Herpes in Pregnancy

The risk for transmission to neonate from infected mother is high (30%-50%) among women who acquire genital herpes near time of delivery. The risk is low (<1%) in women with histories of recurrent herpes at term or who acquire genital HSV during the first half of pregnancy. Prevention of neonatal herpes depends on avoiding acquisition of HSV during late pregnancy and avoiding exposure of the infant to herpetic lesions during delivery.

Genital Herpes Counseling in Pregnancy

Your doctor should:

• Ask all pregnant women whether they have a history of genital herpes.
• Counsel all women without known genital herpes to avoid intercourse during the third trimester with partners known to have or suspected of having genital herpes.
• Counsel all women without known orolabial herpes to avoid cunnilingus during the third trimester with partners known to have or suspected of having orolabial herpes.
• At the onset of labor, question all women about symptoms of genital herpes, including prodrome, and examine all women for herpetic lesions.

Women without symptoms or signs of genital herpes or its prodrome can give birth vaginally. Most specialists recommend that women with recurrent genital herpetic lesions at the onset of labor be delivered abdominally to prevent neonatal herpes. However, abdominal delivery does not completely eliminate the risk for HSV transmission to the infant.

Viral cultures during pregnancy of women with or without visible herpetic lesions do not predict viral shedding at the time of delivery. Therefore, routine viral cultures of pregnant women with recurrent genital herpes are not recommended.

Women who acquire genital HSV in late pregnancy should be managed in consultation with an expert. Some experts recommend acyclovir therapy in this situation, some recommend routine abdominal delivery, and some recommend both to reduce the risk of neonatal herpes.
Acyclovir near term for women with recurrent herpes may decrease the need for abdominal deliveries. There are ongoing studies assessing the efficacy and safety of acyclovir given around the time of delivery for mother and child.

Sources: CDC, DHHS