Recurrent genital herpes in pregnancy

Women who develop genital herpes for the first time while they are expecting a baby are subject to several serious risks. If a primary genital herpes infection shows up in the first trimester, there is the risk that the infection will be passed on to the fetus through the placenta, and cause birth defects. This is, after all, a crucial time in fetal development. In the third trimester, a primary genital herpes attack might well lead to a cesarean section. Newborn herpes can be extremely dangerous, and it can of course be passed on during a vaginal birth. But what if you suffer a secondary attack of genital herpes in pregnancy?

A recurrent outbreak of genital herpes when you are expecting a baby is much less risky than a first outbreak. Studies into the subject showed between zero and three percent risk that herpes will be passed on to the baby, something which could result in neonatal HSV. Because the mother will already have had the chance to develop antibodies, the chance of transmission is much smaller. If you have active herpes lesions on your cervix, in the vagina, or on the outer parts of the genitals, and you are close to your due date, it might still mean your doctor will recommend a c-section. You will discuss the risks of a vaginal delivery with a secondary herpes outbreak vs the risks of a c-section with your healthcare providers.

Your location also matters. In the United Kingdom, cesareans are generally recommended for recurrent genital herpes in the third trimester, while other European countries such as the Netherlands aim for vaginal births in these cases.It will be up to you to weigh the risks and advocate for your choice of delivery if you have secondary herpes.