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Herpes during pregnancy can be an especially scary and tense period for the expectant mum. She needs to decide on the course of treatment and whether to deliver by caesarian section or have natural birth. We cover the various aspects here and invite you read this and other literature and then discuss this with your midwife or obstetrician so that you make an informed decision.

The greatest concern is that of the baby getting herpes. Neonatal herpes can be very serious. Whilst half of infants will recover with intervention, the other half can by presented with serious illness or even death. We therefore need to understand the various risks and to put herpes infection into perspective.

The incidence of neonatal herpes is extremely rare when we consider that a quarter of pregnant women have a history of genital herpes. From the available statistics of births, only 0,00025% to 0,00075% of all infants born contract neonatal herpes. Of these neonates that contract herpes some 5 to 10 % of them contract it after birth. The incidence is therefore extremely low.

Neonatal herpes in mothers with longstanding herpes (herpes for at least 1-2 years before pregnancy) is very rare. This is explained by the fact the mother confers natural protection to the unborn child by passing her antibodies via the placenta to the child. Maternal antibodies pass onto the foetus by the first few weeks of the third trimester. Premature babies are at a slightly higher risk as they may not have got the complete “dose” of maternal antibodies by that time. There may also be asymptomatic shedding by the mother, that is the virus is shed without there being active disease. The fact that there is a lower transmission of antibodies and the asymptomatic shedding, the premature child is more susceptible to infection.

Neonatal transmission is highest in mothers who contract herpes in the last trimester. Although this is not common, it accounts for half of all neonatal herpes. The reason for this high level of transmission is because the mother has not developed sufficient antibodies to confer protection to the baby.

If there is a known history of infection or if you suspect infection, consult your doctor or midwife immediately.

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The symptoms of herpes can appear between 2- 14 days after the person is infected as it takes time for the virus to pass through the anti-body solders. The infection can last up to 2 weeks. Below are the following symptoms that a person with genital or oral herpes could have:

*  Sores or blisters on the infected area.
* Swelling or pain around the infected area.
* Burning and itching sensation in the genitals
* Headaches and muscles aches
* Fever or flu even a high chance of getting a cold
* Penis or vaginal discharge
* Sometimes the patient may experience lower back pain
* An infection of the urethra causing a burning sensation during urination.

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Outbreaks of genital herpes during pregnancy have been associated with miscarriage, stillbirth, prematurity, and herpes infection causing severe brain injury and possible blindness in the baby. Still, women with herpes can give birth to healthy babies. If you have herpes and plan to have children, discuss your illness with your doctor.

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STDs can have many of the same consequences for pregnant women as women who are not pregnant. STDs can cause cervical and other cancers, chronic hepatitis, pelvic inflammatory disease, infertility, and other complications. Many STDs in women are silent; that is, without signs or symptoms.

A pregnant woman with an STD may also have early onset of labor, premature rupture of the membranes surrounding the baby in the uterus, and uterine infection after delivery.

STDs can be passed from a pregnant woman to the baby before, during, or after the baby’s birth. Some STDs (like syphilis) cross the placenta and infect the baby while it is in the uterus (womb). Other STDs (like gonorrhea, chlamydia, hepatitis B, and genital herpes) can be transmitted from the mother to the baby during delivery as the baby passes through the birth canal. HIV can cross the placenta during pregnancy, infect the baby during the birth process, and unlike most other STDs, can infect the baby through breastfeeding.

The harmful effects of STDs in babies may include stillbirth (a baby that is born dead), low birth weight (less than five pounds), conjunctivitis (eye infection), pneumonia, neonatal sepsis (infection in the baby’s blood stream), neurologic damage (such as brain damage or lack of coordination in body movements), blindness, deafness, acute hepatitis, meningitis, chronic liver disease, and cirrhosis. Some of these problems can be prevented if the mother receives routine prenatal care, which includes screening tests for STDs starting early in pregnancy and repeated close to delivery, if necessary. Other problems can be treated if the infection is found at birth.

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See your doctor if you’re at risk for having an STI or if you have any concerns about whether you have one. Most STIs can cause further problems if not treated.

Chlamydia can lead to pelvic inflammatory disease (PID) in women (a disease that can cause women not to be able to have children) and epididymitis in men (painful swelling of the tubes that carry sperm from the testicles).

Gonorrhea can lead to arthritis and PID. HPV (the virus that cause venereal warts) can lead to cancer of the cervix or penis, and syphilis can lead to paralysis, mental problems, heart damage, blindness and death.

