Herpes in pregnancy: symptoms and risk of labial, genital HSV infection and herpes zoster
Herpes in pregnancy can cause concern in expectant mothers, but it is good to distinguish from case to case. HSV infection (the herpes simplex virus) can affect the lips (cold sores) or the genitals (genital herpes), and only in this second case (if primary) it presents the risk of maternal fetal transmission, which in any case concerns about 50/80 cases out of 100 thousand. Here is all there is to know about herpes in pregnancy, but first watch this video on cold sores:
Herpes in pregnancy: what is herpes simplex virus (HVS) infection?
Herpes in pregnancy is no different - as far as symptoms are concerned - from herpes that many of us have already experienced in our lives. Infection with herpes simplex virus (or HVS) is in fact among the most common, especially in the form of cold sores. Genital herpes, on the other hand, affects about 10% of the male and female population.
Cold sores are caused by a virus called HSV-1, the genital one by the HSV-2 virus: if usually this infection (primary or not) does not scare us much, during pregnancy it can cause concern regarding the risk of maternal fetal transmission. The fear of women affected by herpes during pregnancy is that the virus may also infect the fetus. The good news is that this much feared transmission, in most cases, does not happen, it is rather rare.
In the event that, on the other hand, maternal fetal transmission occurs, the fetus could develop quite serious diseases. Unfortunately it is not easy to prevent herpes in pregnancy, but you can pay particular attention to the symptoms, carry out specific tests for HSV-1 and HSV-2 and, in the case of genital herpes, prefer a caesarean section, in order to avoid transmission. vertical to the baby during childbirth itself.
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Cold sores (HSV-1) and genital herpes (HSV-2) in pregnancy: symptoms
Genital herpes and cold sores are very similar: in both cases the infection is caused by two forms of herpes simplex virus that create the same symptoms in different places in our body. cold sores) can travel to the genital area and cause lesions there, and vice versa for HSV-2.
Our body, however, is able to produce the specific antibodies we need to distinguish and eliminate the two different viruses. When they come into contact with our skin or mucous membranes, they cause the appearance of a small cluster of vesicles that cause symptoms such as pain and itching.
If these symptoms go away by themselves within a few days, the virus does not disappear, but enters the nerve cells and, more specifically, the "axons", ie those filaments that make tactile and nervous system sensitivity possible. Through the axons, the virus reaches the nerve cells and remains there for an indefinite period of time, controlled by our immune system.
When the immune system for any reason lowers its defenses (during a particular period of stress, a bad flu or, precisely, during pregnancy), herpes can awaken from its latent state and lead again to the onset of a new cluster of vesicles, with the same symptoms described above.
Risk of maternal fetal transmission of genital herpes during childbirth
While cold sores in pregnancy are at zero risk for the fetus, genital herpes is much more risky with regards to possible maternal fetal transmission, particularly during childbirth. The transmission of the virus to the fetus through the placenta, in fact, is rare (it occurs only in 5% of cases).
In the event that a pregnant woman, on the other hand, contracts the HSV-2 virus for the first time (primary infection), the risk of transmission to the fetus is in fact very high (60% of cases). Genital herpes, in fact, forms on the neck of the uterus and, being the first time she contracts it, the mother has not yet produced the antibodies necessary to reject it, which would have passed to the baby through the blood, protecting him from infection. .
When, on the other hand, it is not a primary infection, but only a reactivation of the herpes virus, then the newborn is already protected by maternal antibodies and the possibility of transmission is decidedly lower (about 2% of cases).
In the event that the mother has contracted the primary infection with genital herpes virus, it will be good to proceed with the caesarean section, because the maternal-fetal transmission takes place during birth, when the child comes out of the birth canal, coming into contact with herpes vesicles.
What to do if herpes is reactivated during pregnancy or if you contract it for the first time?
If it is true that during pregnancy the woman's immune defenses are low to allow her to accept the "foreign body" of the fetus, it is also true that this condition does not increase the possibility of contracting herpes, neither labial nor genital.
However, in the event that herpes occurs during pregnancy, we will proceed with the use of ointments and other drugs for local use, avoiding (if possible) those for systemic use. It will be the treating doctor, however, to evaluate case by case how "it is preferable to proceed.
The risk of a vertical contagion from mother to fetus of the infection, as we have seen, is higher if it is a primary infection: in these cases it will be necessary to proceed with a therapy based on systemic antivirals, usually not recommended in pregnancy. week after therapy, it will be advisable to proceed with an "amniocentesis or a fetal DNA sampling to diagnose a possible infection to the fetus.
Shingles in pregnancy: what is the risk and how is it treated?
If instead of herpes simplex we talk about herpes Zoster (the so-called "shingles"), the situation is different. The Zoster virus is the same that causes chickenpox, which is the result of our body's first contact with the virus. After having chickenpox, the Zoster virus lurks in the cells of the dorsal ganglia and stays there in latency. If it wakes up, at a time when our immune systems are weak, it causes shingles.
Shingles can be contracted during pregnancy, but the risk of infection for the fetus is virtually nil! The baby, in fact, is already protected by the antibodies that the mother developed when she had chickenpox (or was vaccinated against it).
In the event that herpes Zoster occurs during pregnancy, simply proceed with the application of an antiviral cream based on acyclovir, taking paracetamol as a pain reliever in the case. The intake of antibiotics, if the need arises, will be evaluated on a case-by-case basis by the attending physician.
