Herpes and Pregnancy: Risks to Baby and Management Strategies

HSV-1 (oral herpes) is extremely common (~67% global prevalence). It can be transmitted to infants/children, but risk depends on outbreak status.

Transmission to Children

• During active outbreak (cold sore): High risk via kissing, sharing utensils, touching sore then child.
• No visible outbreak: Asymptomatic shedding occurs but at lower viral load. Transmission possible but less likely.
• Genital HSV-1: Can transmit to neonate during vaginal delivery if active lesions present.

Neonatal Herpes (Critical)

• Most often from HSV-2 (genital) during delivery.
• HSV-1 can also cause neonatal herpes if mother has primary genital HSV-1 infection near term.
• Manifestations: skin/eye/mouth (SEM), CNS (encephalitis), disseminated.
• Cesarean delivery indicated if active genital lesions/prodrome at labor.

Pregnancy Management

• Suppressive acyclovir/valacyclovir from 36 weeks if recurrent genital herpes.
• No routine serologic screening for HSV in pregnancy (per ACOG).
• If primary infection in pregnancy → high risk of transmission; specialist care needed.

Practical Advice for Parents with Oral HSV-1

• Don't kiss child when you have active cold sore.
• Don't share utensils, cups, food during outbreak.
• Wash hands frequently.
• When no outbreak: normal affection is generally safe; shedding risk is low.

Children usually have mild illness (gingivostomatitis) if infected. Severe complications (encephalitis) are rare.