Sexual Health STDs Herpes Is Vaginal Birth Safe for Women With Genital Herpes? By Elizabeth Boskey, PhD facebook twitter linkedin Elizabeth Boskey, PhD, MPH, CHES, is a social worker, adjunct lecturer, and expert writer in the field of sexually transmitted diseases. Learn about our editorial process Elizabeth Boskey, PhD Medically reviewed by Medically reviewed by Anita Sadaty, MD on June 25, 2020 facebook twitter linkedin instagram Anita Sadaty, MD, is board-certified in obstetrics-gynecology. She is a clinical assistant professor at Hofstra Northwell School of Medicine and founder of Redefining Health Medical. Learn about our Medical Review Board Anita Sadaty, MD on June 25, 2020 Print Table of Contents View All Risk of Transmission Viral Shedding Risk-Reduction Techniques Herpes Testing Making Your Decision It can be stressful to know that having genital herpes during pregnancy means there is a possibility your child could become infected with the virus during labor or shortly after a vaginal delivery. Because of this, and the potential of serious consequences of infection in babies (which, in rare cases, includes death), women with genital herpes are often advised to consider a Cesarean (C-section) delivery instead of a vaginal one. That said, this may not be necessary in all cases. JGI/Jamie Grill/Blend Images/Getty Images Risk of Transmission Only a small percentage of neonatal herpes transmissions occur during the pregnancy itself. The vast majority happen during birth. Not all pregnant women with genital herpes are at equal risk of transmitting the virus to their infant. The risk of neonatal herpes is highest, by far, for women who become infected with herpes for the first time while they are pregnant. That's particularly true if they become infected near the end of their pregnancy. Transmission rates from mother to infant are substantially lower for women who have been infected for a long period of time. That's true even if they have an active infection during the course of their pregnancy. There is also some data that women with genital HSV-1 infections may have a greater risk of giving their infants neonatal herpes than women with HSV-2. (HSV stands for herpes simplex virus.) Viral Shedding Without an Outbreak A large 2011 study, published in JAMA, investigated how often people with asymptomatic herpes infections shed the virus and how much virus they shed. The researchers found that people with asymptomatic genital HSV-2 shed detectable levels of virus 10% of the time. That's about half as often as people with symptomatic infections. However, the amount of virus they shed was similar. Other studies showed that pregnant women with a history of recurrent genital herpes infections have a 1.4% rate of shedding at the time of delivery. Risk Reduction Techniques Doctors generally recommend suppressive therapy for all pregnant women with HSV infections beginning at 36 weeks gestation. This is to reduce the risk of an outbreak and lower viral shedding. A C-section is recommended if a woman has an active genital herpes outbreak near the time of delivery. This is preferred over a vaginal delivery because it reduces the chance that the infant will be exposed to the virus (as it would if passing through the birth canal). More specifically, the American College of Obstetricians and Gynecologists recommends that C-section delivery should be performed in women with active genital lesions (whether their first infection or if they have had prior outbreaks) or with symptoms that suggest an outbreak will soon occur. Herpes Testing During Pregnancy Of course, knowing whether or not your birth plan should be reassessed depends on knowing you indeed have genital herpes. Doctors can certainly test for viral DNA during pregnancy. Still, there is some question about how useful these tests are, particularly when they're done more than a few days before birth. As well, an increasing percentage of genital herpes cases are due to herpes simplex virus 1 (HSV-1), and testing for it would not distinguish between the site of an outbreak (oral or genital). The American Academy of Family Physicians (AAFP), American College of Obstetrician and Gynecologists (ACOG), and the Centers for Disease Control and Prevention (CDC) do not recommend routine serologic screening for genital herpes simplex virus infection in those who are pregnant. Deciding What to Do About Your Delivery Many pregnant women with genital herpes are understandably torn about their pregnancy management options. That's particularly true if they are interested in having a more natural childbirth experience. In addition, some women worry about infecting their child even with suppressive therapy, since the herpes virus can be present in the body even when there is not currently an outbreak. Some may not feel comfortable giving birth vaginally even if they haven't had an outbreak in years. As with anything related to childbirth, speak with your obstetrician to get a clear picture of your condition and any related risks of childbirth. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Pinninti SG, Kimberlin DW. Preventing herpes simplex virus in the newborn. Clin Perinatol. 2014;41(4):945–955. doi:10.1016/j.clp.2014.08.012 James SH, Sheffield JS, Kimberlin DW. Mother-to-child transmission of herpes simplex virus. J Pediatric Infect Dis Soc. 2014;3 Suppl 1(Suppl 1):S19–S23. doi:10.1093/jpids/piu050 American College of Obstetricians and Gynecologists. Genital herpes. Tronstein E, Johnston C, Huang ML, et al. Genital shedding of herpes simplex virus among symptomatic and asymptomatic persons with HSV-2 infection. JAMA. 2011;305(14):1441–1449. doi:10.1001/jama.2011.420 Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015;64(RR-03):1–137. Bibbins-domingo K, Grossman DC, Curry SJ, et al. Serologic screening for genital herpes infection: US Preventive Services Task Force recommendation statement. JAMA. 2016;316(23):2525-2530. doi:10.1001/jama.2016.16776