A few years back, I got a sore on my vulva which turned out to be herpes. I was pretty sick that first time. I had a fever and body aches. My doctor said that was normal the first time you get a sore and it would be easier after that. She was right. Since then I get sores a few times a year (always in the same place), but I don’t get fevers or anything now. My doctor prescribed acyclovir and I just refill it any time I think I’m getting a sore. When they first told me I have herpes, I was pretty upset. I thought I’d never find a partner who was okay with it, and figured I’d probably be single for the rest of my life. That didn’t happen. I’ve told a few different partners and it hasn’t really been a big deal for them (except this one guy, but he probably wasn’t a guy I wanted around anyway). But now I’m pregnant and it feels really scary again. My doctor sort of blew off my concerns. She just said, “If you have a sore when you go into labor, we’ll just do a c-section. We’ll talk about it more when you’re in your third trimester.” Like, wow, that was a big load to just drop and walk away from. Can you give me some more information about having herpes and having a baby? I’ll have a c-section if that’s the safest thing to do. I guess I just want to understand this better.

Confused and concerned

Dear C+C,

Being pregnant is kind of a trip, isn’t it? There is suddenly so much to learn in order to keep ourselves healthy and our babies safe. I applaud your desire to learn as much as you can about this in order to make good decisions for you and your baby. There are some risks during pregnancy and birth associated with herpes, but for most folks it remains manageable throughout.

Herpes is a contagious virus that usually causes small fluid filled blisters (called lesions) which then burst and form a crusty scab, similar to chicken pox. (They’re actually in the same viral family.) Herpes can be annoying and painful, but it usually doesn’t lead to serious health problems, as you’ve discovered. It is a super-common infection that stays in your body for life. More than half of Americans have oral herpes, and about 1 out of 6 Americans has genital herpes. Herpes is caused by two different but similar viruses: herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). We used to refer to them as oral herpes and genital herpes. It turns out that’s not really accurate. Both kinds can cause lesions on and around the vulva, vagina, cervix, anus, penis, scrotum, butt, inner thighs, lips, mouth, throat, and rarely, your eyes. Herpes can also occur asymptomatically, without any lesions.

Herpes is spread through “shedding” during skin-to-skin contact with infected areas, often during vaginal sex, oral sex, anal sex, and kissing. Herpes is most contagious when lesions are open and wet, because fluid from herpes blisters easily spreads the virus. But herpes can also shed and get passed to others when there are no lesions and your skin looks totally normal.

The first time you get a lesion is called a primary infection. A primary herpes outbreak in pregnancy can lead to an infection in the fetus, though it’s pretty rare (occurring about two percent of the time). Because of this, primary infections are potentially dangerous and require medical attention. Since you’ve had herpes for a few years, this isn’t a concern for you unless you get a lesion in a brand new place on your body. Any new or suspected infection of any sort should be discussed with your healthcare provider immediately to minimize risks to you and baby.

Secondary outbreaks (all outbreaks after the very first one) are usually only dangerous if they occur close to or during your labor. If you have an outbreak while you’re pregnant, acyclovir is considered safe for pregnancy. Double check with your healthcare provider, but you should be able to manage it the same you always have.

Since you had herpes before you became pregnant, your body has already developed antibodies to the virus which are passed onto your baby via the placenta. Your baby should have some protection from herpes before they’re even born. Rarely, transmission of herpes from the birthing parent to baby can still occur if that parent has active genital herpes at the time of a vaginal birth. Since you had herpes before you became pregnant, the chance of transmission during delivery is less than one percent. Most poor outcomes for babies occur when the birthing parent is unaware they have a herpes infection. Infants who contract genital herpes during childbirth can develop lesions on their skin, eyes, and mouth. Herpes can affect their central nervous system or multiple organs, such as the liver and lungs. Infection in newborns can be fatal.

Your healthcare provider will likely want to perform a pelvic exam with a speculum when you first go into labor. This exam, which is similar to a PAP, in early labor allows us to see the entire vulva, vaginal canal, and cervix, ensuring there are no lesions visible. If a herpes lesion is found during the speculum exam, a c-section is your safest choice for giving birth. The Centers for Disease Control and Prevention (CDC) and the American College of Obstetricians and Gynecologists (ACOG) recommend cesarean section as soon as labor starts if you are  experiencing an active genital herpes outbreak. C-section does not prevent all newborn infections, but it dramatically reduces the rate of transmission.

You can minimize the risk of needing a C-section and the risk of transmission to baby by preventing an outbreak at the time of birth. Beginning a daily antiviral medication like acyclovir around 36 weeks of pregnancy is the most effective way to do this. You’ll want to take this medicine as directed until your baby is born. For people who are not experiencing an outbreak, vaginal birth is the safest delivery method. Similarly, if you have lesions that are not in the genital region, such as on the butt or thighs, C-section is not recommended. Those can be covered with a special dressing and a vaginal birth can proceed.

Curious about cunnilingus? Anxious about anal? Do you have questions about queefs or problems with your prostate? Lucky Tomaszek is the education coordinator at The Tool Shed: An Erotic Boutique, Milwaukee’s only mission-driven, education-focused sex toy store. Send her an email at [email protected] and she’ll get back to you with an answer.

About The Author

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Lucky Tomaszek, LM, CPM, is the education coordinator at The Tool Shed: An Erotic Boutique, Milwaukee's only mission-driven, education-focused sex toy store. Most mornings you can find her balancing her cat and her keyboard in her lap, working to make the world a smarter, safer place for people of all genders and orientations.