For most people, having herpes during pregnancy does not affect their pregnancy or the health of the fetus. However, a herpes outbreak shortly before birth increases the chance of passing it on to the baby.

Herpes is an oral or genital infection due to the herpes simplex virus (HSV). People with herpes can pass the infection to a baby during childbirth, which can be dangerous.

HSV infection is very common. According to 2016 data from the World Health Organization (WHO), globally, over two-thirds of people under 50 years of age have the HSV-1 infection. Additionally, around 13% of people aged between 15 and 49 years have genital herpes due to HSV-2 infection. Herpes affects 2–3% of pregnant women.

This article explains how herpes affects pregnancy, the risks involved, and how a pregnant person can manage herpes.

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HSV, the virus that causes herpes, has two categories.

  • HSV-1: This type of HSV causes lesions around the mouth known as cold sores. People spread this between each other through oral contact. It can also cause genital blisters if someone contracts it through oral sex.
  • HSV-2: This HSV subtype usually occurs around the genital area but can cause oral sores. People usually transmit it through sexual contact.

Once a person has the HSV virus, they will always have herpes. It can lay dormant in the body for long periods before recurring.

Learn more about herpes.

A pregnant person usually experiences the same herpes symptoms as nonpregnant individuals.

Around 75% of women with herpes will experience a flare-up during pregnancy, but there is no evidence that pregnancy triggers flare-ups.

If a person has herpes for the first time while pregnant, the risks to an unborn fetus are higher than if they have caught herpes before being pregnant. Initial herpes infections are also usually more severe than recurrent infections.

A doctor may prescribe antiviral drugs, such as acyclovir, to treat herpes during pregnancy. These can cause side effects in some people.

Learn more about the side effects of acyclovir.

Although rare, babies can contract herpes during childbirth. Doctors call this neonatal herpes. The WHO estimates that it occurs in 10 out of every 100,000 births globally.

Neonatal herpes can lead to serious complications, including brain damage, eye issues, or even infant death.

The risk of neonatal herpes is highest when a pregnant person contracts HSV in the third trimester of their pregnancy. The risk is also higher if a pregnant person has an outbreak around the time of childbirth. During natural childbirth, a baby can come into contact with the virus as they move through the cervix and vaginal canal.

The risk of neonatal herpes is lower if a person develops herpes before or at the beginning of pregnancy. The body will have enough time to produce protective antibodies, which the pregnant individual will pass on to the child through the placenta.

Pregnant people may want to avoid sexual contact with a person with genital herpes or use a condom to minimize the risk of transmission. They should also avoid oral sex with an individual who has a cold sore. Infection may still occur through contact with areas that a condom does not cover.

The Preventive Services Task Force does not recommend that all pregnant people undergo screening for herpes. However, people can ask for a test.

Reasons that a person may require herpes testing include having sexual contact with someone who has the infection or experiencing symptoms that are consistent with herpes.

Tests for herpes include the following:

  • Swab test: A healthcare professional will swab a herpes sore to collect fluid and cells.
  • Blood test: A healthcare professional will use a needle to take a sample of blood. Experts will examine the sample in a lab for signs of the virus or antibodies.
  • Lumbar puncture: Involves taking a sample of fluid from between two vertebrae of the spine using a long, thin needle. A doctor will only order this test if they suspect a person has an infection in the spinal cord or brain.

Both oral herpes and genital herpes can be asymptomatic, meaning that an individual with the infection has no symptoms.

When symptoms do occur, they may include:

  • tingling, itching, or burning before sores appear
  • painful blisters that burst and crust over, developing into sores
  • flu-like symptoms such as fever, body aches, and swollen lymph nodes

A pregnant person who experiences these symptoms can ask a doctor to test them for the HSV infection.

Antiviral drugs are the first line of defense against herpes during pregnancy. Medications, such as acyclovir, famciclovir, and valacyclovir, can reduce the severity and frequency of symptoms.

Doctors may prescribe antiviral medication that a person can take daily from 35 weeks of pregnancy until childbirth. This can prevent an outbreak close to birth and reduce the need for cesarean birth, or C-section.

According to a 2018 article, of 100 people who took preventive antivirals at 35 weeks into their pregnancy, only four needed a C-section. And of 100 people who did not take preventive antivirals, 13 needed a C-section.

Pregnant people should also try to avoid triggers that may cause a herpes outbreak, such as stress and fatigue.

Below are some common questions regarding herpes and pregnancy.

How can you prevent your baby from getting herpes?

While no method can guarantee the prevention of a fetus or baby from acquiring an infection, a person can lower the risk by:

  • taking antiviral medications a doctor prescribes toward the end of pregnancy
  • having a C-section birth if doctors think there is a high risk of a baby contracting an infection during natural childbirth
  • stopping breastfeeding if they notice a sore on or around the nipple, until they can have an HSV test
  • covering active cold sores and washing their hands regularly
  • avoiding kissing a baby until a cold sore has completely healed

Can you have a healthy pregnancy with herpes?

A person with herpes has a good chance of having a healthy pregnancy. Because herpes lies dormant for months or years at a time, some pregnant individuals may not experience an outbreak during their pregnancy.

Most people with herpes have mild symptoms, although first-time infections can be more severe.

Can you give birth naturally if you have herpes?

Most people with herpes can have a vaginal birth. A doctor can test the skin for signs of herpes shortly before the birth. If a person shows signs of infection, doctors may recommend a C-section to lower the risk of transmitting the infection to the baby.

C-sections lower this risk by delivering the baby through incisions in the abdomen and uterus. This prevents them from contracting the virus in the birth canal.

For most people, having herpes during pregnancy does not affect their pregnancy, childbirth, or fetal health. In those who develop herpes infection in the final trimester, the virus passes on to their fetuses in 30–50 out of 100 births.

For this reason, doctors recommend C-sections to lower the risk of infection.

The longer a person has the virus in their system, the more antibodies their body will produce. This can make recurrences less frequent. People who develop herpes before pregnancy or in the first two trimesters are likely to pass on antibodies to a fetus through the placenta. This gives them a small amount of protection against the virus.

Herpes is an oral or genital infection that occurs due to the HSV virus. Once a person has herpes, they will have the virus for the rest of their life.

Having herpes during the final trimester of pregnancy increases the risk of passing the infection on to a baby during childbirth. Neonatal herpes can be very dangerous for them.

There is no need for a pregnant person to have a herpes test unless they have had close contact with someone with herpes or are showing symptoms.

A pregnant individual can take antiviral medication in the final weeks of pregnancy to lower the risk of passing on the infection. They may also consider having a C-section.

Most pregnant people with herpes have a good chance of having a healthy pregnancy, childbirth, and baby.