Neonatal Herpes

What is Neonatal Herpes?

Neonatal herpes is a viral infection that occurs when a baby is exposed to herpes simplex virus during birth. This condition happens when a pregnant woman has an active HSV-2 infection in the birth canal. The virus passes to the newborn as they move through the birth canal.

This is a rare but serious condition. Only about 1 in 3,000 babies born in the United States develop neonatal herpes each year. The infection can affect the baby's skin, eyes, and mouth. In more severe cases, it can spread to the central nervous system or affect multiple organs throughout the body.

Early detection and treatment are critical for protecting newborns. Pregnant women who know their HSV-2 status can work with their healthcare provider to create a safe delivery plan. Testing during pregnancy helps identify risk and prevent transmission to the baby.

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Symptoms

Skin blisters or sores on the baby's body
Fever or temperature instability in newborns
Lethargy or poor feeding in the first weeks of life
Irritability or excessive crying
Seizures or abnormal movements
Eye inflammation or discharge
Jaundice or yellowing of the skin
Breathing difficulties or rapid breathing
Localized skin lesions, particularly around the head and scalp

Symptoms typically appear within the first 4 weeks of life. Some babies may show only mild skin symptoms at first. Others develop severe neurological symptoms within days. Early recognition and immediate medical attention can save lives and prevent long-term damage.

Causes and risk factors

Neonatal herpes is caused by transmission of herpes simplex virus from mother to baby during delivery. Most cases involve HSV-2, the virus that typically causes genital herpes. When a pregnant woman has an active outbreak or is shedding virus during labor, the baby can become infected while passing through the birth canal. Women who acquire HSV-2 for the first time during late pregnancy face the highest risk of transmitting the virus to their baby.

Risk factors include a mother having a first-time HSV-2 infection during the third trimester, visible genital sores at the time of delivery, and vaginal delivery when the virus is active. Women with a history of genital herpes who develop recurrent outbreaks near their due date also carry some transmission risk. In rare cases, the virus can spread after birth through contact with infected individuals who have cold sores or active herpes lesions.

How it's diagnosed

Diagnosis of neonatal herpes involves testing the newborn for signs of infection. Doctors collect samples from skin lesions, the eyes, mouth, and other body sites. They may also perform blood tests and spinal fluid analysis to check for virus in the central nervous system. Imaging studies like MRI or CT scans help assess brain involvement in suspected cases.

Prevention starts before birth with maternal screening. Pregnant women can get tested for HSV-2 antibodies through blood work to assess their infection status. Rite Aid offers HSV-2 IgG and IgM antibody testing as an add-on to help identify risk during pregnancy. Knowing your HSV-2 status allows you and your healthcare provider to plan a safe delivery strategy and reduce transmission risk to your baby.

Treatment options

Antiviral medications like acyclovir given intravenously to infected newborns
Treatment duration typically ranges from 14 to 21 days depending on severity
Supportive care including fluid management and nutrition support in the hospital
Preventive antiviral therapy for pregnant women with known HSV-2 starting at 36 weeks of pregnancy
Cesarean delivery recommended for women with active genital lesions at the time of labor
Isolation of infected newborns to prevent spread to other babies in the nursery
Long-term follow-up care to monitor for developmental delays or neurological complications
Suppressive antiviral therapy for some babies to prevent recurrence

Frequently asked questions

Neonatal herpes is caused by herpes simplex virus transmitted from mother to baby during delivery. The baby becomes infected while passing through the birth canal when the mother has an active HSV-2 infection. In rare cases, transmission can also occur after birth through contact with someone who has active herpes lesions.

Neonatal herpes is rare, affecting about 1 in 3,000 babies born in the United States each year. The risk is highest when a mother acquires HSV-2 for the first time during the third trimester of pregnancy. Women with longstanding HSV-2 infections have a lower transmission risk because their antibodies provide some protection to the baby.

Early signs include skin blisters or sores, fever, poor feeding, and lethargy in the first 4 weeks of life. Some babies develop only localized skin symptoms around the head and scalp. More severe cases can cause seizures, breathing problems, or symptoms of organ involvement that appear within the first week after birth.

Yes, prevention strategies can significantly reduce transmission risk. Pregnant women should know their HSV-2 status through blood testing. Women with known HSV-2 can take antiviral medications starting at 36 weeks of pregnancy. Cesarean delivery is recommended if active genital lesions are present at the time of labor.

Testing allows pregnant women to know their risk and plan with their healthcare provider. Women who test positive for HSV-2 antibodies can receive preventive antiviral therapy in late pregnancy. Those who test negative can take precautions to avoid acquiring the infection during pregnancy. Rite Aid offers HSV-2 antibody testing as an add-on to our panel.

HSV-2 IgG antibody testing shows whether you have been previously infected with the virus. High levels of IgG antibodies indicate a past infection and some level of immunity. This test helps pregnant women understand their risk of transmitting the virus to their baby during delivery.

IgG antibodies appear later and remain in your body long-term after HSV-2 infection. IgM antibodies appear earlier during a new or recent infection. Testing for both helps determine if an infection is new or longstanding, which is important for assessing transmission risk during pregnancy.

Infected newborns receive intravenous antiviral medications like acyclovir for 14 to 21 days. Treatment begins immediately when neonatal herpes is suspected. Early treatment improves outcomes and reduces the risk of severe complications. Some babies require long-term suppressive therapy to prevent recurrence.

Outcomes depend on the severity and type of infection. Babies with only skin, eye, and mouth involvement usually recover well with treatment. Those with central nervous system involvement may experience developmental delays or neurological problems. Disseminated disease affecting multiple organs carries the highest risk of long-term complications or death.

Yes, women with HSV-2 can safely breastfeed in most cases. The virus is not transmitted through breast milk. However, avoid breastfeeding if you have herpes lesions on your breast or nipple. Always wash your hands thoroughly before handling your baby and cover any active sores to prevent contact transmission.