Herpes during pregnancy: what do you need to know about this disease?

The herpes simplex virus (HSV) - due to its characteristics - is present in the human body, and almost all of humanity is its carrier. Experts say that being a carrier of the herpes virus does not pose a danger in itself, and it is impossible to “cure” it…

Some people have frequent herpes outbreaks, while others have them very rarely or never at all. The herpes virus manifests its presence in the body much more actively during pregnancy, which can negatively affect the process of bearing a child and even disrupt the normal development of the fetus.

Why is our immune system unable to completely get rid of the herpes virus? Because it is not just a parasitic nucleoprotein organism that can live only in the cells of the human body. It is a neurotropic parasite that “hides” not just anywhere, but in the cells of the neuronal body (neural ganglia), embedding its DNA into their protein structure.

The herpes virus during pregnancy (and not during the “interesting situation” either) is activated by any stress on the immune system due to hypothermia, colds, flu or stress and through the processes of nerve cells (axons) makes its way to the skin and mucous membranes, where rashes appear.

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Causes of Herpes During Pregnancy

As is known, the immune system reduces its ability to protect a person for many reasons, for example, due to a lack of vitamins, poor ecology, chronic infection.

But in pregnant women, immunity is reduced at the cellular level for a special physiological reason: a hormonal restructuring of the body occurs with an increase in the production of those hormones that suppress rejection reactions, creating favorable conditions for the development of new life in the womb of the expectant mother.

And it is this period that the herpes virus "uses". If the disease appears for the first time (primary herpes caused by the HSV-1 virus type), then the cause of herpes during pregnancy is infection through contact with a sick person. But if a woman had a "cold sore" (or "fever") on her lips before pregnancy, then there is a high probability of herpes recurrence during pregnancy.

As a rule, herpes type HSV-1 appears on the lips and in the nasolabial triangle, and the HSV-2 virus type affects the genitals (genitals). When infection and clinical manifestation of the disease occurs in the first trimester of pregnancy (from the 1st to the 13th week), that is, during the period of greatest sensitivity of the embryo and fetus to negative effects, then doctors may recommend terminating the pregnancy. But if herpes of the lips during pregnancy or genital herpes occurs in the third trimester (from the 28th to the 40th week), then the woman continues to bear the child.

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Symptoms of Herpes During Pregnancy

Signs of herpes of the lips during pregnancy appear as usual: a tingling and burning sensation on the lip turns into itching, then this area swells and turns red, and literally the next day, a vesicular rash appears at the site of itching and hyperemia, as well as along the edge of the lip - painful blisters (vesicles) of different sizes filled with serous fluid.

These symptoms of herpes during pregnancy are accompanied by weakness and headache, and the temperature may rise. In some cases, an increase in nearby lymph nodes is observed.

Having reached maximum swelling, the blisters burst open with the outpouring of contents, and weeping ulcers form in their place. As the ulcers dry up, a brownish crust appears on the affected area - a scab, under which a painful wound remains. Recovery comes in about ten days, when the redness and swelling subside, and the dried scab falls off by itself. Doctors warn that you should never tear off the crust: a relapse of herpes during pregnancy is possible.

Genital herpes during pregnancy

The HSV-2 virus enters the human body in the same way as HSV-1, and also during unprotected sexual intercourse. But it is localized in the nerve nodes located in the spine.

Genital herpes during pregnancy has the following symptoms: the appearance of painful rashes (with redness and fluid-filled blisters) in the genital area and buttocks; itching and burning, especially when urinating; vaginal discharge; swelling of the lymph nodes in the groin area. In addition, there are signs of general malaise in the form of chills, an increase in body temperature to +38°C, headache and muscle pain.

As with herpes on the lips, the blisters burst, crusts form, which fall off after a week, leaving behind spots. All these signs of genital herpes during pregnancy, changing in the specified sequence, can last 15-20 days - if the infection occurred for the first time. With repeated infections, pronounced symptoms may not be observed, and the duration of the disease may be limited to several days.

Shingles During Pregnancy

Shingles (herpes zoster or shingles) is a secondary infection. The cause of this disease is a virus of the same family as the herpes simplex virus - the varicella-zoster virus (WZ).

Like the herpes virus, the chickenpox virus (varicella) does not disappear from the body after a person has recovered from the disease, but “hides” in the same nerve nodes.

