• Contact us
• About us
• A-Z topics
• Symptom Checker
• Service Finder
• Linking to us
• Information partners
• Terms of use
• Privacy

Pregnancy, Birth and Baby is funded by the Australian Government and operated by Healthdirect Australia.

Pregnancy, Birth and Baby is provided on behalf of the Department of Health

Pregnancy, Birth and Baby’s information and advice are developed and managed within a rigorous clinical governance framework. This website is certified by the Health On The Net (HON) foundation, the standard for trustworthy health information.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

This information is for your general information and use only and is not intended to be used as medical advice and should not be used to diagnose, treat, cure or prevent any medical condition, nor should it be used for therapeutic purposes.

The information is not a substitute for independent professional advice and should not be used as an alternative to professional health care. If you have a particular medical problem, please consult a healthcare professional.

Except as permitted under the Copyright Act 1968, this publication or any part of it may not be reproduced, altered, adapted, stored and/or distributed in any form or by any means without the prior written permission of Healthdirect Australia.

Support this browser is being discontinued for Pregnancy, Birth and Baby

Support for this browser is being discontinued for this site

• Internet Explorer 11 and lower

We currently support Microsoft Edge, Chrome, Firefox and Safari. For more information, please visit the links below:

• Chrome by Google
• Firefox by Mozilla
• Microsoft Edge
• Safari by Apple

You are welcome to continue browsing this site with this browser. Some features, tools or interaction may not work correctly.

dangerous "recidivist" (j-l "9 months", No. 5, author obstetrician-gynecologist TsIR, Gevorkova E.V.)

Elena Valerievna Gevorkova , obstetrician-gynecologist during pregnancy, as they can affect the health of not only the expectant mother, but also the fetus. Herpes among them occupies one of the main places, since this disease is very common in pregnant women.

Herpes infection is a large group of infectious diseases caused by human herpes viruses. This is one of the most common human diseases. According to numerous studies, by the age of 18 more than 90% of the world's population is infected with one or more strains of herpes viruses. Among sexually transmitted infections, genital herpes ranks second after trichomoniasis.

A feature of herpes is its recurrent course. The dormant virus awakens when immunity is reduced, and pregnancy itself has the property of weakening the body's immune forces, since the woman's body bears a fetus that is half alien from an immunological point of view, which is impossible without reducing the intensity of a number of immunity links. That is why exacerbations of herpes during pregnancy occur quite often. nine0005

Many pregnant women experience blisters and panic, worried that the infection will harm the baby. Most often, women know about the presence of herpes even before the onset of pregnancy, and the appearance of itchy vesicles filled with a clear liquid indicates a “revival” of the disease. But, fortunately, the dangerous impact of herpes is somewhat exaggerated, and there are not many situations when herpes can cause problems during pregnancy.

Manifestations of disease

The clinical manifestations of herpes depend on many factors - the type of virus, the location of the lesion, the age and immune status of the person. The classic symptomatology is the appearance of a group of small vesicles filled with a clear liquid. Herpes is characterized by the appearance of bubbles with the next relapse, always in the same place.

When localized in the upper half of the body, rashes occur mainly on the lips (the so-called "cold"), as well as on the mucous membrane of the nose, mouth, conjunctiva of the eyes, in the ear canal and on the eyelids. nine0005

In the genital herpes variant, the rash is localized on the labia, on the skin of the perineum, inner thighs, pubis, or around the anus.

A few days before the rash appears, there may be a sensation of itching and discomfort at the site of future rashes (herpetic "bell").

The rash is accompanied by discomfort, itching, burning, pain. Then the bubbles burst, in their place first sores are formed, then crusts. Herpetic sores are characteristically painful, and the crusts formed in their place disappear without a trace after 2-3 days, leaving neither pigmentation nor scars on the skin. nine0005

The general symptoms of the disease are very diverse: fever, swollen lymph nodes (often inguinal), joint and muscle pain, persistent migraines, irritability, lack of appetite, etc.

The typical clinical picture appears in no more than a third of cases of genital herpes carriers. Often, genital herpes is asymptomatic or without characteristic rashes.

