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Genital Herpes in pregnancy.

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Query to a Gynecologist...

Hello Doctor,

Please let us know if it is safe to go for a normal delivery when the Mother-to-be had suffered from genital herpes outbreak a couple of years ago.

The mother-to-be has not seen an outbreak again after the first one(which was almost two years ago).

What are the chances that the baby contracts the disease, when the mother-to-be has shown no signs of an outbreak for a very long time ?

Do you recommend normal delivery or cesarean delivery...and the reasons for the recommended advice.

Thanks in advance,
Kiran

Category: OBGYN

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Category: Infertility Specialist
 19 Doctors Online

Hello
Thanks for writing to us at DoctorSpring.com with your health concern.
The risks of perinatal transmission of herpes ( transmission from the mother to the baby ) are -
Primary HSV infection - Transmission rate of 50%
Nonprimary first-episode infection - Transmission rate of 33%
Recurrent infection or asymptomatic shedding - Transmission rate of 0-4%
Since the mother comes under the third category ( the last outbreak was 2 years back, and there was no active outbreak during pregnancy ), the risk of transmission is less than 4 %.
In this scenario, if she has no further outbreak till labour, then vaginal delivery can be attempted.
All the best.
Please feel free to discuss further.
Thankyou



Patient replied :

Hello Doctor,

Thankyou very much for the clarifications.

If cesarean delivery is opted for, does the 4% risk also not be there ? If yes, should we opt for cesarean delivery ? Please advice.

Is some medication recommended for the mother-to-be, to ensure that there is no outbreak during delivery time ?

If the baby does contract Herpes through perinatal transmission, what does it mean ? Is it life threatening for the child ? Should some special care of the baby be taken after birth ?

Also, there is a correction in the data provided. The last outbreak was 5 years ago and not 2 years ago. Does this information change anything ?

Thankyou in advance for the clarifications.


Hello,
Yes with Cesarean delivery, the risk is less than 4 %, but not 0.
The difference is not great enough, to warrant operative delivery.
5 years back means that the chances of transmission are even lower than 4 %.
Herpes in the baby can be a serious condition, unlike adults, as it can affect the brain, heart, lungs etc.
Prophylactic acyclovir from 36 weeks onwards is recommended to prevent outbreaks during labour, but this recommendation is only for women who have had primary herpes outbreak during pregnancy, and those with active lesions.
For an outbreak 5 years back, this treatment is not recommended.
Hope the answer clears your doubts.
Wish you luck


Dr. Aarti Vazirani
Category: Infertility Specialist
Experience: 
Residency: Obstetrics & Gynecolog, BJMC,Civil hospital, Ahmedabad, 2008
Post Graduate: MS (Obstetrics & Gynecology), B.J. Medical College, Ahmedabad, 2008
Medical School: MBBS, B.J. Medical College, Ahmedabad, 2004
Dr. Aarti Vazirani and 4 other Medical Specialists are ready to help you

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