Pregnancy and herpes

  • Definition
    • Newborn infants can become infected with herpes virus during pregnancy, during labor or delivery, or after birth.

  • Alternative Names
    • HSV; Congenital herpes; Herpes - congenital; Birth-acquired herpes; Herpes during pregnancy

  • Causes
    • Newborn infants can become infected with herpes virus:

      • In the uterus (this is unusual)
      • Passing through the birth canal (birth-acquired herpes, the most common method of infection)
      • Right after birth (postpartum) from being kissed or having other contact with someone who has herpes mouth sores

      If the mother has an active outbreak genital herpes at the time of delivery, the baby is more likely to become infected during birth. Some mothers may not know they have herpes sores inside the vagina.

      Some women have had herpes infections in the past, but are not aware of it, and may pass the virus to their baby.

      Herpes type 2 (genital herpes) is the most common cause of herpes infection in newborn babies. But herpes type 1 (oral herpes) can also occur.

  • Symptoms
    • Herpes may only appear as a skin infection. Small, fluid-filled blisters (vesicles) may appear. These blisters break, crust over, and finally heal. A mild scar often remains.

      Herpes infection may also spread throughout the body. This is called disseminated herpes. In this type, the herpes virus can affect many different parts of the body.

      • Herpes infection in the brain is called herpes encephalitis
      • The liver, lungs, and kidneys may also be involved
      • There may or may not be blisters on the skin

      Newborn infants with herpes that has spread to the brain or other parts of the body are often very sick. Symptoms include:

      • Bleeding easily
      • Breathing difficulties
      • Blue appearance (cyanosis)
      • Flaring of the nostrils
      • Grunting
      • Rapid breathing (tachypnea)
      • Short periods without breathing (apneic episodes)
      • Coma
      • Jaundice
      • Lethargy
      • Low body temperature (hypothermia)
      • Poor feeding
      • Seizures
      • Shock
      • Skin lesions, fluid-filled blisters

      Herpes that is caught shortly after birth has symptoms similar to those of birth-acquired herpes.

      Herpes the baby gets in the uterus can cause:

      • Eye disease, such as inflammation of the retina (chorioretinitis)
      • Severe brain damage
      • Skin sores (lesions)
  • Exams and Tests
  • Treatment
    • Herpes virus infection in infants is generally treated with antiviral medicine given through a vein (intravenous). The baby may need to take the medicine for several weeks.

      Treatment may also be needed to for the effects of herpes infection, such as shock or seizures. Because these babies are very ill, treatment is often done in the hospital intensive care unit.

  • Outlook (Prognosis)
    • Infants with systemic herpes or encephalitis often do poorly, despite antiviral medications and early treatment.

      In infants with skin disease, the vesicles may come back repeatedly, even after treatment is finished.

      As a result of the infection, they may have learning disabilities, and may need to be treated.

  • When to Contact a Medical Professional
    • If your baby has any symptoms of birth-acquired herpes, including skin blisters with no other symptoms, have the baby seen by your health care provider right away.

  • Prevention
    • It is important for you to tell your health care provider if you have a history of genital herpes. If you have frequent herpes outbreaks, you will be given a medicine to take during the last month of pregnancy that treats the virus. This helps prevent an outbreak around the time of delivery. C-section is recommended for pregnant women who have a new herpes sore and are in labor.

      Safer sexual practices can help prevent the mother from getting genital herpes.

      Persons with cold sores (herpes labialis) should not come in contact with newborn infants. To prevent transmitting the virus, caregivers who have a cold sore should wear a surgical mask and wash their hands carefully before coming in contact with an infant.

      Mothers should speak to their health care providers about the best way to minimize the risk of transmitting herpes to their infant.

  • References
    • Anzivino E, Fioriti D, Mischitelli M, et al. Herpes simplex virus infection in pregnancy and in neonate: status of art of epidemiology, diagnosis, therapy and prevention. Virol J. 2009 Apr 6;6:40. doi: 10.1186/1743-422X-6-40. PMID: 19348670

      Kimberlin DW, Baley J, Committee on infectious diseases, Committee on fetus and newborn. Guidance on management of asymptomatic neonates born to women with active genital herpes lesions. Pediatrics. 2013;131:e635-46. PMID: 23359576

      Pinninti SG, Kimberlin DW. Neonatal herpes simplex virus infections. Pediatr Clin N Am. 2013;60:351-65. PMID: 23481105