Herpes and Newborn Babies

Herpes is caused by the herpes simplex virus (HSV) and can occur on various parts of the body; however, it most commonly appears on either the mouth or genitals. There are two types of HSV, the first being HSV-1 and the second being HSV-2. Oral herpes, usually in the form of cold sores and fever blisters on the face and around the mouth is primarily caused by HSV-1 while genital herpes, which take the form of lesions around the genitals, is primarily caused by HSV-2.

What Causes HSV?

After a person contracts HSV, it will be carried with them for life. It is a very contagious virus that is transmitted through direct contact. Not everyone who is infected will experience outbreaks, however, the first is considered primary herpes and the virus is most contagious during this period of time. After recovering from the first outbreak, the virus remains dormant in your body for a long period of time and may or may not flare up again. When it does, it is referred to as recurrent herpes.

For HSV-1, general interactions can cause the virus to be transmitted such as sharing utensils, sharing lip balm, or kissing with a person who already has the virus. Additionally, if the infected individual is having an outbreak, the virus can spread more quickly. Believe it or not, HSV-1 is a lot more common than you may think. It is estimated that of people 49 or younger, roughly 67% test positive for HSV-1, although they may never have an outbreak.

In contrast, HSV-2 is rather transmitted through sexual contact with a person who has HSV-2 through contact with a genital lesion/sore. In most cases, HSV-2 will be contracted from sexual interactions with a person who is asymptomatic, meaning they currently are not experiencing an outbreak with sores. The American Academy of Dermatology estimates that roughly 20 percent of adults in the United States who are sexually active have HSV-2.

When it comes to the risks of developing either form of HSV, there a number of factors that can increase them but in reality, the risk of contracting HSV is predominantly based on what the degree of your exposure to the infection is.

For women who are or wish to become pregnant, there are also risks of transmitting HSV to their baby. The Boston Children’s Hospital estimates that roughly 30 out of 100,000 births results in HSV transmission to the baby. If a pregnant woman is experiencing an outbreak of genital herpes when giving birth, the baby can be exposed to both HSV-1 and HSV-2. Additionally, it can result in serious and life-threatening complications. Depending on the particular case, the infection can be very severe and sometimes even cause death.

HSV and Infants

Nearly all HSV infections in newborns are HSV-2 and transmitted when the baby passes through the birth canal. The risks of transmitting HSV to a newborn are the highest when a woman is experiencing primary herpes during the third trimester. After a woman has experienced primary herpes and rather has recurrent herpes while pregnant, the risk of transmission to the baby is only about 3%.

Additionally, pregnant women who are infected with HSV that is not active but was acquired during the pregnancy are also at a high risk of transmitting it to the baby. Whenever there are vaginal lesions either being primary or recurrent, however, the risk of transmission is most heightened for a vaginal delivery. The problem with HSV infections and infants is that in most cases, it occurs when the mother does not know she has HSV and is not symptomatic. This is because in most cases where it is known, the proper preventative steps are taken to prevent transmission.

Newborns and infants can also contract HSV-1 as a result of being in close contact with someone who is infected by either coming into contact with their saliva or through direct skin-to-skin contact with a person who is experiencing an outbreak. HSV-1 is far less severe than HSV-2 in newborns and usually only results in cold sores or blisters around the mouth and/or lips.

When a newborn contracts HSV within the first month of life, it is known as neonatal herpes or congenital herpes. This infection can be very serious; primarily when the baby contracts HSV-2 and it is systemic, meaning that it affects the entire body. In most cases, when newborns exhibit symptoms it is almost always followed by an infection. The severity of the infection is significantly heightened in newborns because their immune system is not fully developed and as a result, the virus can enter the brain and spinal fluid much easier and when it does, it can result in serious complications.

Newborns that are infected at first may exhibit only mild symptoms, such as a low grade fever, poor feeding, or a few small skin blisters. These symptoms can occur anywhere from 2-12 days after transmission of the virus. For some infants, these symptoms will remain mild, but for others with a systemic infection, things can escalate very quickly. In these more severe cases, the fever may become high, the baby may experience seizures, lethargy may kick in where the baby becomes floppy, and eye inflammation, blindness, and respiratory illnesses could occur.

The baby’s vital organs can also be affected such as the lungs, kidneys, liver and central nervous system. When the liver becomes affected, the baby will likely become jaundiced while when the central nervous system is affected, seizures, shock, and hypothermia could occur. In the most severe cases, HSV-2 can cause encephalitis which causes the brain to become inflamed and often results in brain damage. If you think your baby is experiencing any of these symptoms, mild or severe, it is very important to contact a physician immediately to have your baby examined.

Treatment for Babies with HSV

Unfortunately, neither HSV-1 nor HSV-2 can be cured. Rather, they can only be treated and managed. In both children and adults, HSV-1 generally does not need to be treated by a physician. In most cases, a cream containing anti-HSV medication will be sufficient to treat the cold sores. Additionally, for babies anesthetic mouthwashes and/or pain medication may be applied to reduce pain. Intravenous fluids will also likely be given to prevent dehydration due to difficulty drinking as a result of mouth sores.

In contrast, HSV-2 infections require immediate medical attention and treatment for infected infants. An infant that is infected with HSV-2 requires hospitalization for 21 days where intravenous antiviral medication is administered. For infants, the only liquid antiviral medication that is currently approved and used is Acyclovir (Zovirax®). In many cases, this antiviral treatment will be sufficient to take control of the situation, but in some cases, even with the treatment brain damage and/or death could occur as a result of the infection.

How can HSV be Prevented in Infants?

If you know you have HSV-2 and are experiencing an outbreak or think you may show symptoms of it, it is very important to let your physician know as soon as possible. In most cases, a C-section will be recommended for mothers with HSV-2 who are experiencing an outbreak at or around the time of delivery. In doing so, transmission can usually be prevented by preventing the child from coming into contact with the virus.

If you are not pregnant but wish to become pregnant and either you or your partner has HSV, it is also important to consult with your physician prior to becoming pregnant to examine the risk and preventative measures that might be taken. Even if you or your partner has no history of HSV, it is not a bad idea to get tested prior to becoming pregnant as well. Additionally, ensure that anyone who touches or holds your baby washes their hands prior to doing so and do not let others or yourself kiss your baby if they have cold sores in and around the mouth and/or lips.