The atypical course of herpes is more insidious: the absence of blisters is more than offset by the variety of common manifestations, which often creates difficulties in making a correct diagnosis. Symptoms of atypical herpes - burning, cracks in the perineum, labia or anus, swelling, redness of the mucous membranes. In such cases, the diagnosis is often made incorrectly, or women who are confident in the presence of candidiasis (thrush) or bacterial vaginosis self-medicate to no avail. nine0005

The severity of any manifestations of herpes infection is determined by the state of immunity.

Varieties of the virus

The most common are HSV 1 and 2 - herpes simplex virus of the first and second types. HSV 1 most often manifests itself in the form of blistering rashes on the lips, damage to the eyes, mouth, nose is possible. The classic localization of HSV 2 (genital herpes) is the mucous membrane of the genitourinary tract. In some cases, the following phenomenon of cross-infection is observed: the culprit of herpetic eruptions of the upper half of the body is HSV 2 (genital) and vice versa - HSV 1 causes the development of infection of the lower half. As a rule, this is due to two reasons: a violation of elementary hygiene rules, when self-infection occurs - the transfer of the virus through the skin and mucous membranes, and oral-genital contacts. nine0005

Infection with herpes of the genital tract occurs mainly only through unprotected sexual contact. In rare cases, it is possible to transmit the infection through a kiss, the use of common dishes and linen. This is the so-called horizontal transmission path. With a vertical transmission route, the virus is transmitted from the mother to the fetus during pregnancy (when the child passes through the birth canal, provided that the herpes virus is present in the mucosa, that is, during childbirth at the time of exacerbation of the herpes virus infection). With the localization of foci on the lips, you can become infected through common dishes, towels and kisses. It should be noted that the risk of intrauterine infection of the fetus with primary herpes is 50%, with relapse - no more than 4%, during childbirth in the presence of rashes on the cervix and external genital organs - 90%.

How does the virus work?

Consider some features of the interaction of the virus with the human body.

1. Getting into the cell, the herpes virus (however, like any other virus) penetrates into its nucleus and causes the human cell to produce herpes viruses. Thus, the human cell "hand-made" produces new generations of viruses.
2. The herpes simplex virus (HSV) spreads throughout the body through nerve fibers. For a period of downtime (remission), when a person does not feel the presence of a virus in the body, the virus chooses nerve plexuses - ganglia. And spends time there in anticipation of a decrease in the host's immunity. During this period, the carriage of herpes does not manifest itself in any way and it is almost impossible to detect it. HSV of the first type is deposited in the trigeminal ganglion (this is a special plexus of nerve fibers located in the cranial cavity), and HSV of the second type is deposited in the sacral ganglia (nerve plexuses of the pelvic organs). nine0050 When conditions favorable for the virus (hypothermia, stress, pregnancy) occur, it exits and further spreads through the skin and mucous membranes.
3. Under the influence of various factors that damage the immune system, it is possible to weaken the controlling mechanisms of the "host" (human body) and the transition to active reproduction of the virus - this is how a relapse develops, which is manifested by an exacerbation of herpes.

Herpes exacerbations can be associated with two factors:

• already existing immunodeficiency, which is a trigger for the recurrence of herpes infection;
• the effect of the virus on the immune system itself. Long-term presence of herpes in the body has a direct damaging effect on the cells of the immune system. Thus, a vicious circle develops: a weakened immune system triggers a relapse of a herpes infection, and the herpes virus further aggravates the existing immunodeficiency.

Diagnosis

The diagnosis of herpes in a typical picture is not difficult for the doctor (and for the patient too). Clinical manifestations of herpetic infection are very bright: characteristic bubble rashes, recurrent course speak for themselves.

In cases of atypical herpes, virus carriers and during preventive examinations, laboratory diagnostic methods are of particular importance.

