What is genital herpes?
Genital herpes is a sexually transmitted infection (STI), caused by the herpes simplex virus (HSV), usually of the viral subtype HSV-2 but sometimes of the subtype HSV-1. The family of HSV viruses typically causes blisters, ulcers, and sores on the skin and mucous membranes, usually either around the mouth area of the face, or on the genitals, and the infection also can involve the nervous system. Classically, HSV infections on the face tend to involve HSV-1 while genital infections tend to involve HSV-2, but each viral subtype can infect the other body region. As with a herpes infection on the face, a genital infection with HSV can be primary (newly acquired), or the virus can become latent (kept in check by the immune system but not eliminated completely) and then recur in outbreak episodes.
How common is genital herpes during pregnancy?
Genital herpes is extremely common, as approximately 400 million adults worldwide have HSV-2, the HSV subtype that more often causes genital herpes. Among pregnant women, approximately 20 percent test positive for the HSV-2 virus, and more than 60 percent are positive for HSV-1, which can also cause genital herpes. Your risk of having genital herpes increases with the number of sexual partners that you have had. Other factors increasing the risk include having other STIs, a history of bacterial vaginosis and having Group B Streptococcus. Women have about twice the prevalence of genital herpes as men, whereas Hispanic and African American people have it 3-4 times more often than non-Hispanic Caucasians. The use of oral contraceptives also increases your risk.
How is genital herpes diagnosed?
Diagnosis is based first on the clinical presentation of the HSV genital infection. This starts with the appearance of single or clustered fluid-filled sores (called vesicles) on the genitals, buttocks, the area around the anus, or the upper thighs. These vesicles may rupture (form ulcers). When you have a primary infection, you also may develop fever, feel tired, and lymph nodes may swell, particularly in the groin area. You can have similar symptoms when you suffer reactivation of a latent HSV infection, but sometimes symptoms are very mild, whether during a primary or reactivated infection. Consequently, many if not most women with genital herpes may not even be aware that anything is wrong. Usually, genital herpes caused by HSV-1 is milder than when caused by HSV-2. A complete diagnosis is made following blood tests in which HSV-2 or HSV-1 is detected using special antibodies in the laboratory.
Does genital herpes cause problems during pregnancy?
As noted above, genital herpes develops as vesicles (fluid-filled sores) on the genitals and areas around them, such as the buttocks, the region around the anus, and upper thighs. These vesicles may rupture, leading to cracked, red areas, which can be itchy and painful. You may experience tingling sensations. You may also have flu-like symptoms, such as fever and aches, plus lymph nodes may swell, particularly in the groin area, but also around the throat and armpits.
Does genital herpes cause problems for the baby?
HSV infection in a mother puts the baby at risk for what doctors call neonatal herpes, in which HSV from the mother infects the newborn throughout the body, damaging the central nervous system, leading to developmental disorders that can include mental retardation, and that also can lead to death. The chances that your baby will suffer this complication are very slim, even if you are infected with HSV, as less than 0.1 percent of babies are born with neonatal herpes. That is despite roughly 20 percent of pregnant women having genital herpes. However, the risk of neonatal herpes can be reduced dramatically, if you begin taking antiviral therapy by 36 weeks of gestation and continue the medication up to delivery, or if the baby is delivered by cesarean section (thus the baby avoids contact with your genital area). HSV is spread by physical contact with the sores – your baby will not get it before birth.
What to consider about taking medications when you are pregnant or breastfeeding:
- The risks to yourself and your baby if you do not treat the genital herpes
- The risks and benefits of each medication you use when you are pregnant
- The risks and benefits of each medication you use when you are breastfeeding
What should I know about using medication to treat genital herpes during pregnancy?
Genital herpes can be treated with antiviral therapy, consisting of oral acyclovir, famciclovir, or valacyclovir. This treatment does not cure you of the infection, but it can shorten the duration of symptoms in a primary infection and shorten the duration of an outbreak, plus it reduces the chances that you will spread the infection to someone else, including your baby. For each antiviral drug, there is a particular regimen in terms of doses, numbers of days, and numbers of doses per day. While effectiveness varies depending on how soon you begin treatment after you are infected, it is particularly important to take antiviral therapy, such as acyclovir, once you reach the 36th week of pregnancy, as the medication is vital in protecting the developing baby against getting infected with HSV, which could lead to neonatal herpes.
Who should NOT stop taking medication for genital herpes during pregnancy?
If you stop taking your anti-viral medication in the weeks leading to delivery, it will put your baby at risk for neonatal herpes.
What should I know about choosing a medication for my genital herpes during pregnancy?
It is important to stay in communication with your health care provider as the release of new studies over time can change the medications used during pregnancy.
You may find Pregistrys expert reports about the medications to treat HSV and other infections here. Additional information can also be found in the sources listed below.
What should I know about taking a medication for my genital herpes when I am breastfeeding?
The quantities of antiviral drugs, such as acyclovir and valacyclovir, that enter breastmilk are so tiny that they are not considered dangerous. If anything, exposure to such drugs through breastmilk would help protect your nursing infant against HSV infection from you.
What alternative therapies besides medications can I use to treat my genital herpes during pregnancy?
There really isnt any treatment for herpes infections, but the infections can be controlled and outbreaks shortened with anti-viral medication. There is no alternative to such medication other than not having any treatment, but avoiding the treatment puts the baby at risk. If you find your genital herpes outbreaks painful, you can try soaking in a warm bath – adding colloidal oatmeal can help with the itching. Be sure to keep the area of the outbreak dry during your normal daily routine. Some people swear by alternative treatments such as tea tree oil but they have not been proven to do anything – if it makes the area feel less sore, however, it won’t do any harm.
What can I do for myself and my baby when I have genital herpes during pregnancy?
Follow the instructions of your physician and make an informed decision regarding your antivira
Resources for genital herpes in pregnancy:
For more information about genital herpes during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or contact the following organizations:
- Mayo Clinic: Genital Herpes
- Centers for Disease Control and Prevention: Genital Herpes