Genital herpes and pregnancy: The causes, when to seek help, diagnosis and management

What is genital herpes?

Genital herpes is a common sexually transmitted infection caused by the herpes simplex virus (HSV). There are two types, HSV 1 and HSV 2, both of which can cause infection in the genital and anal area (genital herpes). Herpes simplex can also occur around the mouth and nose (cold sores) and fingers and hand (herpetic whitlows).

In women, genital herpes can occur on the skin in and around the vagina, the vulva (lips around the opening of the vagina), the urethra (tube through which urine empties out of the bladder), and the anus (back passage).

How do you get genital herpes?

Genital herpes is usually passed from one person to another during sexual contact. Both women and men can get it. The virus enters the body through small cracks in the skin or through the thin skin of the mouth or genital area. Once you have the virus it stays in your body for life although remains inactive for most of the time.

You may only get one episode, or you may have repeated flare-ups. It can be passed on:

• through skin to skin contact with the affected area when the virus is active
• by having unprotected vaginal, anal or oral sex or sharing sex toys

The causes of genital herpes

The Herpes Simplex Virus (HSV)

Genital herpes is caused by two types of herpes simplex virus. both of which can cause infection in the genital and anal area (genital herpes):

1. HSV-1: Traditionally associated with oral herpes – also known as cold sores. HSV-1 now accounts for an increasing number of genital herpes cases due to oral-genital contact.

2. HSV-2: The most common cause of genital herpes. This is primarily spread through sexual contact.
Both viruses establish lifelong infections. These remain dormant in nerve cells and reactivate periodically.

Transmission of genital herpes

Genital herpes is transmitted in three different ways:

1. Skin-to-skin contact: HSV spreads through direct contact with infected sores, saliva, or genital secretions. It can be passed person to person by having unprotected vaginal, anal or oral sex or by sharing sex toys.

2. Asymptomatic shedding: The virus can transmit even when no visible symptoms are present, a key factor in its spread.

Vertical transmission: Pregnant women can pass HSV to their baby during childbirth, increasing the risk of neonatal herpes.

Genital herpes: The risk factors

There are a number of risk factors that can increase the chances of the transmission of genital herpes:

• Unprotected vaginal, anal, or oral sex.
• Multiple sexual partners.
• A history of Sexually Transmitted Infections (STIs).
• Compromised immune systems (HIV / AIDS).

What are the symptoms of genital herpes?

Some people have no signs or symptoms at all. Some people just get a few blisters in the genital area, which are not particularly painful. Flare-ups are usually mild. An early warning tingling sensation often happens before the flare-up occurs.

However, for some people, the symptoms can be very painful. This is particularly so if it is your first episode when you may also feel unwell and notice very painful sores or watery blisters.

Symptoms can occur within a short time of coming into contact with the virus or it may take many weeks, months or years before any signs or symptoms appear.

Recognizing the symptoms of genital herpes

The first or primary outbreak: The first episode of genital herpes is often the most severe. It can feature:

• Painful blisters or ulcers on or around the vagina, genitals, thighs, or anus.
• Itching, burning, or tingling before sores appear.
• Flu-like symptoms (fever, swollen lymph nodes).

Second and subsequent outbreaks: Subsequent episodes of genital herpes are usually milder, with more localized sores and a shorter duration.

Complications of genital herpes requiring immediate care

There are four main complications of genital herpes that require immediate care:

1. Neonatal Herpes: Newborns exposed during delivery may develop life-threatening infections. Pregnant women with herpes must contact and inform their doctor or healthcare provider.

2. Meningitis or encephalitis: These are rare but serious, neurological complications.

3. Severe pain or urinary retention: These require immediate medical intervention.

4. Psychological distress: Anxiety or depression that is linked to diagnosis of genital herpes demands professional counselling.

What should I do if I think I have genital herpes?

Contact your doctor or a clinic that specialises in sexually transmitted infections (called genitourinary medicine clinics or sexual health clinics). You should have a check-up that will include testing, treatment and advice.

It is possible to have more than one sexually transmitted infection at the same time. You may be offered testing to check for other infections too.

What if I get genital herpes for the first time in pregnancy?

What treatment will I be offered?

You should be referred to a specialist genitourinary medicine clinic. You will be offered testing, treatment and support. You may be admitted to hospital if this first episode is very painful, or you cannot pass urine.

Genital herpes can be safely treated during pregnancy. You will be offered a course of antiviral tablets. This medication is safe to take in pregnancy and whilst breast-feeding.

What will a first episode in pregnancy mean for me and my baby?

If your first episode happens in the first three months of pregnancy, your baby is not more likely to have developmental problems and your risk of miscarriage is not increased. Later in pregnancy a first episode should not affect your baby unless you are in labour (see below).