And in similar circumstances, that is, when the immunity of a pregnant woman decreases, WZ comes out of its "shelter". By the way, according to medical statistics, shingles occurs in every fifth person who has ever had chickenpox.

Symptoms of herpes zoster during pregnancy in the initial stage of the disease (1-4 days) manifest as general malaise with headache, significant increase in temperature (up to +39°C), chills and dyspepsia. Also possible are pain, burning, itching and tingling at the site where the rash appears - on the back (in the lumbar region), on the chest (in the rib area), less often - on the limbs and in the genital area.

The characteristic rash initially appears as pink spots that swell very quickly and turn into blisters. The further picture is the same as with ordinary herpes, with the regional lymph nodes almost always becoming enlarged and painful.

After 18-20 days, the dried crusts at the site of the rash fall off and spots with altered pigmentation remain. But neurological pain along the affected nerves can continue – up to several months.

Most infectious disease doctors and obstetricians and gynecologists say that shingles during pregnancy is not at all dangerous for the unborn child, since with this disease, there are no chickenpox viruses in the pregnant woman’s blood and there are protective antibodies to this virus – IgGP antibodies.

Consequences of herpes during pregnancy

In terms of its potential to cause fetal malformations, the herpes simplex virus is second only to such an acute infectious disease as rubella.

During the studies it was established that the herpes virus during pregnancy can affect the embryo and fetus through the vessels of the placenta, through the fallopian tubes, and also during childbirth complicated by genital herpes.

It should be borne in mind that the shorter the pregnancy period at the time of herpes infection, the higher the probability of spontaneous pathological termination of pregnancy (miscarriage), delayed intrauterine development, or the birth of a child with pathology.

The most dangerous consequences of herpes during pregnancy are genital herpes. If this disease occurs during pregnancy up to ten weeks, it leads to the death of the fetus and miscarriage. Genital herpes in 80% of cases can lead to premature birth, in 75% - to infection of the fetus (neonatal infection), in 60% - to underdevelopment of the fetus, and in 20% of cases - to its death.

When genital herpes occurs during pregnancy at a later stage (especially at 36-40 weeks), the possibility of the child being born with lesions of the nervous system (microcephaly or hydrocephalus of the brain), lungs, liver, spleen or skin cannot be ruled out.

Therefore, in case of genital herpes during pregnancy - in particular, in case of obvious rashes, virus detected in the birth canal, as well as in case of primary infection at the very end of pregnancy - a cesarean section is performed.

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Diagnosis of herpes during pregnancy

Diagnosis of herpes during pregnancy is based on the patient's medical history and examination. This applies to herpes of the lips during pregnancy.

With genital herpes during pregnancy, everything is different. If the manifestations of the disease are typical, then the diagnosis is made based on the data of a routine examination. However, genital herpes often accompanies such sexually transmitted infections as hepatitis, chlamydia, mycoplasmosis, ureaplasmosis, syphilis, and at the slightest doubt in the diagnosis, doctors prescribe laboratory tests.

To detect the herpes simplex virus, a virological method is used: the contents of herpes vesicles, scrapings from the affected areas of the skin or mucous membranes, and, if necessary, urine, tear or cerebrospinal fluid are taken. The herpes simplex virus can be detected using the PCR (polymerase chain reaction) method, for which material is also taken from the affected areas.

To detect antibodies to the virus, serodiagnostics are performed, in which blood serum is examined. The same goal is pursued by the enzyme-linked immunosorbent assay (ELISA) of blood - a comprehensive determination of antibodies to ToRCH infections. In addition to blood, cerebrospinal fluid or amniotic fluid can be taken for examination to diagnose herpes during pregnancy.

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Treatment of herpes during pregnancy

As a rule, when treating herpes during pregnancy, drugs for local external use are used. But, unfortunately, most of them are contraindicated for use during pregnancy.

As a drug for the treatment of herpes during pregnancy, doctors themselves most often recommend Acyclovir ointment, as well as a large number of their analogs with the same active ingredient (Zovirax, Gerpevir, etc.). Many consider this drug to be absolutely safe during pregnancy. Then why in some instructions for the drug - in the "Contraindications" section - is it written in black and white: "The admissibility of use during pregnancy and breastfeeding has not yet been sufficiently studied." And in other instructions it is indicated that use during pregnancy "is possible if the expected effect of therapy exceeds the potential risk to the fetus." What does this mean?

