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| |    Preventing Herpes Infections in Newborns by Marjorie Greenfield, M.D. Expectant couples with a history of genital herpes--in the father or the mother-to-be or both--are often concerned about the possibility of the baby becoming infected in utero or during childbirth. The development of a herpes infection in newborns is rare. But when it does develop, it can be devastating. The following information explains more about herpes infections in babies and details how to prevent transmitting the virus to your newborn. (For an overview of the issues surrounding women who have herpes and are expecting, see "Herpes and Pregnancy.") Herpes infections in the neonate If a baby does become infected with the herpes virus, he can have any of three kinds of presentations: localized infection of the skin, eye, and mouth; localized infection of the brain and spinal cord (central nervous system, or CNS); or an infection that involves multiple organs of the body, known as a disseminated herpes infection. Sometimes the symptoms will overlap. Babies with infection localized to the skin, eye, and mouth generally do better than those with CNS or disseminated disease; but even with treatment, some will later show signs of neurologic impairment. Despite antiviral therapy, many infants with disseminated or CNS disease die or have long-term severe disabilities. Women who have a history of herpes before becoming pregnant may find it somewhat reassuring to know that most newborns who do get herpes catch it from women who became newly infected during their pregnancy and had not yet developed protective antibodies when the baby was born. Methods of prevention For women who contracted genital herpes before conceiving--and who know they are infected--prevention includes reporting any lesions that appear in later pregnancy to your practitioner and being alert to the signs that tell you an outbreak is starting. This is particularly important because the virus can be shed from the skin a day or two before the sores are even noticed. If you have an outbreak at the time of labor, a cesarean will be performed to prevent the baby from passing through the infected birth canal. That said, it is important to know that most babies born to women with longstanding genital herpes will not get sick, even if they are born vaginally and a lesion is present or about to break out. Some women choose to take antiviral antibiotics, such as acyclovir or famcyclovir, after 36 weeks gestation in order to try to fend off an outbreak. If you've been under a doctor's supervision for the duration of your pregnancy, however, there's little likelihood of your baby getting sick--rendering the medication, for all intents and purposes, unnecessary. It may eliminate the need for a C-section, though. Expectant mothers who do not have genital herpes can best protect their babies simply by ensuring that they not contract the virus while pregnant. If a baby is born through an infected birth canal to a mother with a recently acquired infection, the rate of transmission of the virus to the baby is between 30 and 50 percent, and even with optimal treatment, many of these infants die or have permanent disabilities. Standard recommendations for preventing the transmission of herpes include consistent use of condoms and avoiding intimate skin-to-skin contact when lesions are present. If your partner has genital herpes, you might find it helpful to have a blood test that checks for evidence of herpes antibodies, since there is a good chance that you have already contracted the virus and not realized it. In that case, you would want to follow the recommendations as outlined above. If while pregnant you have unprotected sexual relations with someone who has had genital herpes, be sure to tell your practitioner so he can observe you for signs of infection and inform you about the most current guidelines for protecting your baby against this potentially devastating condition.
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