herpes, you may be concerned about the risk of spreading the infection to your baby.

Be reassured that the risk is extremely small. Understanding the Risk Babies are most at risk for neonatal herpes if the mother contracts genital herpes late in pregnancy. The following steps can help make the risk even smaller: Talk with your obstetrician or midwife. Make sure they know you have genital herpes.

At the time of labor, your healthcare provider should examine you early in labor with a strong light to detect any sores or signs of an outbreak. Let your provider know if you have any signs of an outbreak —itching, tingling, or pain. If you have an active outbreak at the time of delivery, the safest course is a Cesarean section to prevent the baby from coming into contact with virus in the birth canal. If you do not have an active outbreak, you can have a vaginal delivery.

Ask your provider not to break the bag of waters around the baby unless necessary. The bag of waters may help protect the baby against any virus in the birth canal. In most cases, an external monitor can be used instead. Ask that a vacuum or forceps not be used during delivery unless medically necessary.

After birth, watch the baby closely for about three weeks. Symptoms of neonatal herpes may include a skin rash, fever, crankiness, or lack of appetite. Take him or her to the pediatrician at once.

Be sure to tell the pediatrician you have genital herpes. Remember, the odds are strongly in favor of your having a healthy baby. Treatment while Pregnant Many women wonder about taking antiviral medication during pregnancy to suppress outbreaks in the third trimester.

The following steps can help protect you from getting an infection during pregnancy: If your partner has genital herpes, abstain from sex during active outbreaks. In fact, the prevalence of HSV infection rises with age, reaching the maximum around 40 years [ 4 ]. This infection appears related to the number of sexual partners, and regarding sex it is more frequent in women than in men [ 8 , 9 ]. In addition, ethnicity, poverty, cocaine abuse, earlier onset of sexual activity, sexual behavior, and bacterial vaginosis can facilitate a woman's risk of infection before pregnancy [ 10 , 11 ].

Regarding pregnant population, there is a high prevalence of genital herpes. Among Italian pregnant women, the seroprevalence varies from 7. Nevertheless it is lower than that reported among pregnant women in other countries. The acquisition of genital herpes during pregnancy has been associated with spontaneous abortion, intrauterine growth retardation, preterm labour, and congenital and neonatal herpes infections [ 12 — 14 ]. When primary HSV infection occurs during late pregnancy, there is not adequate time to develop antibodies needed to suppress viral replication before labour.

Moreover, studies in HIV-infected pregnant women show that coinfection with HSV increases significantly the risk of perinatal HIV transmission above all in women who had a clinical diagnosis of genital herpes during pregnancy [ 15 — 17 ]. Within women it causes blistering and ulceration of the external genitalia and cervix leading to vulval pain, dysuria, vaginal discharge, and local lymphadenopathy [ 18 ]. Vesicular and ulcerative lesions of the internal thigh, buttocks, perineum or in perianal skin are also observed.

All suspected herpes virus infections should be confirmed through viral or serological testing. The tests used to confirm the presence of HSV infection can be divided into two basic groups: 1 viral detection techniques and 2 antibody detection techniques.

The antibody detection techniques include the use of both laboratory-based and point-of-care serologic tests to detect the presence of antibodies to either HSV-1 or HSV With viral detection techniques, negative results do not rule out the presence of infection [ 20 ]. The diagnosis of HSV should be confirmed either serologically or with viral culture. Isolation of HSV in cell culture is the preferred virologic test for patients who seek medical treatment for genital ulcers or other mucocutaneous lesions and allows differentiation of the type of virus HSV-1 versus HSV-2 [ 21 ].

The sensitivity of this test is limited because of several issues related to sampling and transportation of the specimen. Additionally, as the lesions heal, they are less likely to be culture positive [ 21 ]. Thus, a positive genital culture provides conclusive evidence of genital HSV infection; however, a negative result does not exclude the presence of infection.

Polymerase chain reaction techniques involve the amplification of particular sequences of DNA or RNA before detection and can thus detect evidence of viral DNA at low concentrations. In one very large study, PCR results were three to five times more likely to be positive than were cultures.

Cultures were more likely to be positive at increasing concentrations of virus. Polymerase chain reaction provides increased sensitivity over culture and may ultimately replace culture as the standard of care for diagnosis [ 22 ].

At the first prenatal visit also the partner history should be investigated. In case of positive history in the male partner, he should be strongly advised to have no oral and sexual intercourse at the time of recurrence in order to avoid infection in particular during the third trimester of gestation.

Moreover, use of condoms throughout pregnancy should be recommended to minimize the risk of viral acquisition, although the male partner has no active lesions [ 23 ]. Itis necessary to distinguish between congenital infection and neonatal infection with HSV.

In fact, HSV infection of the newborn can be acquired during pregnancy, intrapartum and postnatally. The mother is the most common source of infection for the first two routes of viral transmission. Congenital infection is very rare due to the acquisition of the virus in utero; it comes to the neonatal HSV infection when the appearances of the lesions are more than 48 hours after birth [ 24 , 25 ]. Both primary and recurrent maternal infection can result in congenital disease, even if the risk after recurrent infection is small.

The disease transmission to the newborn is dependent on the type of maternal genital infection at the time of delivery.

The prolonged rupture of membranes is a risk factor for acquisition of neonatal infection [ 28 ]. Congenital intrauterine infection is characterized by skin vesicles or scarring, eye lesions chorioretinitis, microphthalmia, and cataract , neurologic damage intracranial calcifications, microcephaly, seizures, and encephalomalacia , growth retardation, and psychomotor development.

Infants infected intrapartum or postnatally by HSV can be divided into three major categories:. Several studies have demonstrated that disseminated HSV infections are characterized mainly by liver and adrenals failure associated with shock symptoms and disseminated intravascular coagulopathy [ 29 — 31 ].

