Genital Herpes and Pregnancy
Genital herpes is a sexually transmitted infection (STI) that can cause serious health problems in infected newborns. Approximately 45 million Americans have genital herpes (1). Up to 1 million new cases occur each year (2), including about 1,200 to 1,500 in newborns (3). While most women with genital herpes have healthy babies, a small number pass the virus on to their babies during labor and delivery. For this reason, it is especially important for pregnant women to recognize the symptoms of genital herpes and to seek immediate medical treatment if they think they could be infected. Pregnant women should tell their health care provider if they have had herpes in the past, so the provider can take any necessary steps to protect their babies from the infection. What causes genital herpes? There are two main kinds of HSVs:
However, either type can infect oral or genital areas, and pregnant women with genital sores caused by either form of HSV can pass the infection on to their babies. Environmental influences—such as heat, friction, sexual intercourse, menstruation, fever or emotional stress—may trigger a new outbreak of sores. The average infected person experiences four or five recurrences a year. The outbreaks tend to become less frequent and less severe with time. How is herpes transmitted?
An infected person can spread the virus from one part of the body to another with unwashed hands. For example, persons who have cold sores always should wash their hands thoroughly after any contact with saliva before touching the genital area. Children often become infected with HSV-1 during the first years of life. This may occur when a child has direct contact with:
What are the symptoms of genital herpes? Health care providers diagnose herpes by:
The lab tests may be a culture or, sometimes, a newer test called polymerase chain reaction (PCR). The provider also may do a blood test to help confirm the diagnosis. The first, or primary, attack may last as long as 2 to 4 weeks. Recurrent outbreaks generally are shorter and milder. Most herpes infections, both primary and recurrent, do not produce any symptoms. These symptomless (sometimes called silent) infections generally go undiagnosed. As a result, about 90 percent of people who are infected with genital herpes do not know they have it (3). However, individuals with symptomless infections can pass the virus on to others, including a newborn baby. How is genital herpes treated in adults?
A provider may recommend one of these drugs when an individual has a primary or recurrent attack of herpes with severe symptoms. The provider also may recommend daily treatment with one of these drugs to help reduce the number of attacks in individuals who have them often. Pregnant women who have a primary attack of herpes often are treated with acyclovir (3, 4). This drug appears safe in pregnancy and has not been associated with birth defects with more than 20 years of use (3, 5). Valacyclovir and famciclovir usually are not recommended in pregnancy because less is known about their safety (3). What risks does herpes pose during pregnancy? Women who acquire genital herpes for the first time near the time of delivery have a 30 to 50 percent chance of passing the infection on to their babies during a vaginal delivery, whether or not they have symptoms (4). The risk is so high because a newly infected pregnant woman has not yet produced disease-fighting antibodies that could help protect her baby during delivery. Studies suggest that about 2 percent of pregnant women acquire herpes for the first time during pregnancy (3). Women who have had herpes before pregnancy and have a flare-up or silent infection at the time of vaginal delivery have only about a 3 percent chance of infecting their babies (3). Sometimes, what appears to be a first, severe episode of herpes during pregnancy actually can be a flare-up of an old silent infection. These women have a low risk of infecting their babies. Blood tests sometimes can help determine whether a woman has a new infection or a recurrence of an old one. Are there other ways in which a baby can become infected? What are the symptoms of herpes infection in the newborn? However, herpes infections in newborns often spread to the brain and many internal organs. Infected babies may appear irritable, eat poorly and have seizures. Even with treatment, about 30 percent of infants with widespread infections involving the internal organs die, as do about 4 percent of those with brain infections (3). Many babies who survive widespread infections and brain infections develop lasting disabilities, such as mental retardation, cerebral palsy, seizures, and vision or hearing loss. How are infected newborns treated? How can the baby be protected from infection if the mother has herpes? Some providers recommend that women with a primary infection during pregnancy or with recurrent flare-ups take acyclovir for the last month of pregnancy. Some studies suggest that this treatment may help prevent active infections during labor and delivery and help reduce the need for cesarean delivery (3, 5). However, most mothers of infants with newborn herpes infections have no signs or symptoms of active herpes infection at delivery (3). Providers have not yet developed a good way to protect babies when their mothers have silent infections at delivery. Virus-culture tests are not helpful during labor and delivery because results are not available for 1 to 3 days. Researchers are seeking to develop vaccines, as well as blood tests that may offer rapid diagnosis during labor, in order to prevent more newborn infections. How can a woman avoid getting genital herpes during pregnancy? Does the March of Dimes fund research on newborn herpes infections?
August 2008 |
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