Pregnancy and herpes
HSV; Congenital herpes; Herpes - congenital; Birth-acquired herpes; Herpes during pregnancyNewborn infants can become infected with herpes virus during pregnancy, during labor or delivery, or after birth.
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
Herpes mouth sores
Oral herpes is an infection of the lips, mouth, or gums due to the herpes simplex virus. It causes small, painful blisters commonly called cold sore...
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If the mother has an active outbreak of 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.
Genital herpes
Genital herpes is a sexually transmitted infection. It is caused by the herpes simplex virus (HSV). This article focuses on HSV type 2 infection....
Read Article Now Book Mark ArticleSome 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 may remain.
Herpes infection may also spread throughout the body. This is called disseminated herpes. In this type, the herpes virus can affect many 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:
- Skin sores, fluid-filled blisters
- Bleeding easily
- Breathing difficulties such as rapid breathing and short periods without breathing, which can lead to nostril flaring, grunting, or blue appearance
Blue appearance
A bluish color to the skin or mucous membrane is usually due to a lack of oxygen in the blood. The medical term is cyanosis.
Read Article Now Book Mark Article - Yellow skin and whites of the eyes
- Weakness
- Low body temperature (hypothermia)
- Poor feeding
- Seizures, shock, or coma
Shock
Shock is a life-threatening condition that occurs when the body is not getting enough blood flow. Lack of blood flow means the cells and organs do n...
Read Article Now Book Mark ArticleComa
Decreased alertness is a state of reduced awareness and is often a serious condition. A coma is the most severe state of decreased alertness from whi...
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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
Tests for birth-acquired herpes include:
- Checking for the virus by scraping from vesicle or vesicle culture
Vesicle culture
Herpes viral culture of a lesion is a laboratory test to check if a skin sore is infected with the herpes virus.
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EEG
EEG
An electroencephalogram (EEG) is a test to measure the electrical activity of the brain.
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MRI of the head
MRI of the head
A head MRI (magnetic resonance imaging) is an imaging test that uses powerful magnets and radio waves to create pictures of the brain and surrounding...
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Spinal fluid culture
Spinal fluid culture
A cerebrospinal fluid (CSF) culture is a laboratory test to look for bacteria, fungi, and viruses in the fluid that moves in the space around the spi...
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Additional tests that may be done if the baby is very sick include:
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Blood gas analysis
Blood gas
Blood gases are a measurement of how much oxygen and carbon dioxide are in your blood. They also determine the acidity (pH) of your blood.
Read Article Now Book Mark Article - Coagulation studies (PT, PTT)
PT
Prothrombin time (PT) is a blood test that measures the time it takes for the liquid portion (plasma) of your blood to clot. It measures the functio...
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Complete blood count
Complete blood count
A complete blood count (CBC) test measures the following:The number of white blood cells (WBC count)The number of red blood cells (RBC count)The numb...
Read Article Now Book Mark Article - Electrolyte measurements
- Tests of liver function
Treatment
It is important to tell your health care provider at your first prenatal visit if you have a history of genital herpes.
- If you have frequent herpes outbreaks, you'll be given a medicine to take during the last month of pregnancy to treat the virus. This helps prevent an outbreak at the time of delivery.
- C-section is recommended for pregnant women who have an active outbreak of herpes sores and are in labor.
- You may have some prodromal symptoms before a sore appears. You may experience itching in the affected area, "tingling" or "pinching" sensations, muscle tenderness, shooting pains in the buttocks, legs, or groin, and nerve pain in the leg. Be sure to notify your provider if you are having these sensations.
- For women with a first-episode genital herpes infection during the third trimester of pregnancy, C-section may be offered due to the possibility of prolonged viral shedding.
Herpes virus infection in infants is generally treated with antiviral medicine given through a vein (intravenous). The baby may need to be on the medicine for several weeks.
Treatment may also be needed 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. This is despite antiviral medicines and early treatment.
In infants with skin disease, the vesicles may keep coming back, even after treatment is finished.
Affected children may have developmental delay and learning disabilities.
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 the provider right away.
Prevention
Practicing safe sex can help prevent the mother from getting genital herpes.
Practicing safe sex
Safe sex means taking steps before and during sex that can prevent you from getting an infection, or from giving an infection to your partner. These...
Read Article Now Book Mark ArticlePeople with cold sores (oral herpes) should not come in contact with newborn infants. To prevent transmitting the virus, caregivers who have a cold sore should wear a mask and wash their hands carefully before coming in contact with an infant.
Cold sores
Oral herpes is an infection of the lips, mouth, or gums due to the herpes simplex virus. It causes small, painful blisters commonly called cold sore...
Read Article Now Book Mark ArticleMothers should speak to their providers about the best way to minimize the risk of transmitting herpes to their infant.
References
Dinulos JGH. Sexually transmitted viral infections. In: Dinulos JGH, ed. Habif's Clinical Dermatology. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 11.
Duff P. Maternal and fetal infections. In: Resnik R, Lockwood CJ, Moore TR, Greene MF, Copel JA, Silver RM, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 51.
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(2):e635-e646. PMID: 23359576 pubmed.ncbi.nlm.nih.gov/23359576/.
Kimberlin DW, Gutierrez KM. Herpes simplex virus infections. In: Wilson CB, Nizet V, Maldonado YA, Remington JS, Klein JO, eds. Remington and Klein's Infectious Diseases of the Fetus and Newborn Infant. 8th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 27.
Schiffer JT, Corey L. Herpes simplex virus. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 135.
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Congenital herpes - illustration
Infants may acquire congenital herpes from a mother with an active, possibly inapparent herpes infection at the time of birth. Aggressive treatment with antiviral medicine is required, but may not be effective in the case of systemic herpes.
Congenital herpes
illustration
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Congenital herpes - illustration
Infants may acquire congenital herpes from a mother with an active, possibly inapparent herpes infection at the time of birth. Aggressive treatment with antiviral medicine is required, but may not be effective in the case of systemic herpes.
Congenital herpes
illustration
Review Date: 7/2/2022
Reviewed By: John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.