Most STIs can be diagnosed through an exam by your doctor, a culture of the secretions from your vagina or penis, a blood test or a urine test, depending on the type of infection.

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In most cases you can’t prevent CMV, and you wouldn’t even want to. It’s best to be infected when you are young to reduce the risk of getting it for the first time during pregnancy. Pregnant women who get CMV infection ma pass the virus along to their unborn baby. How can you prevent this? Unfortunately, I can’t offer any easy answers.

One expert suggested that pregnant mothers with children younger than two who attend group child care should avoid intimate contact with their toddlers during the first six months of pregnancy. I find this utterly unrealistic. But you can make a point of washing your hands well after changing diapers and wiping noses. Disposable wipes are handy when frequent running to a sink becomes impossible.

Pregnant nurses at the Children’s Hospital of Philadelphia had to do their best to avoid CMV. We advised them to assume that all babies and toddlers were shedding CMV in their urine and to use care when handling urine and saliva. Some wore gloves while others preferred to wash their hands carefully after handling a young patient. If you are pregnant and work with small children, or have a toddler attending day care, you can request a test for CMV antibodies when you begin prenatal care. Babies born to mothers with prior immunity are at less risk of congenital CMV infection.

In the future, we hope to learn more about why some babies who are infected with CMV become sick while most others don’t, and we will likely develop better medicines to fight this infection. In the meantime, strange as it seems, the best protection is to be infected young.

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There is no cure for congenital CMV because the virus damages the baby before birth. Antiviral drugs cannot undo this damage once the baby is born. Doctors have good results with two antiviral drugs—ganciclovir (Cytovene) and foscarnet (Foscavir)— for treating and curing CMV disease in AIDS patients. Both these drugs are used to treat CMV retinitis and must be given by IV.

Nursing Care

Babies with congenital CMV need hospital care. Nursing care will depend on which organs the virus has damaged. Transplant patients and AIDS patients also need hospital care. Patients with serious CMV pneumonia require intensive care.

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Information about the incubation period varies, and it is not well determined. Illness following transfusion may begin from three to eight weeks after receiving the infected blood. Babies born with congenital CMV may show symptoms from three to eight weeks after birth.

Infectiousness

Babies infected before birth excrete the virus on and off for years and are infectious during this time. Young children are infectious from six months to two years old. Adults are infectious for only a few months.

Immunity

Once you are infected, the virus remains latent in your body, just like other herpes viruses, and can be reactivated later in life under periods of stress or weakened immunity.

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Babies. Almost all babies infected before birth are perfectly normal. Only about 10 percent of babies infected before birth are sick, and of these, 20 to 30 percent may die. Most survivors will have permanent damage. Some long-term studies suggest that a small number of apparently normal but CMV-infected babies at birth may have problems later in life. Congenital CMV has been linked to hearing loss and learning disabilities in children.

Children. Young children may have a mild cold or fever for a few days when first infected
with CMV.

Adults. CMV causes no signs or symptoms of illness in most adults. It will, however, cause an illness similar to mono  in about ten percent of young adults.

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Babies. Babies infected before birth who become sick with CMV have symptoms affecting many major organs including the liver, brain, eyes, and lungs. The baby may suffer from convulsions, lethargy, a rash that looks like tiny red pinpoints on the skin, and breathing problems. Surviving babies often have such permanent damage as mental retardation, small brain or water on the brain (micro- or hydrocephalus), hearing loss, eye inflammations, poor coordination, and liver disease.

Children. Young children have few, if any symptoms. They may experience a mild cold- or flulike illness with fever, but you can’t tell it apart from any other mild viral illness.

Adults. Very few adults, including pregnant women, have any symptoms. Symptoms will be so mild—achiness, a low fever, sore throat—that you won’t be aware you are sick.

Tests

Because the virus is excreted in blood, urine, saliva, cervical secretions, and breast milk, CMV can be grown in any of these samples. It is not difficult to grow the virus, and the test is available in most large hospital and commercial labs. The virus grows slowly, however, and you may wait from two to six weeks for results.

You can also have your blood tested for the CMV antibody. If you have the antibody, you’ve been previously infected with CMV, but this test won’t tell whether the virus is present in your blood, urine, or saliva.

Newborns with possible congenital CMV infection must have virus cultured from their urine, nose, eyes, or spinal fluid to confirm CMV as the cause of illness.

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