This means that the relevant studies on the safety of the drug in pregnant women have not been conducted. Acyclovir crosses the placenta! And this is the data of an observation that was nevertheless conducted in 1999, but on a small number of women who took acyclovir during the first three months of pregnancy. There were only a little over 700 such women. It is for this reason that "reliable and definite conclusions about the safety of acyclovir during pregnancy cannot be made."

In the United States, the Centers for Disease Control and Prevention (CDC), a health department agency, recommends the use of acyclovir in pregnant women to treat life-threatening herpes infections when the benefits outweigh the risks.

In addition, as early as 2008, Western online publications reported that the common herpes drug Acyclovir usually has no harmful side effects. However, about 1% of people who take the drug orally or intravenously experience psychiatric side effects, including a rare depressive syndrome in which a person imagines that some part of his body is missing.

Many Internet sources (apparently simply copying information from each other) include Alizarin ointment and oxolinic ointment among ointments approved for pregnant women and report that “there are no restrictions on the use of these ointments for pregnant women, since they do not have a negative effect on the fetus.” Regarding oxolinic ointment, this information is correct. As for Alizarin, the instructions attached to it say the following: “Contraindications: pregnancy and individual intolerance”…

For the treatment of herpes during pregnancy, you can use the drug Viferon (ointment, gel, suppositories). Its active ingredient is interferon alpha-2. Since with external and local use, the systemic absorption of interferon is low and the drug acts only in the lesion, it is possible to use the drug during pregnancy. In the complex therapy of acute and chronic recurrent herpes infection (at any stage of the disease), a strip of gel not longer than 0.5 cm is applied with a cotton swab to the previously dried affected surface 3-5 times a day for 5-6 days. The course of treatment continues until the rash disappears. And for genital herpes, the gel is applied with a cotton swab twice a day for a week.

There is also a 2% tebrofen ointment for herpes (simple, recurrent, and shingles), which is applied to the affected areas 3-4 times a day for 5-7 days. Among the side effects of this ointment is a burning sensation at the site of application, and among the contraindications, the manufacturers name only hypersensitivity to the drug and individual intolerance.

According to the manufacturer, the gel for topical application Panavir contains a glycoside of the plant Solanum tuberosum (0.002 g per 100 g) as the main active ingredient. This is the Latin name for nightshade tuberosum, that is, our common potato. By the way, this is not mentioned in the instructions for the drug... This gel is recommended for use at the earliest signs of the disease, then you can completely stop its further development, without bringing it to the stage of herpes rashes. The drug is also available in the form of a solution for intravenous administration, spray and rectal suppositories. However, the injection solution and rectal suppositories can be used during pregnancy only if the expected benefit to the mother and fetus exceeds the potential risk of developing adverse events associated with individual intolerance and hypersensitivity to the components of the drug.

It is not without reason that people used grated fresh potatoes to treat many skin diseases, including eczema. And when treating herpes during pregnancy, such folk remedies for external use as Corvalol, alcohol tinctures of calendula and St. John's wort, sea buckthorn and rosehip oil are popular. At the first signs of herpes on the lips, use the aseptic properties of essential oils - chamomile, wormwood, eucalyptus, fir, geranium, tea tree.

Herpes Prevention During Pregnancy

Prevention of herpes during pregnancy, first of all, consists of maintaining immunity. Of course, no one - including a woman during pregnancy - can just increase the amount of antibodies and other molecules involved in immune reactions.

Here you will have to act indirectly - eat rationally and in a balanced way so that the body gets everything it needs and can resist infections. You need to eat fresh vegetables, fruits and berries (cabbage, carrots, beets, celery, apples, grapefruit, lemons, black currants, cranberries, etc.), dairy products (low-fat), cereals, lean meat and fish. And do not forget that salty, peppery, fried and smoked foods will not bring any benefit to a pregnant woman.

The immune system largely depends on the health of the intestines. So the main task is to empty the large intestine in time, that is, to fight constipation, which affects more than half of pregnant women. In addition, it is necessary to avoid stress, get enough sleep and be outdoors for at least 2-3 hours a day.