Having a baby with herpes

Can you have a healthy baby if you have herpes?

The CDC describes a low risk of neonatal herpes, except when you acquire genital herpes late in pregnancy, or a prodrome or lesions are present at delivery. That risk is not a promise of an uncomplicated pregnancy.

You can pass herpes to your unborn child before birth, but it more commonly passes during delivery. Passing it can lead to a deadly infection in your baby, called neonatal herpes. Some research suggests a genital herpes infection may lead to miscarriage, or make it more likely that you deliver too early.

Tell your obstetric clinician if you have ever had a genital herpes diagnosis or symptoms, and tell them about any possible exposure to genital herpes. If you acquire HSV in the second half of pregnancy, the CDC says you should be managed in consultation with maternal-fetal medicine and infectious disease specialists.

The CDC's STI treatment guidelines say routine HSV-2 serologic screening of pregnant women is not recommended, and no data support use of antiviral therapy among asymptomatic HSV-seropositive women without a history of genital herpes. Acyclovir can be given by mouth to pregnant women with first-episode genital herpes or recurrent herpes, and it should be given by IV to pregnant women with severe HSV.

How likely is it to pass herpes to a baby?

The risk for transmission to the neonate from an infected mother is high (30%–50%) among women who acquire genital herpes near the time of delivery and low (<1%) among women with prenatal histories of recurrent herpes or who acquire genital herpes during the first half of pregnancy. That low figure isn't a rate for every person who has ever had herpes.

ACOG says herpes can be passed to the fetus during birth, through the infected birth canal. That is most likely with a first infection during pregnancy, or a first outbreak late in pregnancy. A recurrent outbreak can also pass it in a woman infected before pregnancy, although the risk is much lower.

Mothers of newborns who acquire neonatal herpes often lack a history of clinically evident genital herpes. Preventing neonatal herpes depends both on preventing acquisition of genital herpes during late pregnancy and on avoiding exposure of the newborn to herpetic lesions and viral shedding during delivery.

What do doctors do near delivery?

When labor starts, the CDC says all women should be questioned thoroughly about genital herpes symptoms, including a prodrome (pain or burning at the site before a lesion appears), and examined thoroughly for lesions. Women with recurrent genital herpes lesions at the onset of labor should have a cesarean delivery to reduce the risk of neonatal herpes, though a cesarean does not eliminate that risk. Women without symptoms or signs of genital herpes or its prodrome can deliver vaginally.

Cesarean birth is not indicated for individuals with a history of genital herpes simplex virus (HSV); however, it is indicated if a patient is experiencing genital lesions or prodromal symptoms at delivery and in cases of primary or nonprimary first-episode genital HSV infection in the third trimester of pregnancy. ACOG's practice bulletin says a cesarean may be offered in that third-trimester first episode, because of possible prolonged viral shedding.

If you have genital herpes, you may need anti-herpes medicine toward the end of pregnancy, and that medicine may reduce your risk of having signs or symptoms of genital herpes at delivery. Suppressive acyclovir treatment starting at 36 weeks’ gestation reduces the frequency of cesarean delivery among women who have recurrent genital herpes by diminishing the frequency of recurrences at term. That treatment might not protect against transmission to neonates in all cases, and the recommended regimens are Acyclovir 400 mg orally 3 times/day or Valacyclovir 500 mg orally 2 times/day. ACOG says antiviral medicine in the third trimester, as prevention for HSV coming back in patients with a known history, should be the primary consideration for reducing HSV-related cesarean births in a first, full-term pregnancy with one head-down baby (what ACOG calls NTSV).

What if your partner has herpes and you're pregnant?

Women without known genital herpes should be counseled to abstain from vaginal intercourse during the third trimester with partners known to have or suspected of having genital herpes. To prevent HSV-1 genital herpes, the CDC says pregnant women without known orolabial herpes should be advised to abstain from receptive oral sex during the third trimester with partners known to have or suspected to have orolabial herpes.

The CDC also says it is important that you avoid getting genital herpes during pregnancy. If you both have herpes, the guide for couples who both have it is for you, and the transmission guide covers the risk between partners rather than to the baby.

The CDC says the effectiveness of antiviral therapy among sex partners with a history of genital herpes to decrease the risk for HSV transmission to a pregnant woman has not been studied. A type-specific blood test can be useful for identifying pregnant women at risk of HSV and for guiding counseling about the risk of acquiring genital herpes during pregnancy. It might be offered if you have no history of genital herpes and your sex partner has HSV.

Can you donate eggs or sperm if you have herpes?

ASRM says donors should undergo a complete physical examination and should be declined when a listed finding is present, including Physical evidence for the risk of sexually transmitted disease, such as genital ulcerative lesions, herpes simplex, chancroid, or urethral discharge. A history of herpes with none of those findings on exam is not on that list.

The FDA regulates donated eggs (oocytes) and sperm (semen). Screening reviews the donor's relevant medical records for risk factors and for clinical evidence of relevant communicable disease agents and diseases. The FDA requires testing for the infectious diseases named below, and herpes simplex is not among them. Chlamydia and gonorrhea testing is required unless the recovery method ensures freedom from contamination by infectious organisms that may be in the genitourinary tract.

Anonymous semen donors are tested again at least 6 months after donation, for those same agents. A donor-eligibility determination, screening, and testing aren't required for reproductive cells from a sexually intimate partner of the recipient, and that exception isn't a rule about a gestational carrier. ASRM's table of FDA-required laboratory tests for gamete donors also names a West Nile virus test, and still does not name herpes simplex.

The FDA's default rule is to determine a donor ineligible for physical evidence of a relevant communicable disease, or for high-risk behavior linked to HIV, hepatitis, syphilis, or vaccinia. Genital ulcerative disease, herpes simplex, and chancroid are a listed exception: Physical evidence for risk of sexually transmitted diseases such as genital ulcerative disease, herpes simplex, chancroid (you should consider these signs in light of other information obtained about the donor in making a donor eligibility determination) (seen in HIV, Hepatitis B virus, Chlamydia trachomatis, and Neisseria gornorrheae).

Can you be a surrogate if you have herpes?

The FDA does not require a donor-eligibility determination for a gestational carrier, and its guidance says No. Gestational or surrogate carriers are not considered to be donors according to the FDA definition of a donor (§ 1271.3(m)). ASRM says the carrier should not be used when physical evidence of herpes simplex is present, such as genital ulcerative lesions, herpes simplex, chancroid, and urethral discharge.

The egg donor and the sperm donor still need a donor-eligibility determination. ASRM defines donors as people who are not sexually intimate partners of the recipients, and requires that determination for donor sperm, donor eggs, donor embryos, and the sperm and egg sources used with a gestational carrier.

A complete personal and sexual history should be obtained, to identify people who might be at high risk of HIV, STIs, or other infections that might pass to the fetus. A remote history of herpes, with no lesion on exam, is not by itself a reason ASRM gives for not using a carrier. There is no method to completely ensure that the GC will not have infectious agents that could be transmitted to the fetus.

The FDA does not require screening or testing of gestational carriers for infections that could pass to the fetus. ASRM recommends testing carriers and their partners before embryo transfer, to protect the health and interests of all parties involved. Herpes simplex antibody or PCR testing isn't in that laboratory list. ASRM names a nucleic acid test for gonorrhea and chlamydia on urine or a cervical or urethral swab, using an FDA-licensed, approved, or cleared test labeled for detecting these organisms in an asymptomatic, low-prevalence population.