Navigating a Herpes diagnosis whilst also trying for a baby? With 50% of sexually active people carrying at least one STI by 25 years old, it’s likely you’re in good company. Obstetrician/ Gynaecologist Dr Kara Thompson shares her top tips for pregnancy, labour and birth if you're Herpes Simplex (HSV) positive.
Can I have a healthy pregnancy with Herpes?
“...The overwhelming majority of people with a history of HSV have completely normal pregnancies and give birth to a healthy baby.”
First things first. “...The overwhelming majority of people with a history of HSV have completely normal pregnancies and give birth to a healthy baby.” Particularly if symptoms are managed and under control at the time of birth, Dr Thompson stresses.
This is particularly important to know, as different clinicians may have varying responses to fertility management and HSV. Hazel* had a confronting experience on a visit to her local GP for a prescription for her herpes symptoms, which she felt was an unnecessary approach to herpes and fertility management.
“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.”
Should I have a caesarean if I have herpes?
Experiencing your first outbreak during the third trimester? Then a caesarean birth may be recommended. “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. 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.”
“Much more commonly, a woman goes into pregnancy having already had genital herpes at some point in the past. In this case, 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. If you have a recurrent genital herpes lesion at the time of vaginal birth, the chance of the baby being infected is around 1-3%. 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.”
“The final thing to keep in mind, is that if you are recommended to have a caesarean for herpes by your medical team, that doesn't mean you will need caesarean births for all your babies. 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 any medication to manage herpes in pregnancy?
“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. 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.”
“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.”
How do I deal with herpes while I'm pregnant?
Knowledge is power. So is timely management of symptoms. Staying on top of your symptoms can help reduce the impact they may have on your fertility. Whilst other STIs, like Chlamydia and Gonorrhoea, can lead to infections that have the potential to damage the fallopian tubes and uterus, getting tested and receiving treatment has the power to prevent this damage.
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.”
Herpes and pregnancy can harmoniously coexist, fertility doesn’t have to be hampered in response to a diagnosis. All that’s required is the right information to navigate the space with confidence.