If you go into labour less than six weeks after a first episode of genital herpes, your immune system won’t have time to produce antibodies to protect your baby. Therefore there is a high chance of passing the virus to your baby if you have a vaginal birth. If your first episode is earlier in pregnancy your immune system will provide protection to your baby.

Neonatal herpes

When a baby catches the herpes virus at birth, it is known as neonatal herpes. It can be serious, but is very rare in the UK (1 to 2 out of every 100,000 newborn babies). Your baby will be looked after in a neonatal unit by a specialist team of doctors.

How can I reduce the risk of genital herpes to my unborn baby?

Medication for you and your baby should help prevent or reduce the chance of your baby being seriously ill:

• If your first episode is before 28 weeks of pregnancy you may be offered anti- viral treatment at that time and again from 32 weeks of pregnancy until your baby is born.
• If your first episode is at or after 28 weeks of pregnancy you will be advised to continue your treatment until your baby is born.
• If you are at risk of giving birth before 37 weeks, anti-viral treatment should start from 22 weeks.

If your first episode is late in pregnancy (within six weeks of your due date) you should be offered a planned caesarean section to reduce the chance of your baby getting neonatal herpes.

If your first episode is earlier in pregnancy the risk to your baby is low and you should be able to have a vaginal birth. Talk to your midwife or doctor if you have any concerns.

What if I have recurrent flare-ups?

• If you have caught genital herpes before you become pregnant, your immune system will provide protection to your baby in pregnancy. Flare-ups of genital herpes during pregnancy do not affect your baby.
• Even if you have a flare-up when you go into labour and give birth, the risk to your baby is extremely low. Most women who have recurrent genital herpes can have a vaginal birth. Your doctor or midwife will discuss this with you.
• If you have frequent flare-ups during pregnancy, you may be offered continuous anti-viral treatment from 32 weeks of pregnancy to birth.

My partner has HSV, what can I do to reduce the risk to me and my baby?

During pregnancy, if your partner has an episode of HSV (cold sores, genital herpes or herpetic whitlows), you should avoid skin-to-skin contact with the affected area during the flare-up.

There is a very small risk that a sexual partner who has genital herpes can pass on the infection even when there are no signs or symptoms. You may consider using condoms throughout your pregnancy, particularly in the last three months.

After your baby is born make sure you wash your hands after touching any sores.

Priority cases of genital herpes

Pregnant women: Seek urgent care to prevent neonatal transmission. Antiviral therapy may be prescribed in the later stages of pregnancy.

Immunocompromised patients: More frequent/severe outbreaks of genital herpes require prompt treatment.

Clinical examination, testing and diagnosis of genital herpes

A doctor or healthcare provider will examine and symptoms, sores and review an individual’s medical and/or sexual history.

Laboratory tests for genital herpes

1. Viral culture: A swab is taken of a sore to detect HSV. This becomes less reliable as sores heal.

2. PCR test: A highly accurate DNA test for identifying HSV type.

3. Blood tests (Serology): Detect HSV antibodies. Limitations can include an inability to pinpoint the infection site or timing.

Differential diagnosis of genital herpes

Conditions such as syphilis, chancroid, or some allergic reactions may mimic herpes. Effective testing can ensure a more accurate diagnosis.

The management and treatment of genital herpes

Episodic therapy: Short-term use of antiviral medications such as acyclovir, valacyclovir during outbreaks to reduce the severity.
Suppressive therapy: Daily antivirals can be used to treat frequent recurrences of genital herpes. Antivirals can decrease the risk of transmission by up to 50%.

Symptom relief and care at home of genital herpes

• Pain relievers (ibuprofen). Please check suitability first with your doctor or healthcare provider.
• Warm baths with Epsom salts.
• Loose clothing and cool compresses to soothe sores.
• Lifestyle changes
• Stress management: Meditation or yoga can reduce the triggers for outbreaks.
• Healthy diet and sleep: Targeted nutritional therapy and healthy eating can support more effective immune function.

Strategies for the prevention of genital herpes

Condoms: Protected sex can reduce the risk of transmission of genital herpes.

Disclosure: Informing sexual partners will better enable informed decisions.

Avoiding sex: Avoiding sex during an outbreak of genital herpes lowers the chances of transmission.

Psychological support for genital herpes sufferers

Counselling or support groups Joining a counselling group can help address the stigma and the emotional challenges of living with genital herpes.

Conclusion

Although genital herpes is incurable, it is easily manageable with antivirals, lifestyle changes, and preventive measures. Early diagnosis and treatment of genital herpes can help mitigate complications and reduce its transmission. Breaking the stigma through education and communication is essential for improving the outcomes of sufferers. If you suspect you’ve been exposed to genital herpes or experience symptoms, consult a doctor or healthcare provider immediately.

*This article is for information only and is not a substitute for professional medical advice. It is important to always consult your own doctor or healthcare provider for specific guidance related to you.