Other symptoms of HSV disseminated infection include irritability, seizures, respiratory distress, jaundice, and frequently the characteristic vesicular exanthem that is often considered pathognomonic for infection. The prognosis of infants with disseminated HSV disease or neurological manifestations is poor.

The risk of infection to the infant appears to be higher when the first infection occurs during the third trimester of pregnancy. If infection occurs in the first trimester of pregnancy, this seems to be linked to an increase in spontaneous abortions and cases of intrauterine fetal growth restriction.

Only in rare cases there is the transmission of the virus transplacentally, resulting in a very severe congenital infection that can occur with microcephaly, hepatosplenomegaly, intrauterine fetal death, and IUGR. The use of antivirals is also permitted in the first trimester of pregnancy if the mother's injuries are particularly serious.

At the moment there are enough data to define dell'acyclovir safe to use during pregnancy [ 35 ]. When primary infection is acquired during the first two trimesters of pregnancy, it is advisable to carry out sequential viral cultures on genital secretions from 32th week of gestation [ 36 ].

Both viral culture that the nucleic acid amplification tests NAATs are considered as a test of choice for symptomatic patients. However, some NAATs for HSV detection have been developed and are available in Eastern Europe, but have not been validated against their internationally acknowledged analogues.

However, if two consecutive cultures result negative and there are no active herpetic genital lesions at the time of delivery, it is possible to perform a vaginal delivery. If seroconversion is completed at the time of delivery, caesarean section is not required since the risk of HSV transmission to the foetus is low, and the neonate should be protected by maternal antibodies.

If primary genital infection is acquired during the third trimester of pregnancy, the optimal way of proceeding is not well defined. A pregnant woman with HSV lesion that has already presented a first infection in the past has circulating IgG, which are then able to pass the placenta and reach the fetus. It is so unusual that the fetus develops the infection with HSV. Randomized trials showed that the use of antiviral drugs from the 36th week of pregnancy reduces the risk of spreading of the virus in the absence of clinically visible lesions and the risk of viral reactivation with decreased percentage of caesarean sections [ 21 ].

The use of antiviral drugs is allowed before the 36th week in case of very serious events in the mother, or if there is an increased risk of preterm delivery. In absence of clinical herpes lesions but with positive viral cultures at delivery, caesarean section is recommended.

On the contrary, if all viral cultures are negative, in the absence of clinical lesions, a spontaneous delivery is indicated. Finally, in presence of clinical genital HSV lesions at the onset of delivery, if it may be assumed that the foetal lungs are mature, a caesarean section should be performed as quickly as possible within 4—6 hours after membranes rupture [ 20 , 21 , 34 ].

Pregnant women with a first clinical episode or a recurrence may be treated with acyclovir or valacyclovir at the recommended dosages Table 1. Since acyclovir and valacyclovir are not officially approved for treatment of pregnant women, patients should be informed to give consent before the administration [ 20 ].

However, no increase of foetal abnormalities was ascribed to these treatments, although long-term outcomes were not evaluated [ 20 ]. Recommended doses of antiviral medications for herpes in pregnancy [ 20 ]. The characteristics of an outbreak may be tingling, burning, or pain prior to the appearance of vesicles that form ulcers that crust over, possible systemic malaise, or mild pubic irritation.

To assist with the diagnosis of HSV, doctors may collect cultures, which are most effective early in the outbreak Kriebs, Other diagnostic methods include viral DNA by polymerase chain reaction and serology Kriebs, Typing of the virus is diagnosed by serologic assay Kriebs, This information helps the obstetrical provider and the woman choose the best course of action for her pregnancy.

Many women may still have questions. As a trusted source of information, the perinatal educator can be another avenue for answers. A class participant concerned about herpes might ask the perinatal educator for information prior to the start of a class or just after.

It is recommended that the educator be prepared to answer questions about herpes during pregnancy. It is also important for the perinatal educator to be nonjudgmental and to provide direct and accurate information.

When giving any information, the perinatal educator must always refer the woman back to her obstetrical provider. An expectant mother who has a history of herpes may well have concerns about protecting her baby from the virus.

To help the woman have a safe and healthy pregnancy, her health-care provider can review treatment options with her. Suppression therapy has been shown to be beneficial in decreasing viral shedding of HSV Kriebs, The treatment regimens of acyclovir are mg by mouth twice daily or valacyclovir, mg to 1, mg daily Kriebs, The other way to prevent transmission of herpes to the infant is cesarean surgery, which the woman must discuss with her health-care provider.

Another important feature of HSV in pregnancy is the timing and the rate of perinatal transmission to the neonate. Understanding these risks and providing screening for HSV can help reduce the rates of transmission during pregnancy. After talking with her health-care provider, the woman may remain apprehensive about the possible need for cesarean surgery.

For women who have active lesions during the time of birth, cesarean surgery is the current recommendation Ural, The perinatal educator can encourage the woman to discuss what her health-care provider has told her and can help identify the need for any further information about her option of cesarean surgery.

For women who have active lesions during the time of birth, cesarean surgery is the current recommendation. Researchers conducted a study to understand the importance of HSV serologic screening during pregnancy Gardella et al. The results showed that obstetricians feel HSV serologic screening is important during pregnancy, yet many do not routinely provide screening during routine prenatal care. Baker suggests the reason for not screening in pregnancy is related to the lack of recommendations from the Centers for Disease Control and Prevention or from ACOG.

Baker also supports the school of thought that all prenatal clients should have serologic testing for herpes to determine whether the client has or is susceptible to the disease. When discussing herpes and pregnancy, it is important not to forget the effects of the virus on the neonate. The disease in neonates can be hard to diagnose.