All human herpes viruses are shed in small amounts in body fluids, including vaginal fluids, saliva and seminal fluids.* However, there is no evidence that the transmission of the virus comes from contact with these fluids. Rather, evidence shows that herpes is transmitted through direct contact with 'mucosal surfaces', such as the mouth, vagina or anus during vaginal sex, oral sex, anal sex or kissing.

*Note: the presence of HSV in semen and vaginal fluids is associated with occasional reactivation/shedding of the virus cells coming into contact with the fluids.

As an expectant parent eagerly awaiting the birth of your new baby, you are probably taking a number of steps to ensure your baby’s health. One step many experts recommend is that you become informed about herpes simplex virus (HSV). This common virus is usually a mild infection in adults. But in infants, HSV can cause a very rare, but serious, illness. It is important to tell your health care professional or midwife if you or your partner have had a history of genital herpes. They will then be able to provide information, reassurance and optimal management.

Recurrent episodes of genital herpes during pregnancy are not harmful to the fetus. If you have genital herpes at the time when your baby is due, there is a small risk that the baby could become infected at delivery. This risk is most substantial for those who are having their first ever episode of genital herpes near to or during delivery. However, if you are simply having a recurrence of genital herpes, then the chances of your baby becoming infected at delivery are low as the baby is protected by your antibodies.

People who acquire genital herpes before they become pregnant have a very low risk (less than 1%) of transmitting the virus to their babies. This is because their immune system makes antibodies that are passed to the baby through the placenta. Even if HSV is active in the birth canal during delivery, the antibodies help protect the baby. Also, if a pregnant person knows they have genital herpes, their health care professional can take steps to protect the baby.

Protecting the baby: Genital herpes while pregnant

If you are pregnant and you have genital herpes, you may be concerned about the risk of spreading the infection to your baby. Be reassured that the risk is extremely small – especially if you have had herpes for some time. The following steps can help make the risk even smaller:

• Talk with your obstetrician or midwife. Make sure they know you have genital herpes.
• At the time of labour, check yourself for any symptoms in the genital area –sores, itching, tingling or tenderness. Your health care provider should also examine you with a bright light to detect any signs of an outbreak.
• The choices regarding an active outbreak at the time of delivery should ideally be discussed with your Lead Maternity Carer (LMC) early in the pregnancy. The choices are to proceed with a vaginal delivery (avoiding routine use of instruments) or have a caesarian section. The risk of transmission with vaginal delivery is low (less than 3%) and needs to be weighed against the risk of caesarian section to the parent. Other factors that might affect your delivery need to be considered too before a decision can be made.
• Ask your LMC not to break the bag of waters around the baby unless necessary. The bag of waters may help protect the baby against any virus in the birth canal.
• Ask your LMC not to use fetal scalp monitor (scalp electrodes) during labour to monitor the baby’s heart rate unless medically necessary. This instrument makes tiny punctures in the baby’s scalp, which may allow herpes virus to enter. In most cases, an external monitor can be used instead.
• Ask that a vacuum or forceps not be used during delivery unless medically necessary. These instruments rarely cause breaks in the baby’s scalp, allowing virus to enter.
• After birth, watch the baby closely for about four weeks. Symptoms of neonatal herpes include blisters on the skin, fever, tiredness, irritability, or lack of appetite. While these can be several mild illnesses, don’t wait to see if your baby will get better. Take them to the hospital to see the pediatric specialists as soon as possible.
• The odds are strongly in favour of you having a healthy baby.

The greatest risk of neonatal herpes is to babies whose mother contracts a genital infection for the very first time late in pregnancy. While this is a rare occurrence, it does happen, and can cause a serious, even life-threatening, illness for the baby. The best way you can protect your baby is to know the facts about HSV and how to protect yourself. The first step may be finding out whether you already carry the virus. If you have a partner who knows they have genital herpes and you don’t know whether you have it, you need to discuss this with your health care professional.

How can I get tested for genital HSV?

If you have symptoms, the best test is for a swab to be sent for laboratory confirmation and typing. To perform this test, your health care provider must take a sample from an outbreak while it is active, preferably on the first day. Test results are available in a few days.

How can I make sure I don’t get genital HSV?

If you test negative for genital herpes, the following steps can help protect you from getting an infection during pregnancy:

• If your partner has genital herpes, abstain from sex during active outbreaks. Between outbreaks, use a condom from start to finish every time you have sexual contact, even if your partner has no symptoms. (HSV can spread when no symptoms are present.) Consider abstaining from sex during the last trimester. Your partner may also consider the use of suppression therapy.
• If you don’t know whether your partner has genital HSV, you may wish to speak with your LMC regarding your risks. If your partner has genital or facial HSV, there is a very real chance that you may acquire it unless you take steps to prevent transmission.
• Do not let your partner perform oral sex on you if your partner has an active cold sore (facial herpes). This can give you genital herpes.

