What to Know About Herpes and Pregnancy

Herpes infections are common in the sexually active population, and pregnancy with herpes is also common. Most of the time, herpes during pregnancy does not cause complications. However, on rare occasions it can cause serious problems for the fetus. Problems are most likely with a new herpes infection during pregnancy.

This article will discuss the effects herpes has on fertility, how it can affect gestation and delivery, and concerns after delivery.

Herpes and Fertility

Herpes simplex virus (HSV) infections are sexually transmitted. Both HSV-1 and HSV-2 can be transmitted during sexual contact.

Although many people with herpes infections have no problems with fertility, there is some data that herpes infections can cause problems with semen quality. Herpes infection is also associated with increased infertility rates in people who have a uterus and ovaries.

It is important to know that the data supporting a link between herpes infections and reduced fertility is somewhat limited. The mechanisms by which herpes infection affects fertility are not as clear as with other sexually transmitted infections (STIs).

Herpes and Gestation

While most people do not experience serious consequences of herpes during pregnancy, if you are at risk of herpes during pregnancy, you should take appropriate precautions. Non-monogamous individuals should practice safer sex to reduce the risk of herpes transmission.

If you are susceptible and have a partner who is known to be infected, that partner might also consider suppressive therapy to reduce transmission risk.

Risks of Herpes During Pregnancy

The major risk associated with herpes and pregnancy is neonatal herpes infections. These infections of the newborn are rare, but can be quite serious or even fatal. The biggest risk for neonatal herpes occurs for people who are newly infected during pregnancy—particularly near the time of delivery.

Cesarean section (C-section) is recommended instead of vaginal delivery for people who have genital symptoms at the time of delivery. It is also recommended for people who are having prodromal symptoms that signal a likely outbreak. C-section has been shown to significantly reduce the risk of herpes transmission to the infant.

Herpes Treatment During Pregnancy

If you are experiencing symptoms that could be associated with herpes, discuss those symptoms with your doctor. In general, treatment is recommended for symptomatic herpes infections. However, people without symptoms generally are not treated during early pregnancy.

Near the time of delivery, obstetricians recommend using suppressive therapy to reduce the risk of a late-term outbreak. This daily treatment is generally started at 36 weeks of gestation and continued through delivery. Preventing an outbreak may also reduce the risk of needing a C-section instead of being able to deliver vaginally.

Concerning Symptoms

Symptoms of herpes during pregnancy are the same as symptoms of herpes at other times. These include:

• Pain or itching
• A burning sensation in the skin
• Small bumps or blisters (may or may not be visible)

If you are pregnant and experiencing symptoms that could be associated with herpes, talk to your doctor. Herpes symptoms can be difficult to distinguish from other STIs, particularly if you can’t see any sores. Your doctor may be able to diagnose you with a physical exam or you may need STI testing.

If you have herpes symptoms during pregnancy, treatment is important. This is particularly true if pregnancy is the first time you’ve had symptoms that could be caused by genital herpes infection. New herpes infections are most likely to cause problems during pregnancy.

Herpes and Postpartum

If you have an oral or genital herpes infection, it is important to clean your hands between touching your sores and touching your infant. Herpes infections are spread from skin to skin.

This also means that infants may be at risk of getting herpes from affectionate contact with other adults in their lives. Remember that cold sores are also caused by a herpes virus.

Breastfeeding is not considered risky for people with herpes. The exception is for people who have an active herpes lesion on the breast, who should not breastfeed.

Valacyclovir is considered to be safe for breastfeeding mothers, although acyclovir (a metabolite of valacyclovir) can be found in breast milk.

Frequently Asked Questions

How do prior herpes outbreaks affect my pregnancy?

If you’ve had previous herpes outbreaks, they won’t necessarily affect your pregnancy. Unless you have an outbreak during pregnancy, no treatment is needed or recommended.

There is some limited evidence that suppressive therapy starting at 36 weeks of gestation may be helpful. However, in the absence of outbreaks, there is no need to change your pregnancy or delivery plans.

What are the complications of having herpes and being pregnant?

Most people who have herpes when they’re pregnant will not have any complications. In rare cases, herpes infection during pregnancy can be transmitted to the newborn. This can potentially cause serious or even life-threatening disseminated neonatal herpes.

The more likely complication of having herpes when you’re pregnant is that your doctor might recommend that you have a C-section instead of giving birth vaginally.

What if I have a herpes outbreak while pregnant?

If you have a herpes outbreak while pregnant, treatment with acyclovir or valacyclovir is recommended. These drugs are generally considered to be safe during pregnancy. Oral medication is used for treatment unless the outbreak is severe.

If you have an outbreak or prodromal symptoms at the time of delivery, a C-section is recommended over vaginal delivery.

Do they test for herpes when you’re pregnant?

In general, herpes testing is not recommended during pregnancy. However, there is an exception for people with symptoms.

If you have symptoms of herpes during pregnancy, your doctor will likely recommend testing. That’s particularly true if you have never had symptoms in the past.

Herpes Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

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Summary

Herpes is primarily a concern during pregnancy if the pregnant person gets a new infection or if they have an outbreak or prodromal symptoms at the time of delivery. These carry a risk of transmission to the infant. Suppressive therapy starting at 36 weeks is recommended, and a C-section may also be indicated.

A Word From Verywell

If you have herpes, it can be reassuring to know that people infected with herpes before they become pregnant rarely have complications. That doesn’t mean it’s not important to pay attention to herpes symptoms. It just means that with appropriate treatment, other problems are unlikely.

If you have never been infected with herpes, the story is slightly different. If you’re pregnant and could be at risk of a new herpes infection, it’s a good idea to take appropriate precautions. That means practicing safer sex for not just penetrative sex, but oral sex as well. While barriers aren’t 100% effective at preventing herpes infection, they can significantly reduce risk.