Main areas of laboratory research methods:

1. Determination of the viral particles themselves. For this, electron microscopy methods are used using special smear staining methods, ELISA (enzymatic immunoassay) and PCR. The last method (polymerase chain reaction) is widely used and gives fairly accurate results - it is accessible, highly sensitive, and specific. As a rule, material for PCR analysis is taken by scraping (smear) from the cervix, vagina, urethra, scraping from the bottom of the wound or the contents of the vesicle are also examined. If a latent course of infection is suspected, urine and saliva are also examined. nine0048
2. A blood test for antibodies to the herpes simplex virus, which detects immunoglobulins of classes M and G. If the infection of a person occurred for the first time (primary infection) or at the time of diagnosis corresponds to the acute phase of the disease (relapse), then early antibodies of class M are detected in the blood.

The determination of class G late immunoglobulins indicates that the organism's encounter with the virus has already occurred much earlier.

Particular attention is paid to laboratory diagnostics in case of newly diagnosed symptoms of herpes during pregnancy. Such a situation may correspond to both the primary episode and the first relapse (i.e., the body has already met with the virus before, but did not show any manifestations). nine0005

If there are IgG (late immunoglobulins) in the blood, then herpes is recurrent and there is practically no threat to the fetus or embryo. If there is no Ig in the blood, but there is IgM, then it is necessary to show an extreme degree of alertness, since this is a laboratory confirmation of the primary episode.

Genital herpes and pregnancy

In the event of an exacerbation of type 1 herpes, one should only carefully observe preventive measures to prevent the virus from being transferred to the “below the belt” zone. With recurrent genital herpes or virus carriers, the risk to the fetus becomes minimal, since maternal antibodies help to cope with the virus even in cases of active relapse. nine0005

Genital herpes is of particular relevance during pregnancy.

During pregnancy there is a powerful restructuring of all systems, including immunity. Pregnancy itself is a physiological immunosuppressive factor; there is a natural decrease in the protective properties of the body in order to prevent miscarriage. The reverse side of this immunological retreat is the manifestation of previously "dormant" infections, including genital herpes. nine0005

Obviously, when the problem of herpes arises, the future mother has a lot of worries. Fortunately, in most cases these worries are unfounded.

When is there really cause for concern? The greatest danger is the situation when infection with herpes occurs in a woman during pregnancy - the primary episode of genital herpes. This situation is characterized by pronounced manifestations, because. there are no antibodies in the mother's body that protect against herpes. For the fetus, the risk is especially high when infected with genital herpes in the first and third trimesters. Infection of the fetus in the first trimester of pregnancy leads to hydrocephalus (accumulation of fluid in the brain), heart defects, anomalies in the development of the gastrointestinal tract, etc. Such cases are extremely rare, since during the primary episode of herpes, as a rule, spontaneous abortion occurs before period of 10 weeks. nine0005

Infection in the second and third trimesters leads to the development of fetal diseases of the liver (hepatitis), pancreas (pancreatitis), lungs (pneumonia), brain (encephalitis). Primary infection in the second half of pregnancy is almost always manifested by rashes, which allows for early diagnosis and timely treatment. With recurrent genital herpes or virus carriers, the risk to the fetus becomes minimal, since maternal antibodies help to cope with the virus even in cases of active relapse. nine0005

Treatment of herpes during pregnancy

In case of proven primary infection in early pregnancy, termination is discussed.

The treatment of herpes relapses during pregnancy and outside of it has no fundamental differences. In any case, the same goals are pursued: reducing the severity of symptoms (pain, itching, fever, etc.), reducing the time for wound healing, and preventing new exacerbations. It should be remembered that the sooner treatment is started, the greater the effect it will have. If treatment is started in the prodromal period (when the initial signs of the disease appear - tingling or slight itching at the site of future blisters, chills, malaise), then this will significantly help reduce the severity of herpes manifestations. nine0005

A feature of the treatment of herpetic infection is the exact observance of the prescribed dose and regimen of medication. If the next dose of an antiviral drug is missed, then the herpes virus may have time to multiply during this period, which will lead to treatment failure.

The only drugs with proven efficacy in the treatment of herpes infection are specific virostatics - nucleoside analogues (ACICLOVIR, VALACIKLOVIR, PENCICLOVIR, FAMCICLOVIR). nine0005

Treatment of herpes infection during pregnancy involves the use of approved antiviral drugs (acyclovir ZOVIRAX and valaciclovir VALTREX) in the form of ointments, creams and tablets.

