From the Guidelines
If you have herpes and are planning to give birth, it's recommended to discuss your condition with your healthcare provider early in pregnancy, and if you have active genital herpes lesions at the time of delivery, a cesarean section (C-section) is typically recommended to prevent transmission to the baby, as supported by the most recent evidence from 2022 1. When considering vaginal delivery in a patient with genital herpes, several factors come into play, including the risk of transmission to the newborn, the presence of active lesions, and the use of antiviral medication.
- The risk of transmission is greatest when a woman has primary HSV infection, with a range of 30%--50% 1, and much lower (0--5%) for infants born to women shedding HSV caused by reactivated infection 1.
- Genital shedding of HSV at the time of delivery is associated with increased risk for transmission, and prolonged rupture of membranes (>6 hours) also increases the risk for HSV transmission to the infant 1.
- Cesarean delivery substantially lowers the risk for transmission 1.
- The use of antiviral medication, such as acyclovir (400mg three times daily) or valacyclovir (500mg twice daily), starting at 36 weeks of pregnancy, can reduce the risk of an outbreak during delivery and decrease viral shedding, thereby lowering transmission risk 1.
- It is essential to note that the American College of Obstetrics and Gynecology recommends against routine screening for HSV serostatus during pregnancy based on a lack of evidence for cost-effectiveness, as stated in the 2022 guidelines 1.
- Regular prenatal care and open communication with your healthcare team about your herpes status are crucial for planning a safe delivery, as the risk of transmission can be significantly reduced with proper management and precautions.
- In cases where the woman has no active lesions or symptoms at delivery time, vaginal birth is usually safe, but this should be determined on a case-by-case basis, taking into account the individual's specific situation and medical history.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Recommendations for Vaginal Delivery in Patients with Genital Herpes
The following are recommendations for vaginal delivery in patients with genital herpes (Herpes Simplex Virus, HSV):
- For women with a first episode of genital herpes during pregnancy, daily suppressive antiviral treatment with acyclovir or valacyclovir is recommended from 36 weeks of gestation until delivery 2.
- A cesarean section should be performed in case of suspicion of first episode genital herpes at the onset of labor, or premature rupture of the membranes at term, or in case of first episode genital herpes less than 6 weeks before delivery 2.
- For women with recurrent genital herpes, antiviral prophylaxis should be offered from 36 weeks of gestation until delivery 3, 4.
- Vaginal delivery can be considered in women with recurrent genital herpes if there are no clinical recurrences or prodromal symptoms at the onset of labor, and the membranes are ruptured after 37 weeks of gestation in an HIV-negative woman 3, 4.
- Cesarean delivery should be considered in women with recurrent genital herpes if the membranes are intact, or in case of prematurity, or in case of HIV-positive woman 3.
Antiviral Treatment
The following antiviral treatments are recommended:
- Acyclovir 200mg 5 times daily or valacyclovir 500mg twice daily for 5 to 10 days for recurrent herpes during pregnancy 3.
- Acyclovir 400mg 3 times daily or valacyclovir 500mg twice daily for daily suppressive antiviral treatment from 36 weeks of gestation until delivery 3, 2.
- Acyclovir 200mg 5 times daily or valacyclovir 1000mg twice daily for 5 to 10 days for first episode genital herpes during pregnancy 2.
Risk of Neonatal Herpes
The risk of neonatal herpes is around 1% in women with recurrent genital herpes 3. The risk of neonatal herpes is higher in women with first episode genital herpes during pregnancy, especially if the infection occurs less than 6 weeks before delivery 2.