What if I contract genital HSV during late pregnancy?

If you experience genital symptoms, or believe you have been exposed to genital HSV, tell your obstetrician or midwife at once. However, be aware that herpes can lie dormant for several years. What appears to be a new infection is usually an old one that is causing symptoms for the first time. Talk with your provider about the best way to protect your baby. If a pregnant person gets a new genital HSV infection during the last 6 weeks of pregnancy, a caesarean delivery is recommended, even if no outbreak is present, as there is a greater than 50% risk of neonatal HSV.

Is it safe to take drug treatment for genital herpes during pregnancy?

Oral antiviral tablets are not routinely recommended for use during pregnancy. However, valaciclovir/aciclovir have been used for treating genital herpes for over 40 years and as with any drug, a register has been kept to report any adverse side effects for pregnant people who have taken it. To date there have been no adverse side effects reported for either the baby or the parent.

Due to the potential seriousness of a primary episode of genital herpes for the baby and the relative safety of valaciclovir/aciclovir, it is now recommended that valaciclovir/aciclovir are used for treating a first episode of genital herpes or severe recurrent herpes in the last trimester of pregnancy. It is believed that the benefit of using these antivirals, by reducing the risk of transmission of herpes to the baby, outweighs the risk of not using it.

For partners of pregnant people

If your partner is pregnant, and they do not have genital HSV, you can help ensure that the baby remains safe from the infection. Remember, approximately 20% of sexually active adults have genital HSV, and most do not have symptoms. If you find that you have the virus, follow these guidelines to protect your partner during the pregnancy:

• Use condoms from start to finish every time you have sexual contact, even if you have no symptoms. HSV can be spread even when no symptoms are present.
• If you have genital outbreaks, abstain from sex until the outbreak has completely healed.
• Talk with your health care provider about taking antiviral medication to suppress outbreaks and to reduce the risk of transmission between outbreaks.
• Consider abstaining from intercourse during the last trimester. Explore alternatives such as touching, kissing, fantasising, and massage.
• If you have cold sores (usually caused by HSV-1), avoid performing oral sex on your partner when a cold sore is present.
• Your partner needs to tell their health care professional if you have genital herpes so that baby can be kept safe.

The best way to protect your baby from neonatal herpes is to prevent contracting genital HSV during late pregnancy, especially during the last 6 weeks.

• Herpes simplex is most often spread to an infant during birth if the parent has HSV in the birth canal during delivery.
• HSV can also be spread to the baby if they are kissed by someone with an active cold sore.
• In rare instances, HSV may be spread by touch, if someone touches an active cold sore and then immediately touches the baby.

How many babies get neonatal herpes?

Less than 0.1% of babies born in the United States each year get neonatal herpes. The limited information from Australasia suggests the incidence is even lower in Australia and New Zealand (4/100,000 live births in Australia). By contrast, some 20-25% of pregnant people have genital herpes. This means that the great majority of pregnant people with genital herpes give birth to babies who do not have HSV.

Which babies are most at risk?

Babies are most at risk from neonatal herpes if the pregnant person contracts genital HSV for the first time late in pregnancy. This is because a newly infected pregnant person does not have antibodies against the virus, so there is no natural protection for the baby during birth. In addition, a new herpes infection is frequently active, so there is a real chance that the virus will be present in the birth canal during delivery.

Parents should be aware, however, that HSV can be transmitted from facial cold sores simply by kissing and can cause serious, widespread (disseminated) infection in the new born.

Reassurances

Parents commonly tell us about worries they have about passing on genital herpes to their children in the course of daily life (we are not referring here to pregnancy and childbirth – that’s another topic). Perhaps because there is so little information that addresses parents’ concerns, parents end up devising all sorts of ‘safety strategies’ that are completely unnecessary.

The key message is – loving parents (this category includes grumpy, tired, in-need-of-a-break parents) do not pass on genital herpes to their children through the ‘normal’ intimacies of family life. It’s important that fear of transmission doesn’t get in the way of loving touch and shared experiences.

• Snuggling in bed together is ‘safe’ – the virus isn’t crawling on the sheets from one person to the next.
• Sharing a bath or shower together isn’t a way the virus is passed on – the same is true for spa baths and swimming pools.
• Washing clothes in the same washing machine, even when a person has a recurrence, will not pass on the virus.
• A child brushing against an adult’s upper thighs or abdomen while the adult has a recurrence won’t pass on the virus.
• If an adult uses the toilet or has touched the genital area and forgotten to wash their hands, this omission is not problematic in terms of herpes. The virus is fragile and dies easily.
• Washing with ordinary soap and water is clean enough – there’s no need to use any special hand or toilet seat sanitisers.
• Children do all sorts of odd things that you can’t anticipate, but even if they put your worn knickers on their head they are not going to contract the virus – relax and laugh with them.

We hope this information will reassure parents (nieces, nephews, grandkids, stepkids etc) and help you to enjoy your parenting experience.