Simultaneously with antiviral drugs in complex treatment, immunomodulators (VIFERON), vitamins, physiotherapeutic methods, local antiseptics are used for faster wound healing.

Of course, the appropriateness and course of treatment is determined in each individual case. The situation of a combination of pregnancy and herpes should be under the vigilant supervision of a doctor and self-medication in these cases is simply unacceptable. nine0005

Herpes of the newborn

In what cases does the insidious virus still achieve its goal and cause illness in newborns? In the vast majority of cases (90%), infection occurs by contact during passage through the birth canal. Intrauterine infection of a newborn is noted only in 5% of cases of herpes in newborns. Moreover, an important condition is the presence of a primary episode of genital herpes in the mother, in cases of asymptomatic carriage or recurrent herpes, infection of the fetus during childbirth occurs no more than in 4% of cases. nine0005

Symptoms and signs of herpes in babies appear as early as 2 weeks after birth. Herpes of the newborn is characterized by the presence of vesicles on the skin, mucous membranes (oral cavity, genital organs) and conjunctiva of the eyes. The more premature babies are born, the more difficult the infection is; in such cases, damage to the brain (herpetic encephalitis) is common.

Prevention

Unfortunately, there are no specific methods for the prevention of herpes. Prevention of infection at the planning stage, during pregnancy and after childbirth is exclusively preventive. The following measures apply:

1. Examination of the body before pregnancy is an extremely important stage of pregnancy planning.
2. Strengthening immunity during pregnancy.
3. Physical activity (swimming, fitness, outdoor walks and other types of hardening), taking multivitamins, rational nutrition, a favorable emotional background - all this will help the immune system to cope with its work perfectly.
4. A categorical rejection of bad habits (smoking, alcohol, drugs) - and not only because of the fear of a herpes infection ...
5. Certain rules for sexual relations during pregnancy. If the expectant mother does not have late antibodies (IgG), and the sexual partner has signs of herpes or laboratory confirmation of herpes carriage, then it is recommended to refuse sexual intercourse, even using condoms. In other cases, the rules are less categorical: it is enough to use condoms and refrain from oral sex, since in this case, type 1 HSV can be transferred to the genitals and cross-infection of the genital organs, followed by infection of the fetus. If there are people with rashes on the lips surrounded by a pregnant woman, then you should pay special attention to the rules of personal hygiene (do not use common dishes, towels, avoid close contact - kiss, touch the rashes with your hands). This is especially true for women who do not have immunity to the herpes virus. It is possible to determine it by a blood test: with positive values ​​​​of class G immunoglobulins, there is immunity, with negative ones - no. nine0048
6. As a prevention of herpes in newborns in the presence of a recurrence of infection in the mother 4 weeks before delivery, delivery by caesarean section is indicated. This is a common tactic aimed at eliminating the slightest possibility of infection of the child during childbirth. However, according to many studies, even in the case of physiological childbirth, there is no serious danger, since the antibodies present in the mother's body pass through the placenta to the fetus and protect it during pregnancy, childbirth and after childbirth. However, today the presence of rashes on the cervix and genital tract at the time of delivery is an indication for operative delivery. In cases of herpes carriage without activation, childbirth is carried out naturally. An additional factor in protecting the fetus is breastfeeding. nine0048
7. Strict observance of personal hygiene rules - frequent hand washing, use of individual hygiene items and utensils.
8. In case of recurrence of herpes after childbirth, to prevent the transmission of infection to the newborn, avoid contact of the child's skin with foci of rashes (do not kiss the child, do not touch the bubbles with your hands, wash your hands thoroughly, wear a protective mask), undergo a course of treatment in a timely manner.

