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Genital Herpes And Pregnancy: A Threat To Neonates

Genital Herpes And Pregnancy

Genital Herpes and pregnancy concomitantly induce a deadly infection in newborns, frequently termed as “Neonatal Herpes (NH).” The occurrence of Neonatal Herpes is usually not seen but, if it exists, overwhelming infection often makes its presence. With high mortality and morbidity rate, the diagnosis of Herpes in a baby is an ominous sign that needs prompt and intensive treatment.

Even immediate treatment sometimes doesn’t assist babies born with Herpes, leaving them with significant brain damage and eventually death. The infant who dares to survive left with some long-lasting neurological sequelae.

Mercifully, genital Herpes rarely interacts with the infant during pregnancy. Data suggests that nearly 30 per cent of infected pregnant women every year give birth to neonates in the United States Of America, a mere 0.1 per cent or less receive Neonatal Herpes. Rest infants born safe, healthy and don’t represent any sign of Neonatal Herpes. However, anyone who has Herpes can have a baby with Herpes.

What Makes Your Infant Vulnerable To Infection?

Factors are many that play a substantial role in making infants ill with Herpes simplex virus during pregnancy. One apparent factor is the type of maternity infection the mother has. Primary or newly acquired genital Herpes in pregnancy increases the risk of neonatal Herpes by many times. 

Herpes Virus loves the body’s environment of a newly affected host. Lack of antibodies impairs the immune system to make a barrier allowing opportunistic herpes virus to create its DNA in abundance. This stage of pregnancy may let the penetration happen to the birth canal that higher the odds of infection to neonates. 

Recurrent herpes infection is comparatively related to low risk of HSV transmission to the baby than recently acquired HSV infection. Data confirms that the woman who exposes to herpes virus before conception is less likely to carry the virus in the infant. The time the immune system witnesses the first exposure to HSV, it establishes the internal defence system against HSV in the form of antibodies. When the subsequent attack occurs from the same pathogen, the immune system identifies it as a threat immediately and counterattacks them.   

So, even if recurrent Herpes flares up during pregnancy, the herpes virus has to battle with immunity. 

It is common to kiss neonates to show love and care, but an infected kiss sometimes becomes disastrous to neonates. I recently read a story where a pregnant woman gave birth to a child but the infant kissed by Herpes sufferer, which later developed in disseminated Herpes and eventually killed that neonate. Hence, be cautious to protect your baby from the contaminated kiss. 

Cases reported flaring up of Herpes Zoster during pregnancy but, comparatively possessing slight risk of neonatal Herpes. Studies suggest herpes Zoster contagious while there is an active lesion. 

You Are Pregnant, But Not Sure About Your Herpes Status?

Herpes virus is difficult to perceive as you may never know you have Herpes even if it invades your body. It may not present a single sign for the entire life of an individual. The flip side of herpes virus scares people as it represents dire consequences, high morbidity and mortality rate in infants, and HIV positives. 

The herpes virus is highly contagious, quickly passes during sexual intercourse if there is an active lesion. Viral shedding also represents a high risk of HSV transmission.

If you are at the maternal stage, abstain from any physical relationship with a susceptible herpes partner. In case, you think yourself sensitive to HSV exposure during pregnancy; the following symptoms may help you uncover the shadow of doubts from your Herpes status in pregnancy. 

Symptoms

Pregnancy and Herpes is a deadly combination

Exposure to the Herpes Simplex Virus simply puts its host to some characteristic clinical manifestations, typically the itchy and painful blisters. Usually, symptoms appear 2-12 days after acquiring the Herpes Virus. The primary herpes infection tends to be more dire than recurrent and affects broader parts of the genitals. 

Beside fluid-filled blisters, genital Herpes may cause inflammation to vulva, vagina, labia, and cervix. Sometimes inflammation induces vaginal bleeding accompanied by pain. Odds to develop tingling and the burning sensation is high with Genital Herpes in pregnancy. An altered vaginal discharge sometimes represents the HSV presence. 

The herpes virus causes a feverish infection which may further move to headache, malaise, shivering, body pain, and exhaustion. 

Before the Herpes outbreak, tingling and itching sensation occasionally occur while pregnant. Thigh pain, buttock pain and pain in genital parts are potential indicators that you might want yourself tested for HSV presence. 

Data suggests higher odds of disseminated herpes infection in pregnancy than regular days. It causes appalling consequences to mother and higher the virus transmission to neonates. With broader skin lesions, the involvement of the brain and severe inflammation of the liver increases the maternal mortality rate. 

Compromised immunity, particularly with HIV or AIDS, enables HSV arbitrariness and induces recurrent Disseminated Herpes Infection. These people are dangerously prone to develop resistance to widely used antivirals Acyclovir and Valacyclovir.

A Proper Diagnoses Is Still Needed

Having above said herpes signs and symptoms does not necessarily mean you are a mother with Herpes. Most of the symptoms mentioned above could be representing other infections in you. By this fact, a proper diagnosis is essential to establish whether or not you are a herpes host. 

Your GP may approve specific laboratories tests to confirm your status over genital herpes infection during pregnancy. You may be taken for a blood test, or just a little swab can verify your status. Polymerase Chain Reaction Test (PCR Test) looks for Virus DNA in a swab taken from the active lesion. The test is often accurate in detecting HSV presence. 

Herpes Blood test establishes antibody in the presence of the herpes virus, but, the test may not diagnose Herpes as precisely as PCR does. The antibody detection is done with the help of Direct Fluorescent Antibody Testing (DFA) and the solution carrying Herpes antibodies. 

The test that involves viral culture is also holding a promise to diagnose Herpes but, apparently less sensitive to PCR. 

