Pregnancy and herpes

HSV; Congenital herpes; Herpes - congenital; Birth-acquired herpes; Herpes during pregnancy

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.

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)

Tests for birth-acquired herpes include:

• DFA test for herpes (scraping from vesicle)
• EEG
• MRI of the head
• Spinal fluid culture
• Vesicle culture

Additional tests that may be done if the baby is very sick include:

• Blood gas analysis
• Coagulation studies (PT, PTT)
• Complete blood count
• Electrolyte measurements
• Tests of liver function

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.

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.

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.

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.