Tags: cir media

Genital herpes during pregnancy

Genital herpes is a rather serious problem during pregnancy, as it can lead to transmission of the infection to the fetus or newborn. In newborns, herpes infection can be local, widespread, and can cause damage to the central nervous system. Local herpetic lesions usually occur on the skin, eyes and mouth. Common herpes infection of newborns and herpes infection of the CNS (central nervous system) can lead to death or chronic illness. nine0005

Genital herpes in pregnancy can occur in four clinical forms:

1. Primary - infection with genital herpes in pregnancy occurs for the first time during pregnancy. In this case, there is a clinical manifestation of herpes and there are no antibodies to the herpes simplex virus of both types 1 and 2.
2. First episode of non-primary genital herpes - implies clinical manifestations of genital herpes caused by type 2 virus when the pregnant woman has antibodies to herpes simplex virus 1 in the blood.
3. Recurrent genital herpes - the appearance of herpetic eruptions during pregnancy due to the activation of a virus that a woman contracted before pregnancy. At the same time, a virus of one of the types (for example, type 2) is detected in the lesion, and class G antibodies (igG) to herpes simplex virus type 2
are detected in the blood
4. Asymptomatic viral spread is a short period, usually 24-48 hours, during which the virus rapidly replicates and spreads to new host cells. Usually, periods of asymptomatic viral spread are observed in women with a history of recurrent genital herpes. nine0050

In order to determine which form of genital herpes is found in pregnant women, blood tests are used to detect the presence and type of class G antibodies to the herpes simplex virus. This analysis should be done by all pregnant women.

Herpes infection can be transmitted to the fetus or newborn before, during and after childbirth.

Antenatal (antenatal) transmission of herpes infection to the fetus occurs in 5% of cases from mothers with primary genital herpes. In the primary form of genital herpes, there is a period when the herpes virus appears in large quantities in the blood of a pregnant woman and is thus transmitted through the placenta to the fetus. This mechanism of intrauterine infection is also characteristic of other TORCH infections (TORCH (toxoplasmosis, other infections, rubella, mega cytolovirus, and herpes simplex) and fetal malformations such as microcephaly, microophthalmia, intracranial calcifications, and choreoretinitis may occur. 0005

The largest percentage (75-90%) is infected during childbirth during passage through the birth canal of mothers with genital herpes.

Postpartum infection occurs through contact with the mother or loved ones.

The frequency of infection during childbirth depends on the clinical form of genital herpes in the pregnant woman.

The greatest risk of infection in the primary form of genital herpes is infected up to 50% of newborns.

In the first episode of genital herpes against the background of a non-primary (already existing) herpes infection, the percentage of infection is 33.

Recurrent genital herpes and asymptomatic viral spread - infection rate 0-4.

Research data show that mothers who do not have antibodies to the herpes virus are most likely to contract herpes infection.

The presence of antibodies to the herpes virus in a pregnant woman reduces the risk of transmission of herpes infection to the newborn.

Herpes simplex virus type 1 is most commonly transmitted to a newborn.

Pregnant women without antibodies to herpes simplex virus 1 and herpes simplex virus type 2 are now considered to be at risk, since infection in such pregnant women often leads to the development of herpes infection in the fetus. nine0005

If a pregnant woman has normal levels of antibodies to herpes simplex virus type 1 or 2, and the partner is elevated, then such couples should be protected (or use a condom) from sexual intercourse during the entire period of pregnancy. Oral-genital contact is also excluded.

The risk of herpes infection in the fetus and newborn is highest in the last trimester of pregnancy, reaching 57%. This is due to the fact that protective antibodies to the herpes virus do not have time to form in the mother's body by the time of birth. nine0005

If genital herpes in pregnant women appears after 36 weeks, antiviral suppressive therapy with drugs such as acyclovir, valaciclovir and famciclovir is used. Medicinal antiviral therapy for genital herpes of pregnant women is carried out until childbirth.

Learn more

• 
  How long does a woman bleed after miscarriage
• 
  How to have a small baby at birth
• 
  How to teach a child another language
• 
  Baby born 2 months early
• 
  Women pregnant at 40
• 
  Way to increase breast milk
• 
  What does the hospital do with miscarried babies
• 
  What to take if constipated while pregnant
• 
  How child grow
• 
  Different types of miscarriages
• 
  Growth spurt 16 weeks