by Nicole Evans M.D.

Created on: August 16, 2009

Approximately 22% of pregnant women are carrying Herpes Simplex Virus type 2 (HSV-2), the virus that causes genital herpes. Almost 90% of these pregnant women are undiagnosed. These women are dangerously unaware of the risks to their unborn infant.

Of women who are unaffected prior to becoming pregnant, 2% will become infected during their pregnancy. However, even with a new infection, approximately 70% of are asymptomatic or simply not recognized as a herpes infection by the pregnant woman.

Why is it important to identify pregnant women who are HSV-2 positive? Certainly, this STD can cause the mother distressing symptoms. But the real concern is for the child she is carrying. Infants who are born to women who have had genital herpes are at risk of developing neonatal herpes, a potentially lethal condition.

There is a spectrum of neonatal disease conditions caused by the herpes simplex virus. This disease spectrum includes:

1. Skin, eye and mouth HSV disease

2. Central nervous system (CNS) HSV disease

3. Disseminated HSV disease

About 45% of infants will develop skin, eye, and mouth herpes lesions. This form of neonatal herpes is the least severe and does not affect the internal organs.

30% of infants with neonatal HSV will develop central nervous system (CNS) disease. Neonatal CNS herpes is manifest by:

-seizures

-lethargy

-irritability

-tremors

-poor feeding

-temperature instability

-a bulging fontanelle

Around 25% of neonatal herpes is of the most severe form, disseminated disease. Infants with disseminated herpes infection have multi-organ involvement. These infants can die from severe coagulopathy (defective blood clotting), liver dysfunction, and/or pulmonary failure.

If you are pregnant and have genital herpes, or had genital herpes in the past you must tell your doctor. This information is of vital importance in how your obstetrician will manage your pregnancy and delivery. This information is critical to the pediatrician who will care for your newborn infant.

However, as mentioned above, many pregnant women do not know that they are carrying the herpes simplex virus. Some of the common symptoms of genital herpes infection include:

- Vesicular and/or ulcerative lesions on external genitalia, perianal region, buttocks

- Vulvar or perianal fissures

- Mild discomfort, itching, severe local pain

- Dysuria (discomfort with urination)

- Vaginal or urethral discharge

- Sacral parasthesia

- Tender regional lymphadenopathy (swollen lymph nodes)

- Fever, malaise, myalgias, headache

- Aseptic meningitis, disseminated disease occurs rarely

Importantly, it is impossible to rely on clinical presentation for the diagnosis of genital herpes in a pregnant woman. Remember that many infections are asymptomatic. 75-90% of women are unaware of having the infection! Additionally, women may confuse their symptoms with other situations. For example, in women symptoms are often attributed to:

- Recurrent yeast infections, urinary tract infections (UTIs), bacterial vaginosis

- Allergies to condoms, semen, spermicides, pantyhose

- Irritation from sex

- Heat rash

- Hemorrhoids

If you are not sure whether you are HSV positive, you may want to ask your doctor to do a screening test for HSV-1 and HSV-2 antibodies. This information can then further guide the management of your pregnancy.

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