Herpes in pregnancy

Herpes in pregnancy: description

When talking about “herpes”, it usually refers to an infection with herpes simplex. The trigger is herpes simplex virus type 1 (HSV1) or type 2 (HSV2). An initial infection with HSV1 usually takes place in younger years, often already as a baby or toddler. With HSV2 sufferers usually become infected through unprotected intercourse.

The herpes simplex viruses are excreted by acutely ill persons and transmitted mainly by direct physical contact, more rarely by droplet infection, to a healthy person. Anyone who has been infected with herpes once, will not let go of it for a lifetime. Although most of the time the viruses sleep unnoticed in certain nerve cells, however, it can come at any time to a renewed herpes outbreak, if the immune system is weakened. However, such reactivations usually run weaker and shorter than a first infection with herpes.

Pregnancy can reactivate viruses

Herpes in pregnancy is not uncommon, as the associated hormonal changes may even encourage virus reactivation. Therefore, some women suddenly experience herpes again during pregnancy after being spared years of outbreaks.

The pregnancy-related hormone changes seem to slightly weaken the immune system and thus make it easier for herpes viruses to get out of their “nerve cell hiding place”. A similar phenomenon is observed in some women also during menstruation. The risk of first infections, however, is not greater during pregnancy than usual

Herpes in pregnancy: So he transfers to the child

There are three ways in which the herpes simplex virus can be transmitted from the mother to her child. On the one hand on the cake (transplacental) during pregnancy, on the other hand during the birth process (intrapartum) by contact infection and finally shortly after birth (postpartum).

About 85 percent of the infections occur at birth, about ten percent thereafter and about five percent occur during pregnancy. Herpes can only be transmitted transplacental if the herpesviruses circulate in the bloodstream of the mother, so there is a so-called viremia. This complication, also known as herpes sepsis, is very rare. Due to a common outbreak of lip or genital herpes infection of the fetus on the mother cake can not take place.

However, genital herpes infections can also rise above the vagina and infect the child in the uterus. However, this happens only after the rupture of the bladder, when the cervix is ​​already open and the viruses can penetrate more easily.

If the mother suffers from an active genital herpes during childbirth, there is a relatively high risk of transmission to the baby. Herpes is transmitted directly from the diseased areas in the genital area of ​​the mother to the newborn, while this passes the birth canal.

Incidentally, even after the birth there is a risk of infection with herpes. Newborns do not yet have a fully developed immune system and are therefore much more susceptible to infection.

Herpes in pregnancy: what role does the virus type play?

In case of herpes in pregnancy, the region in which the disease breaks out is of crucial importance. Because the risk of transmission to the child depends on it.

For herpes in infants usually HSV2, the typical causative agent of genital herpes, responsible. However, it can also happen that genital herpes is triggered by HSV1. This is usually done via a so-called orogenital transmission, so by the transport of viruses from the mouth to the genital area in oral sex. If the genital herpes of the mother is due to an HSV1 infection, then the child is also infected with HSV1 in the event of infection during the birth. Both types of virus can trigger herpes in the baby and mother, but HSV2 is much more responsible.

Herpes in pregnancy: Why are primary infections more dangerous?

It makes a difference whether it is a herpes in pregnancy is a first-time infection, or a reactivation already existing in the body of viruses. On the one hand, because first infections usually last longer and thereby more viruses are eliminated, but especially because the mother still has no antibodies, if they had never before had contact with the herpes simplex virus. Although antibodies can not prevent reactivation, they are milder than a primary infection.

The antibodies are also passed on to the child during pregnancy. When it becomes infected with herpes at birth, it helps to fight the virus and cause a weakened course of the disease or even prevent infection. If, on the other hand, an outbreak of herpes during pregnancy is a primary infection, the child has no antibodies and is at the mercy of the virus.

Herpes and Baby: The symptoms in the newborn

Herpes in the newborn (herpes neonatorum) is a serious disease and in terms of severity and possible complications not to compare with the disease progression of herpes in adults. Due to the still weak immune system, the viruses can proliferate more and spread throughout the child’s body.

After infection, it takes a few days for the child to experience symptoms. Sometimes even weeks pass before it comes to first complaints. The herpes viruses enter the child’s body via the skin, mucous membrane or eyes, where they first multiply in superficial skin cells or in the cornea of ​​the eye. Most of the time, however, it does not remain in a small area, but instead there is a widespread infestation of the entire body surface and the mucous membranes.

One speaks then also of a disseminierten or generalized herpes infestation. This creates the typical small cold sores on the skin, which burst after some time and leave ulcers on the skin. In the eye it comes through the herpes viruses to inflammation and clouding of the cornea (cornea), sometimes the infection attacks even on the inside of the eye, which can lead to blindness. In addition to these symptoms, common, nonspecific symptoms such as fever, vomiting, refusal to eat, and excessive fatigue often occur.

However, the greatest risk of herpes infection in the newborn is the involvement of internal organs and / or the central nervous system. Because only in about half of the cases, the infection is limited to skin and eyes alone. The herpes then affects, for example, the lungs, liver or other organs, or even leads to blood poisoning (sepsis). In the worst case, even the brain is affected, so that it comes to the dreaded herpes simplex encephalitis. Such, often accompanied by seizures brain inflammation is extremely dangerous and often ends with the death of the newborn.

The symptoms of the unborn child

If there is a transplacental transmission of the virus to the unborn child during pregnancy, this usually results in serious complications. For example, malformations of the fetus (microcephaly, hydrocephalus, microphthalmia) occur or the mother even suffers a miscarriage. Infection of the still unborn child is herpes in pregnancy but fortunately very rare.

Herpes in pregnancy: diagnosis

A routine investigation for herpes in pregnant women who show no symptoms is currently not recommended by the guidelines, unless episodes of genital herpes are known to the sexual partner. In rare cases, however, the mother may excrete viruses, although there are no clinical symptoms. Therefore, the newborn must be expected with herpes, if the mother is apparently healthy.

Herpes in pregnancy: prognosis and protective measures

The danger of a herpes in pregnancy is not for the mother, but for the child. If the embryo becomes infected in the uterus, malformations and miscarriages are very often the result. In infected newborns, the consequences and chances of recovery depend very much on how strongly the central nervous system is affected. In meningitis, the prospects of survival are poor, but the central nervous system is spared, early treatment is usually successful. Left untreated, about 50 to 80 percent of herpes infected newborns die.

Sometimes it comes to the affected children years after a herpes neonatorum to dangerous reactivation, in which the viruses often attack the retina of the eye and can lead to blindness. Such a reactivation can also occur if the initial infection itself was mild. and was successfully treated early on.

Herpes in pregnancy: How to protect yourself and your child

In order to avoid the life-threatening herpes infection in the newborn, expectant parents should pay attention to some points. If the woman herself has no genital herpes, she should minimize the risk of primary infection during pregnancy. If the partner has already had genital herpes, sexual intercourse during pregnancy should always be practiced with a condom. If the partner is even an active outbreak of genital herpes, then it is better for the duration of pregnancy to renounce sex completely.

A herpes reactivation can not be safely avoided. However, a strong immune system can put the mother at risk Herpes in pregnancy reduce. You can help it by avoiding additional stress factors. That means: sleep sufficiently and regularly, pay attention to a healthy, vitamin-rich diet and avoid physical overstrain.