We have comprehensive information on how the herpes diagnosis made through different tests, and you can go there by Clicking What The Herpes Test Is | Herpes Blood Test Accuracy | PCR Test for Herpes.

Post Diagnosis Of Genital Herpes and Pregnancy

If the test has determined your herpes status as positive, it is a time to prevent your baby from being born with Herpes.

Society of Obstetricians and Gynaecologists of Canada outlined some crucial suggestions to prevent Herpes in babies. ACOG is another institution that came up with relevant information on HSV and pregnancy. 

The first necessary step is informing the obstetrician about your herpes status. It is advisable even if maternal care led by midwifery. They hold expertise in preventing diseases spread in neonates and maternal care.

Secondly, immediate treatment needs to be initiated to inhibit viral proliferation and reduce the severity of symptoms. Antiviral herpes management is still a mainstay treatment for Herpes management. Mother with Disseminated genital herpes infection requires intensive care with intravenous herpes therapy. Prompt treatment lessens the duration of viral shedding. The accepted dose of Valacyclovir is 400mg three times a day for five days.

Acyclovir is yet to be licensed for use in pregnancy; however, it is well tolerated by mothers & is safe.

Primary maternal infection holds a higher risk to pass the virus to infants; hence it is advised to perform herpes test at a constant basis to determine the likelihood of HSV transmission. Nucleic acid amplification tests or viral culture are available to accumulate the data over herpes presence.

Mothers who acquire genital Herpes but the delivery does not occur within the six weeks, the vaginal delivery is predictable. However, during those six weeks, the infection should be managed vigorously. 

Primary infection acquired during the third trimester is advisable to Caesarean section of delivery. During this period a high rate of transmission (about 41%) is expected. 

The committee of the American College of Obstetricians and Gynecologists also recommends cesarean delivery with mothers who develop lesions or initial manifestation of symptoms at birth. 

Management Of Recurrent Genital Herpes In Pregnancy

Recurrent Genital Herpes Infection during pregnancy does not impose a significant threat to neonates, though the management is still highly advisable. 

In a clinical trial, the recommended dose of Acyclovir given to pregnant women who surpassed their 36 weeks of gestation. All women were having the history of recurrent herpes infection. The trial detected promising results.

A substantial reduction was seen in recurrent herpes outbreak after getting Acyclovir therapy. Additionally, most women were available to standard delivery than cesarean.  

Note: ACOG recommends no need for cesarean delivery in women with the history of Genital Herpes Infection but no signs of Symptoms at the birth.

Obstetrician or Midwife requires to cover non-genital lesions of a pregnant woman with Occlusive dressing before a vaginal delivery.

In case, disseminated Herpes outbreak occurs during pregnancy, a suppressive antiviral regimen based on Acyclovir highly recommended to prevent Herpes in the baby. 

Contamination Of Herpes In Neonate: A Disastrous Event

Above guidelines surely have significance in shielding your infant from deadly herpes infection, but sometimes circumstance remains beyond our rein. Hence, a dire condition occurs when Herpes breaks the protective shield and neonate gets the virus. 

Neonatal Herpes is connected to the high mortality rate even if the baby is being treated intensively. Studies suggest about 33 per cent mortality rate in neonates with neonatal Herpes.

Baby born with Herpes may represent some alarming signs, mostly rashes on the eyes, mouth or skin. The symptoms of lethargy and poor feeding are also noticeable in most cases. Apnea (Breathlessness), seizures, and High-grade fever may progressively occur. Herpes virus also interferes with the blood’s ability to form clots; hence the condition coagulopathy may appear.

Disseminated herpes infection in babies causes significant mortality threat by involving the central nervous system (CNS), liver and lungs. Herpes virus can easily invade brain cells and cause inflammation. This condition is what we can term as Herpes Encephalitis

Neonatal Herpes Treatment That Matters

Baby born with Herpes is highly vulnerable to death if prompt treatment not initiated. The therapy may be started in sensitive cases even if there is no diagnosis to confirm the herpes presence.  

Intravenous Acyclovir is a widely accepted treatment method for treating Herpes in babies. The type of Neonatal HSV often dominates the doses of Acyclovir. 

For SEM (skin, eyes and mouth) infection, 14 days of Acyclovir therapy recommended with 60 mg/kilogram three times a day every 8 hours. 

The same doses of Acyclovir exceed upto 21 days with Disseminated or CNS disease. 

The other form of antivirals such as Valacyclovir and Famciclovir induces higher plasma level; therefore, they less frequently used with a decreased daily dose. 

FAQs 

Can You Have A Baby Born With Herpes?

Herpes virus is highly transmissible, so yes, there is a possibility to pass the virus to your baby. 

Can You Give Birth Naturally If You Have Herpes?

If you do not have an active outbreak at the time of delivery, you can give birth Naturally. However, the woman with newly acquired genital Herpes with active lesions at the time of delivery should prefer cesarean delivery.

Can You Breastfeed If You Have Herpes?

Typically, breastfeeding is completely safe until there is an active lesion on your breast. You require not to breastfeed with active sores on your breast, nipple or areola. 

Can I Kiss My Baby If I Have Herpes?

We recommend not to kiss your baby if you are up with the cold sore or any kind of lesion related to Herpes on your lips or surroundings. Kissing your baby with an active injury can cause dire consequences.

Can You Take Herpes Medication While Pregnant?

No Herpes Antivirals licensed for the use in pregnancy; however, all the available antivirals are considered safe. You can opt to take herpes medication while pregnant; however, ask your physician for the safe side of use. 

How Common Is Neonatal Herpes?

Neonatal Herpes is a rare entity with approximately 1 case in every 5000 to 8000 live births.

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Tags: , Last modified: April 2, 2020
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