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Q: Can genital herpes create problems in early pregnancy or harm fetal development? Dangerous to baby-to-be?

A: Try to calm your fears. Stress itself can cause recurrent herpes outbreaks. About 80 percent of women with herpes will have an average of two to four recurrences during pregnancy. Some occur without symptoms as well.

Infection is transmitted only rarely across the placenta or intact membranes. When the fetus does become infected, it is almost always by the virus that is shed from the cervix or vagina. The virus then either invades the uterus following rupture of membranes or comes into contact with the fetus at delivery.

Some research shows a slightly increased risk of miscarriage or preterm labor if the initial outbreak of herpes occurs during pregnancy. No fetal anomalies have been identified with herpes during pregnancy.

Your care provider should know about all outbreaks or suspicious episodes. Cultures can be taken but generally, only active lesions or symptoms suspicious of an upcoming outbreak at the time of the delivery warrant cesarean birth.

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Q: I have had herpes for 10 years, with five outbreaks in the 13 weeks of this pregnancy. You said that a woman having an outbreak while in labor our delivering should have a cesarean and not attempt a vaginal birth. What are the statistics for babies contracting herpes in vaginal birth during outbreaks? I want to avoid a cesarean at all cost but, want to know the real risks in percentages. Is there something that I can do to stop all of these outbreaks. I have most outbreaks after being short on sleep.

I have had herpes for 10 years, with five outbreaks in the 13 weeks of this pregnancy. You said that a woman having an outbreak while in labor our delivering should have a cesarean and not attempt a vaginal birth. What are the statistics for babies contracting herpes in vaginal birth during outbreaks? I want to avoid a cesarean at all cost but, want to know the real risks in percentages. Is there something that I can do to stop all of these outbreaks. I have most outbreaks after being short on sleep.

A: Adverse pregnancy outcomes are more likely when the initial outbreak of genital herpes is during pregnancy, because with the first episode, there are usually no maternal antibodies for the baby.

“Williams Obstetrics” (1997) states that the presence, absence or frequency of recurrences does not predict asymptomatic shedding at delivery. Such shedding appears to be an entirely random event of short duration, usually less that seven days. There is more than a 95 percent chance of a negative culture seven days after an episode of asymptomatic shedding during pregnancy.

We no longer recommend weekly cultures to detect asymptomatic shedding, and cultures taken during labor are rarely positive. It is known that genital cultures for herpes are not predictive of the risk for neonatal infection.

The following approach is now used by most services (American College of Obstetricians and Gynecologists):

1. Cultures are taken to confirm the diagnosis when a pregnant woman has lesions If there are no visible lesions at the onset of labor, then vaginal delivery is acceptable
2. Weekly surveillance cultures of women with a history of herpes but without lesions are not necessary and vaginal delivery is acceptable.
3. Cesarean delivery is performed if primary or recurrent lesions are visualized near the time of labor or when the membranes are ruptured or if there are prodomal symptoms of a recurrence.

Nearly half of all those newborns infected with herpes virus are preterm. Primary herpes causes infection in infants about 50 percent of the time and only four to five percent of the time with recurrent disease. Another study showed no infants infected with exposure to recurrent disease.

This data might lead us to believe that even if a mother has evidence of a lesion or who is suspicious of asymptomatic shedding might attempt a vaginal delivery. But I don’t know any care provider who would recommend a vaginal birth under these circumstances.

I wish you the best making this decision. It is not uncommon for herpes infection to decline in the later weeks of pregnancy, so I hope you won’t have to worry.

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* I have several up-to-date, good quality latex condoms, dams and/or gloves — whichever I need for the specific sexual activities I want to engage in — and both I and my partner know how and when to use them, and are both willing to do so without argument in line with the infection risks we wish to reduce.
* I have a large bottle of latex-safe lubricant (KY, Liquid Silk, Astroglide, Wet, etc.) for use as needed.
* If I am having opposite-sex intercourse, and I or my partner are not comfortable using condoms alone, I have a secondary method of birth control. If I am using condoms alone, I and my partner know how to use them properly and know my partner will do his or her part to always use them.
* I have a list, or know where to find one easily, of local sexual health clinic or gynecologist phone numbers.
* I have some money of my own, or access to money, I can use at any time to take care of any needed birth control, safer sex items and annual testing and sexual health care or sexual crisis management, like abortion, for myself or my partnership AND/OR am aware of and participating in a national, state or city program which can provide me with, or subsidize all or some of, my needed birth control, safer sex, sexual health or sexual crisis management, like abortion.
* I am covered under a health insurance policy or public health program, which could cover pregnancy, neonatal care, gynecological visits, STI testing and/or birth control, or I have or can raise the funds to pay for these services myself.

Those material items are ideal to prevent and deal with disease, illness, infections or pregnancy (when applicable). Obviously, your mileage may vary when it comes to what sexual health and sexuality items might be covered by your insurance or your country, city or state’s services provided to you for free or low-cost. These items may also be limited by your age or personal or family means. There is no sex, save masturbation — no matter how long you and your partner have known each other, or what you have convinced yourself of — that does not carry some risks, no matter how safe you play it, and reducing and managing those risks often costs money.

Some things were not included. For instance, I didn’t say you needed to be able to insist on using a condom if your partner didn’t want to use one, because a partner who doesn’t want to take good care of both of you isn’t one you should be sleeping with. It’s really that simple. Toss the checklist to your partner too: talk about the items on it together. This is about both of you. You may find that simply discussing the reality of the situation makes a big difference for you both. A lot of sex is innate and intuitive, and it is perfectly normal to feel driven by our libido and our emotions, but it isn’t smart to ignore good sense and responsible behavior, or the practical parts of sex, because of those feelings and desires. Rather, when we have our basic needs in place, it can be a lot easier to be spontaneous and free-spirited with sex.

That’s a lot to look at, we know. How did you do? What do you have already set, and what might you need to look into evaluating, talking about or acquiring?

Realistically, even most adults will not check every single thing on this list. But we can safely say that any person who is realistically ready for partnered genital sex should have a lot of what is on this list, as should their partner. If you can see some areas where you’re lacking, give yourself some time to think about them, maybe re-evaluate, slow down, and take extra time before you become sexually active to work on being able to say “yes” to those items. When you see weak spots in what you’ve got on the list, how about just doing some work on those? In talking to a partner who feels they’re ready, you might want to remember this list so that you can better articulate and explain in what areas you don’t feel you or they are really ready.

There isn’t a statute of limitations on your sex life, and it doesn’t begin or end with intercourse. You can initiate any level of it at any time during your life, and change what you want to do as you go along, determining at any time what is best for you, and for your partner(s). If you haven’t checked almost all of the things on those lists, take a look at the ones you didn’t check and try and figure out what you need to do for yourself right now. There is no reason to set yourself up for a fall, or rush into something that won’t be enjoyable or rewarding, when it isn’t going to go away if you wait. Be honest with yourself, and above all else, do what is right for YOU.

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