Birth-acquired herpes

HSV; Congenital herpes; Herpes - congenital

Newborn infants can become infected with herpes virus:

• In the uterus (intrauterine herpes -- this is very rare)
• Passing through the birth canal (birth-acquired herpes, the most common method of infection)
• Right after birth (postpartum)

If the mother has an active genital herpes infection at the time of delivery, the infant is more likely to become infected during the birthing process. It is possible for a mother with a first-time (primary) herpes infection to pass the virus to her child during birth.

In addition, some people have had herpes infections in the past, but have not been diagnosed or treated. These people, not knowing that they have it themselves, may pass herpes on to their child. Herpes type 2 (genital herpes) is the most common cause of herpes infection in newborn babies, but herpes type 1 can also occur.

Intrauterine herpes can cause:

• Eye disease, such as inflammation of the retina (chorioretinitis)
• Severe brain damage
• Skin lesions

Birth-acquired herpes can produce localized or systemic (throughout the body) disease. Infants may develop only a localized skin infection consisting of small fluid-filled blisters (vesicles) that rupture, crust over, and finally heal, often leaving a mild scar.

A second type of birth-acquired herpes infection leads to encephalitis, an inflammation of the brain that can result in seizures and later brain and nervous system (neurologic) problems. If untreated, it may lead to death.

Disseminated herpes infection is the most dangerous type. In this type, the herpes virus can affect many different internal organs including the liver, lungs, kidneys, and brain. There may or may not be vesicles on the skin. This type of infection is often fatal.

Herpes acquired in the period shortly after birth has symptoms similar to birth-acquired herpes.

Symptoms of birth-acquired herpes include:

• Bleeding easily
• Breathing difficulties
  • Blue appearance (cyanosis)
  • Flaring of the nostrils
  • Grunting
  • Rapid breathing (tachypnea)
  • Short periods without breathing (apneic episodes)
• Coma
• Enlarged liver and spleen
• Jaundice
• Kidney failure
• Lethargy
• Poor feeding
• Seizures
• Shock
• Skin lesions, fluid-filled blisters
• Stress or anxiety

Tests:

• Blood gas analysis
• Coagulation studies (PT, PTT)
• Complete blood count
• CT scan of the head
• DFA test for herpes (scraping from vesicle)
• Electrolyte measurements
• MRI of the head
• Spinal fluid culture
• Swab culture (from nose, throat, or rectum)
• Tests of liver function
• Urine culture
• Vesicle culture

Herpes virus infections in infants are generally treated with medicine given through a vein (intravenous). Acyclovir is the most common antiviral medicine used for this purpose. A course of several weeks may be required.

Other therapy is often needed to treat the effects of herpes infection, such as shock or seizures.

Infants with systemic herpes or encephalitis often have poor outcomes, despite antiviral medications and early treatment.

Infants with skin disease may have recurrences after therapy is finished. The recurrences put them at risk for learning disabilities, and may need to be treated.

• Bacterial or fungal infection of skin lesions
• Coma
• Death
• Developmental delay
• Excessive bleeding, disseminated intravascular coagulation (DIC)
• Eye problems (chorioretinitis, keratitis)
• Gastrointestinal problems, including diarrhea
• Hepatitis
• Jaundice
• Liver failure
• Lung problems including pneumonia or pneumonitis
• Brain and nervous system (neurological) problems
• Respiratory distress
• Seizure
• Shock
• Skin lesions

Call your health care provider if you have had a baby and think that you might have herpes, or have had it in the past.

If your baby has any symptoms of birth-acquired herpes, including skin lesions alone, have the baby seen by your health care provider promptly.

Safer sexual practices can help prevent the mother from getting genital herpes. Mothers who are not infected with herpes cannot pass the herpes virus to the fetus during delivery.

People with "cold sores" (herpes labialis) should avoid contact with newborn infants. If the person with a cold sore is a caregiver, have them wear a surgical mask and wash their hands carefully before coming into contact with the infant to prevent transmitting the virus.

Mothers should speak to their health care providers about the best way to minimize the risk of transmitting herpes to their infant.