There is no need for surgical treatment for genital herpes. However, if you are pregnant and genital herpes is diagnosed or suspected at the time of labor and delivery, a cesarean section (surgical) delivery may be recommended to protect the baby from getting a herpes simplex infection, which can cause serious health problems. A mother can pass the herpes simplex virus (HSV) to her baby if she has a sore or blister present during a vaginal delivery.

The biggest risk occurs during a first-time (primary) outbreak of genital herpes. Usually, in these cases, the woman either does not have symptoms or is unaware of symptoms. Experts disagree about the use of cesarean section delivery in women with recurrent outbreaks of genital herpes. If a pregnant woman has recurrent outbreaks, the risk of passing the virus to her baby is less than 1% because the baby has some immune protection from the mother.

Cesarean section may be recommended if a woman has symptoms such as tingling or pain (prodromal symptoms) that signal an impending outbreak. For these women, acyclovir (Zovirax) used in the last 4 weeks of pregnancy may reduce the need for delivery by cesarean section by reducing the risk of a recurrent outbreak at the time of delivery.

A cesarean section is usually not done if a woman with recurrent genital herpes has blisters or sores only on her thighs, buttocks, or another area that is not close to the vagina.

A mother can infect her baby during delivery, often fatally. But if a woman had genital herpes before getting pregnant, or if she is first infected early in pregnancy, the chance that her baby will be infected is very low – less than 1%. Women with genital herpes are examined carefully for any symptoms before giving birth. If sores or signs that an outbreak is coming show up at the time of delivery, the baby may be delivered by cesarean section (also called a C-section).

The risk of infecting the baby is high (30% to 50%) when a woman is newly infected late in pregnancy, however. That’s because the mother’s immune system has not developed protective antibodies against the virus. Women with an older herpes infection have antibodies against the virus, which help protect the baby. If you are pregnant and you think you may have been infected recently, tell your doctor right away.

Ways to Avoid Risks of Getting Herpes While Pregnant

Women who don’t have genital herpes should be careful about sex during the third trimester. Unless you know for sure that your partner is herpes free, you should avoid sex altogether during the third trimester. If your partner gets cold sores (oral herpes), he or she should not perform oral sex on you during this time.

Some doctors think all women should be tested for herpes when they get pregnant, especially if their sex partners have herpes. Ask your doctor if you or your partner should be tested.

Treatment Issues

Women taking antiviral drugs for herpes – either daily suppressive therapy or occasional therapy for outbreaks – should consult their doctor about whether to take the drugs during pregnancy. The answer is not set in stone: You and your doctor have to discuss the risks and benefits to decide what’s right for you.

Herpes infection in a newborn is also serious. Do not allow anyone with a cold sore on the mouth to kiss the baby. If you have a cold sore, don’t kiss the baby, and wash your hands with soap and water before touching the baby.

What are the issues for pregnant women who have herpes?

• All mothers-to-be who have had herpes should inform their doctor or midwife at a prenatal appointment. Recurrences during pregnancy pose no risk to the baby until labor starts, but babies born through an infected birth canal may catch herpes on the way out. Herpes infections in newborns can occasionally cause severe illness, leading to brain damage or death.
• If the mother has a herpes sore when labor begins, cesarean delivery will help prevent transmission to the baby.
• Many moms-to-be take an anti-viral medication in the last month of pregnancy to try to decrease the possibility of an outbreak during labor, and to lower the likelihood of needing a cesarean.
• A mother who had herpes prior to pregnancy already has antibodies against the herpes virus. These antibodies pass through the placenta, and provide some protection to the baby if born vaginally while the mom is shedding the virus. That is why recurrent herpes during pregnancy isn’t as dangerous as having a first-time infection while pregnant.

Talk to your doctor or midwife if you have concerns about herpes or other sexually transmissible infections during pregnancy.

The best protection for the baby is for the mother not to catch herpes during pregnancy.

If a woman’s partner has herpes, it is likely that she will have caught it by the time she is pregnant. In some ways, this is good news, since she already has antibodies. Once you have antibodies, you don’t re-catch an infection from another person. Antibodies also cross the placenta and provide some protection to the baby, lowering the chance of the baby becoming infected during birth.  That is why a mom’s recurrent herpes is much less dangerous to the baby than is a first time infection. Antibody testing of a woman whose partner is known to have herpes can help determine if she is at risk of catching a first-time infection during pregnancy. If she already has antibodies she can be considered to already have herpes.

If the mom’s partner has herpes and the mom has no history of herpes or antibodies against herpes, all steps should be taken to prevent transmission during pregnancy. Most infections are passed during a time when the infected person is not aware of a sore. The usual recommendations to prevent transmission in non-pregnant couples are to use condoms for every sex act, and to avoid intimate contact during an outbreak. The infected partner may choose to take anti-viral medication every day, to diminish the number of days he is infectious. In pregnancy is it imperative not to catch herpes. Some couples choose to abstain from sexual contact since abstinence is the most effective way to prevent transmission.

All moms-to-be should do their best not to catch herpes during pregnancy. About fifty percent of adults with herpes have such minimal symptoms that they are not aware that they carry this virus; so identifying which partners put you at risk can be tricky. If you have a new partner during pregnancy, or your partner has other partners, ask about a history of sexually transmitted infections or genital sores, and practice safe sex, either by abstinence or consistent condom use, especially in the third trimester. If your partner has herpes, abstinence may be the best approach. Talk to your practitioner about how best to protect yourself and your baby-to-be.

• Use condoms from start to finish every time you have sexual contact, even if you have no symptoms. Herpes can be spread when no symptoms are present (through a process called asymptomatic shedding).
• If you have genital outbreaks, abstain from sex until the outbreak has completely healed.
• Talk with your health care provider about taking antiviral medication to suppress outbreaks and to significantly reduce the risk of transmission between outbreaks.
• Consider abstaining from sex (oral, vaginal, and anal) during the last trimester. Explore alternatives such as touching, kissing, fantasizing, and massage.

If you have oral herpes (sometimes called cold sores or fever blisters), avoid performing oral sex on your partner to prevent transmitting the virus.