Having babies when infected with genital herpes
Q: I am in my late 20s. Unfortunately, I was recently infected by my former partner with genital herpes. I am in great psychological and mental distress. I am still unmarried and am worried that I will infect my future husband who is uninfected and also affect my children in future. I am really confused and deeply saddened as I'm planning to get married soon.

Can I have sexual intercourse without wearing condoms with my husband when there are no sores present and not infect him?
Can I have healthy babies and children in future? What if there are sores or attacks during pregnancy?
A: Genital herpes is an infection of the genitals, buttocks, or anal area caused by two types of herpes simplex virus (HSV). They are:

>>HSV type 1 commonly infects the mouth and lips, causing 'fever blisters' or cold sores. It spreads by direct contact or kissing.

>>HSV type 2 is the usual cause of genital herpes, but can infect the mouth through oral sex.

Herpes is not curable. Once you contract the virus, it settles in a bundle of nerves near your spine forever and may surface again and again. The virus can be active even though you do not notice any visible sores or symptoms.

During these times, asymptomatic (without symptoms) shedding of the virus may occur at or near the mouth, penis or vagina, or from unnoticeable sores. In this way, the virus spreads and infects your partner without your knowledge. Using condoms during sexual activity may decrease transmission, but infection can still occur. Recently, antiviral medication has been shown to reduce transmission of genital herpes to an uninfected partner. However, this is not foolproof and the medication has to be taken continuously by the infected person.

Herpes can infect a baby in various ways. If the mother-to-be gets infected for the first time during pregnancy, serious defects in the baby's nervous system can result. She is also at increased risks of miscarriage and premature birth. Since you have previous infection already, it is unlikely your child will be affected in this way.

The biggest concern is that you may transmit the virus to your baby during labour and delivery. But newborn herpes is relatively rare (risk is less than 1 per cent, according to the Centers for Disease Control in the United States). However, in these cases, the disease can cause serious brain damage, mental retardation and death.

Infection usually occurs when the baby comes into contact with the virus in the birth canal during delivery.

Your obstetrician should be informed of your previous infection. He can then examine you with a strong light at the onset of labour. This is currently the best way to detect herpes lesions. A viral culture can also be taken.

If you have sores or symptoms at delivery, the safest option is a Caesarean section to prevent the baby from coming into contact with active virus.

If you do not have herpes lesions at the time of delivery, the standard of care recommended by the American College of Obstetrics and Gynaecology is vaginal delivery.

Your baby may have some natural protection against the virus from your previous infection. Antibodies in your blood cross the placenta to the baby and help protect the baby from getting infected.

SOURCE: DR PETER CHEW, CONSULTANT OBSTETRICIAN AND GYNAECOLOGIST AT GLENEAGLES HOSPITAL

Dr Chew is also a founding member of aLife, a voluntary welfare organisation dedicated to nurturing a healthy respect for fertility and family life. For more information, visit www.alife.org.sg

This story first appeared in Mind Your Body on Dec 20, 2006.