HERPES AND PREGNANCY (1): WHAT IS IT? WHAT ARE THE RISKS?

Dr. Claude Allouche, Gynecologist 

Ahuza Clinic, Raanana
📞 058 726 02 64

A common but potentially dangerous infection

 

Genital herpes, usually benign and widespread, can be dangerous for pregnant women and their unborn babies. Being well-informed about the risks is essential for optimal care.

WHAT IS HERPES?

  • Herpes viruses 1 and 2 enter through the skin in the genital area or oral mucosa and can remain dormant until triggered (e.g., by a weakened immune system), causing viral shedding.

  • It is most commonly transmitted from men to women.

  • Many cases of genital herpes are asymptomatic.

  • Asymptomatic shedding of the virus can still lead to transmission.

  • 5% of women of childbearing age have a history of genital herpes, and about 2% contract it during pregnancy.

  • In 90% of cases, the infection is silent, but in cases of primary infection during pregnancy, it can cause miscarriage, stillbirth, prematurity, or neonatal infection.

  • Herpes et grossesse1

WHAT ARE THE RISKS FOR THE BABY?

The primary risk is neonatal herpes, contracted at birth.

A rare but severe condition

Neonatal herpes is a rare but severe viral infection that occurs in newborns within a few days of birth. It is highly feared by doctors due to its potentially fatal outcome, with a mortality rate of around 50%.

Symptoms of neonatal herpes

  • Vesicular or ulcerative skin lesions

  • Septicemia symptoms:

    • High fever

    • Generalized deterioration

    • Jaundice

    • Bleeding

    • Enlarged liver and spleen

    • Neurological and respiratory distress (dyspnea, cyanosis)

    • Feeding difficulties

    • Seizures

Possible consequences

  • Neurological sequelae (developmental delays in case of brain involvement)

  • Vision problems

  • Extensive skin lesions

  • In severe cases, death

HOW IS THE VIRUS TRANSMITTED FROM MOTHER TO CHILD?

  • More than 85% of cases: Direct contact during vaginal delivery.

  • Postnatal transmission: Through contact with skin lesions after birth.

  • Less than 5% of cases: Transplacental transmission in utero during maternal viremia.

Risk levels depending on the type of infection

  • Primary infection in the 3rd trimester: 30-50% risk of neonatal herpes.

  • Recurrent infection: 1-3% risk.

  • Previous herpes history but no outbreak during pregnancy: 0.02-0.05% risk.

HERPES AND PREGNANCY (2): MANAGEMENT

How is herpes managed during pregnancy?

The treatment is mainly preventive.

Key preventive measures

  • A detailed medical history should be taken to check for previous genital herpes in the patient or her partner.

  • C-section is recommended in case of active genital herpes before membrane rupture.

  • Early antiviral treatment (Acyclovir) for newborns has significantly improved outcomes, often preventing the progression to meningoencephalitis.

Can herpes be prevented during pregnancy?

  • Avoid direct contact with someone experiencing an outbreak.

  • Routine screening is not necessary, but a virological examination may be required if the doctor identifies a risk.

TREATMENT APPROACH

In case of primary infection or initial outbreak

  • Antiviral medication (Acyclovir or Valacyclovir) is recommended.

  • If lesions are present during labor → C-section is required, except if membranes have been ruptured for more than 6 hours.

  • No lesions at delivery → Vaginal birth is possible.

  • Primary infection more than 1 month before delivery → Vaginal birth is possible if treated.

In case of recurrent outbreaks

  • If treated for more than 7 days → C-section is not mandatory.

  • If treated for less than 7 days → Decision to be discussed.

RELATED ARTICLES

  • Herpes and Pregnancy (1): What is it? What are the risks?

  • Herpes and Pregnancy (2): Management

GLOSSARY

  • Primary infection: The first invasion of the body by an infectious agent.

  • Internal monitoring: Recording fetal heart rate using an electrode attached to the baby's head.