Is Vaginal Birth Safe for Women With Genital Herpes?

It can be stressful to know that having genital herpes (herpes simplex virus, or HSV) during pregnancy means there is a possibility your child could become infected with the virus during vaginal delivery.

Because of this, and the potential of serious consequences of infection in babies—which, in rare cases, includes death—women with genital herpes are often advised to consider a Cesarean (C-section) delivery instead of a vaginal one. That said, this may not be necessary in all cases.

Risk of Transmission

Only a small percentage of neonatal herpes transmissions occur during the pregnancy itself. The vast majority happen during birth.

Not all pregnant women with genital herpes are at equal risk of transmitting the virus to their infant. The risk of neonatal herpes is highest, by far, for women who become infected with herpes for the first time while they are pregnant. That's particularly true if they become infected near the end of their pregnancy.

There is also some data that women with genital HSV-1 infections may have a greater risk of giving their infants neonatal herpes than women with HSV-2.

Viral Shedding Without an Outbreak

A large 2011 study published in JAMA investigated how often people with symptom-free herpes infections shed the virus and how much virus they shed.

The researchers found that people with asymptomatic genital HSV-2 shed detectable levels of virus 10% of the time. That's about half as often as people with symptomatic infections. However, the amount of virus they shed was similar.

Other studies showed that pregnant women with a history of recurrent genital herpes infections have a 1.4% rate of shedding at the time of delivery.

Risk Reduction Techniques

Women who experience recurrent genital herpes or HSV genital lesions during pregnancy may take suppressive acyclovir treatment starting at 36 weeks gestation and continuing until the onset of labor. This is to reduce the risk of an outbreak and lower viral shedding.

A C-section is recommended if a woman has an active genital herpes outbreak near the time of delivery. This is preferred over a vaginal delivery because it reduces the chance that the infant will be exposed to the virus (as it would if passing through the birth canal).

More specifically, the American College of Obstetricians and Gynecologists (ACOG) recommends that C-section delivery be performed in women with active genital lesions (whether a first infection or subsequent outbreak) or with symptoms that suggest an outbreak will soon occur.

Herpes Testing During Pregnancy

Of course, knowing whether or not your birth plan should be reassessed depends on knowing you indeed have genital herpes.

Doctors can certainly test for viral DNA during pregnancy. Still, there is some question about how useful these tests are, particularly when they're done more than a few days before birth.

As well, an increasing percentage of genital herpes cases are due to HSV-1, and testing for it would not distinguish between the site of an outbreak (oral or genital).

Deciding What to Do About Your Delivery

Many pregnant women with genital herpes are understandably torn about their pregnancy management options. That's particularly true if they are interested in having a more natural childbirth experience.

In addition, some women worry about infecting their child even with suppressive therapy, since the herpes virus remains present in the body even when there is not currently an outbreak. Some may not feel comfortable giving birth vaginally even if they haven't had an outbreak in years.

As with anything related to childbirth, speak with your obstetrician to get a clear picture of your condition and any related risks of childbirth.