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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 rare, but serious, illness.
HSV can cause sores near the mouth (oral herpes or “cold sores”), or sores on the genitals (genital herpes). HSV-1 is the usual cause of oral herpes, and HSV-2 is the usual cause of genital herpes. But either type of HSV can infect either part of the body. Either type can infect a baby.
Approximately 80% of New Zealand adults have oral herpes and 30% have genital herpes. These figures are based on New Zealand studies and studies from countries with similar population groups to New Zealand. You can get genital herpes if you have sexual contact with a partner who is infected with herpes, or if a partner who has an active cold sore performs oral sex on you. Most people with HSV don’t know they are infected with herpes because they have no herpes symptoms, or symptoms too mild to notice.
HSV can cause neonatal herpes (babies up to 28 days old, infected by herpes), a rare but life-threatening disease. Neonatal herpes can cause eye or throat infections, damage to the central nervous system, mental retardation, or death. Medication may help prevent or reduce lasting damage if it is given early.
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 25-30% of pregnant people have genital herpes. This means that the great majority of pregnant people with genital herpes give birth to healthy happy babies.
Babies are most at risk from neonatal herpes if the parent contracts genital HSV for the first time late in pregnancy. This is because a newly infected parent does not have antibodies against the herpes 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 herpes virus will be present in the birth canal during delivery.
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 from contracting HSV . In addition, if someone knows they have genital herpes, their doctor can take steps to protect the baby.
If you are pregnant and you have genital herpes, you may be concerned about the risk of spreading the herpes 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:
The greatest risk of neonatal herpes is to babies whose expectant parent contracts a genital herpes infection 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 herpes 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 doctor.
If you have symptoms, the best test is a viral culture. To perform this test, your health care provider must take a sample from a herpes outbreak while it is active, preferably on the first day. Test results are available in about a week.
If you don’t have symptoms, a blood test can tell you whether you carry HSV-2, the type of herpes that usually infects the genital tract. A blood test may also tell you whether you have HSV-1, but in many cases this simply means you have oral herpes.
Ask your doctor about these tests as they differ regionally and some tests are not accurate. Also the doctor needs to be aware how to interpret the test in light of the clinical presentation.
If you test negative for genital herpes, the following steps can help protect you from getting a herpes infection during pregnancy:
If you experience genital herpes 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 herpes infection is usually an old one that is causing herpes 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 six 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.
How can I protect the baby after birth? A baby can get neonatal herpes in the first eight weeks after birth. Such infections are almost always caused by a kiss from an adult who has a cold sore. To protect your baby, don’t kiss them when you have a cold sore, and ask others not to. If you have a cold sore, wash your hands before touching the baby.
If your partner is pregnant, and they do not have genital HSV, you can help ensure that the baby remains safe from the infection. Find out whether you have a genital HSV (see “How can I get tested?”). Remember, approximately 20% of sexually active adults have genital HSV, and most do not have herpes symptoms. If you find that you have the herpes virus, follow these guidelines to protect your partner during the pregnancy:
The best way to protect the baby from neonatal herpes is to prevent contracting genital HSV during late pregnancy, especially during the last six weeks.
You can also download our guides in pdf form:
If you would like to get a print copy of the information booklets, fill out the form on the consumer request for printed materials page (it contains sections on Genital Herpes - The Facts, Herpes and Relationships, Herpes and Pregnancy, Facial Herpes).
This website is brought to you by the Sexually Transmitted Infections Education Foundation (STIEF) - an initiative funded by the Ministry of Health through collective District Health Boards (20) to educate New Zealanders about STIs. District Health Boards (DHBs) are responsible for providing or funding the provision of health services in their district.
The medical information in this website is based on the STIEF Guidelines for the Management of Genital Herpes in New Zealand. The New Zealand Ministry of Health supports the use of these clinical guidelines, developed by clinical experts and professional associations to guide clinical care in New Zealand.
The Guidelines are a consensus opinion of the STIEF Professional Advisory Group (PAG). The PAG has representation from nationwide medical, nursing and allied disciplines involved in the management of STIs. The Guidelines are produced by considering available literature, both New Zealand wide and international, and by basing the medical recommendations on the evidence in the literature or reasonable supposition and opinions of medical experts.
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