Herpes and Pregnancy: An Obstetrician Answers Your Questions
Written by Dr Kara Thompson, Obstetrician and Gynaecologist at Berth Geelong | Last reviewed June 2026
Navigating a herpes diagnosis while trying for a baby can feel isolating, but it shouldn't. With around 50% of sexually active people carrying at least one STI by age 25, according to sexual health research, a herpes diagnosis is far more common than most people realise.
"The overwhelming majority of people with a history of HSV have completely normal pregnancies and give birth to a healthy baby," says Dr Kara Thompson, an obstetrician and gynaecologist. This is particularly true when symptoms are managed and under control at the time of birth.
How different doctors respond to herpes in pregnancy, and why it matters
Different clinicians can respond very differently to a herpes diagnosis, and that inconsistency causes real harm. Hazel, who asked that her name be changed, experienced this firsthand during a visit to her GP for a herpes prescription.
"Out of nowhere, this male doctor decided to mansplain my condition to me. He pulled a medical book off the shelf and proceeded to show me images of a newborn baby covered in blisters, because it was born vaginally while the mother was having a herpes outbreak," she recalls. "He really tried to scare me, which was unusual because I hadn't asked anything about pregnancy and giving birth."
Experiences like Hazel's are exactly why clear, accurate clinical information matters. Fear-based scare tactics are not good medicine, and they are not necessary given how manageable HSV actually is in pregnancy.
Will I need a caesarean if I have herpes?
This depends entirely on timing, and the difference matters significantly.
"If you have HSV for the first time when you are pregnant, and are close to the time of giving birth, then there is a higher chance that the infection may jump onto the baby in the birth canal during a vaginal birth," Dr Thompson explains. "In these circumstances a caesarean birth would be recommended to reduce the chance of your baby getting the virus, as babies can get very unwell if they do get infected with HSV as a newborn. However, this scenario is quite uncommon."
Far more commonly, a woman enters pregnancy having already had genital herpes at some point in the past. "Because the infection has been around for a much longer time prior to giving birth, there is a much smaller chance of the baby being infected during a vaginal birth," Dr Thompson says. "If you have a recurrent genital herpes lesion at the time of vaginal birth, the chance of the baby being infected is around 1 to 3%. If there are no lesions present at the time of birth, the risk is less than 1%. Because of this, if you do have a genital lesion present at the time you are in labour, a caesarean birth will be recommended."
A caesarean for one birth does not dictate future births. "A lot of women choose to try for a vaginal birth after a caesarean in their next pregnancy, which for most women is a safe way to give birth and a great option to keep in mind."
Will I need medication to manage herpes in pregnancy?
Suppressive antiviral medication is a common and effective approach. "In order to make it much less likely that you will have a lesion at the time of birth and be recommended to have a caesarean, one option is to take medication to suppress the virus from around 36 weeks," says Dr Thompson. "The most common medications recommended are antivirals, Aciclovir or Valaciclovir. In particular, this is recommended for people who have had frequent recurrences of their herpes lesions."
Antiviral medication can also be valuable for comfort alone. "Women who are planning on birthing their baby via caesarean section for another reason may still wish to be on antiviral medications for their own comfort if they are having frequent or painful outbreaks during pregnancy."
Can diet and nutrition reduce herpes outbreaks during pregnancy?
A well-supported immune system can help the body respond more effectively to recurrences, which makes general health maintenance, including a healthy diet, regular exercise and adequate sleep, a worthwhile investment during pregnancy.
Some people with herpes report that reducing high-arginine foods, such as chocolate and nuts, may reduce the frequency or severity of outbreaks, though individual responses vary considerably and this is not a substitute for medical management. A naturopath or dietitian can help build a personalised approach. Maintaining baseline nutrient levels with a quality prenatal vitamin supports overall immune resilience through pregnancy, though it should be considered a supportive measure rather than a treatment for HSV itself.
The Prenatal by moode is Australian made and contains a full B complex, zinc and calcium folinate to support general immune and nutritional health through pregnancy. Always read the label and follow directions for use.
What should I actually do if I am pregnant and have herpes?
Knowledge and timely management are the two most useful tools available. Knowing your personal triggers and recognising the early signs of an outbreak allows you to act quickly, whether that means starting antiviral treatment or planning your birth approach with your care team.
As Dr Thompson stresses: "HSV is incredibly common and absolutely nothing to be ashamed of. In fact, one way to look at it is that if you are aware of the condition, that is actually a bonus. Knowledge is power. Many women are unaware that they have a history of genital herpes, and then they aren't in a position to take steps to reduce the risks in pregnancy. In fact, research tells us that most mums whose babies are diagnosed with herpes following birth had no idea that they had a history of ever having HSV. Being aware of your HSV status gives you a great opportunity to reduce these rare risks."
This distinguishes herpes meaningfully from other STIs such as chlamydia and gonorrhoea, which can cause silent damage to the fallopian tubes and uterus if left untreated. With HSV, awareness itself is the primary protective tool. For more detail on how different infections affect long term fertility, see Having an STI and Trying to Conceive.
moode answers your questions about herpes and pregnancy
Can herpes be passed to my baby during pregnancy, not just at birth?
Transmission during pregnancy itself, rather than at birth, is rare. The much more significant risk window is during vaginal delivery if an active lesion is present, which is why birth planning, not pregnancy itself, is the primary clinical focus.
Is it safe to take antiviral medication throughout pregnancy?
Aciclovir and Valaciclovir are both considered safe options during pregnancy and are commonly prescribed from around 36 weeks for suppressive therapy. Discuss timing and dosage with your obstetrician based on your specific history of outbreaks.
Will my baby be tested for herpes after birth if I have a history of HSV?
Not routinely, unless there are visible lesions at the time of birth or other risk factors identified by your care team. Most babies born to mothers with a history of herpes, particularly when managed appropriately, show no signs of infection and require no special testing.
Does having herpes affect my ability to conceive?
No. Herpes does not affect fertility. It has no impact on ovulation, egg quality or sperm function. The relevant considerations for HSV are entirely related to pregnancy management and birth planning, not conception itself. For more on what does and does not affect fertility across different STIs, see Having an STI and Trying to Conceive.
Should I tell my obstetrician about my herpes history even if I have no current symptoms?
Yes, always. Even a distant or infrequent history of HSV is clinically relevant information that helps your care team plan appropriately for your birth, including whether suppressive antiviral therapy near term is worth discussing.
About Dr Kara Thompson
Dr Kara Thompson is an Obstetrician and Gynaecologist at Berth Geelong, with a clinical interest in pregnancy management for women with sexually transmitted infections.
