A baby was born with a sore on its scalp, was tested and discovered it was genital herpes.

The mother was not aware she had herpes.

Complications for the newborn include seizures, respiratory distress, shock, jaundice and bleeding. The mortality rate of babies infected during labor and delivery is high---greater than 80 percent. Among the babies who survive, few do so without serious impairment

Postpartum women, family members and nursery personnel with active herpetic lesions of the mouth or skin should be instructed to use contact precautions with the infant. Nursery personnel with an active herpetic whitlow should not have direct care of neonate

Read more: http://www.livestrong.com/article/151618-how-does-herpes-affect-a-baby/#ixzz1iSDLCOa5

Post-Natal Infection
Babies have immature immune systems, and when they become ill, they are often unable to effectively combat the disease, points out Lois McGuire, a nurse with the Mayo Clinic. Cold sores, or so-called "fever blisters," are caused by herpes, most often by HSV-1. An adult with herpes can infect a baby through normally harmless acts such as kissing the baby, or by touching the baby after having touched a herpes lesion. Though symptoms are not always present in older individuals, they're almost always apparent in infants.

Read more: http://www.livestrong.com/article/151618-how-does-herpes-affect-a-baby/#ixzz1iSDUe06L

Pregnancy and Genital Herpes

Pregnant women with genital herpes should be careful about passing the virus on to the baby, but not overly worried about it. A mother can infect her baby during delivery, often fatally. But if a woman had genital herpes before getting pregnant, or if she is first infected early in pregnancy, the chance that her baby will be infected is very low -- less than 1%. Women with genital herpes are examined carefully for any symptoms before giving birth. If sores or signs that an outbreak is coming show up at the time of delivery, the baby may be delivered by cesarean section (also called a C-section). The risk of infecting the baby is high (30% to 50%) when a woman is newly infected late in pregnancy, however. That's because the mother's immune system has not developed protective antibodies against the virus. Women with an older herpes infection have antibodies against the virus, which help protect the baby. If you are pregnant and you think you may have been infected recently, tell your doctor right away. Ways to Avoid Getting Herpes While Pregnant

Women who don't have genital herpes should be careful about sex during the third trimester. Unless you know for sure that your partner is herpes free, you should avoid sex altogether during the third trimester. If your partner gets cold sores (oral herpes), he or she should not perform oral sex on you during this time. Some doctors think all women should be tested for herpes when they get pregnant, especially if their sex partners have herpes. Ask your doctor if you or your partner should be tested. Genital Herpes Treatment During Pregnancy Women taking antiviral drugs for herpes -- either daily suppressive therapy or occasional therapy for outbreaks -- should consult their doctor about whether to take the drugs during pregnancy. The answer is not set in stone: You and your doctor have to discuss the risks and benefits to decide what's right for you. Herpes infection in a newborn is also serious. Do not allow anyone with a cold sore on the mouth to kiss the baby. If you have a cold sore, don't kiss the baby, and wash your hands with soap and water before touching the baby.

Reducing the Risk of Transmission of Herpes to Infants

From Heather Brannon, MD, former About.com Guide Updated June 29, 2008
About.com Health's Disease and Condition content is reviewed by the Medical Review Board

See More About:

Ads

herpes diagnosis herpes symptoms viral infections herpes treatments

Enterprise TreasurySingle platform for integrated treasury and risk managementwww.reval.com Scar Reducing CreamReduce scars and strech marks. Free worldwide shipping. Buy now.www.elicina.sg U.S. FDA RequirementsAssisting Companies Comply With US FDA Electronic Device RegulationsRegistrarCorp.com/US-FDA Dermatology Ads

Pregnancy First Trimester Pregnancy Pregnancy Health Risks Pregnancy Due Date Herpes Outbreak

The following measures are taken by health care providers to reduce the risk of transmission of the herpes simplex virus to infants:

At the first prenatal visit, all women should be asked whether they or their partner have a history of genital herpes. It is important for women to be honest about any known or concerning rash they, or their partner, have had in the past. Pregnant women who do not have a history of genital herpes should be counseled about methods to avoid infection especially during the third trimester. A provider who discusses these issues is not making judgments about the woman being counseled; rather the provider is informing the woman about a potential risk of which she should be aware. If the pregnant woman does not have a history of genital herpes, but her partner does, the partner should be encouraged to use a condom throughout the pregnancy. The use of acyclovir taken regularly to suppress outbreaks should be considered in pregnant women with frequent genital herpes outbreaks. Acyclovir should be given to all pregnant women with active genital herpes near their due date or at the time of delivery. All women in labor should be asked about symptoms of genital herpes. All women who are in labor and have an active outbreak of genital herpes should have a cesarean section. Women who have herpes lesions that are not in the genital area do not have to have a cesarean section, but the lesions should be covered with an occlusive dressing before vaginal delivery.

Genital Herpes Transmission The herpes simplex virus is transmitted during close personal contact through the exchange of saliva, semen, cervical fluid, or vesicle fluid from active lesions. The virus generally does not infect the dead, keratinized cells in the epidermis. It must come in contact with mucosal cells or abraded skin to begin replication and infection. Genital Herpes Transmission in Women Women are approximately 4 times more likely to acquire a herpes simplex type 2 infection than men. Susceptible women have a higher likelihood of contracting genital herpes from an infected man than a susceptible man becoming infected by a woman. In other words, if a non-infected man and woman each have intercourse with an infected partner, the woman is more likely than the man to contract a herpes simplex virus infection. Why Women are at Greater Risk with Genital Herpes Women may be more susceptible to genital herpes infections because:

The genital area has a greater surface area of cells moist with body fluids (mucosal cells) than men. Hormone changes during a womans menstrual cycle may affect the immune system, making it easier for the herpes simplex virus to cause an infection.

First Genital Herpes Outbreak in Women The first genital herpes outbreak is more painful and lasts longer than recurrent genital herpes outbreaks in both men and women. However, women tend to have more severe disease and higher rates of complications during the first genital herpes outbreak. In women, herpes lesions can occur anywhere in the genital area including the vulva, inside the vagina, on the cervix, and urethra. Herpes lesions can also occur in areas other than the genital area such as the buttocks and thighs. These first lesions are infectious for an average of 3 weeks, longer than in men and longer than recurrences in women, because the blisters contain a large number of infectious viral particles.

Pictures of Herpes Simplex Virus Infections

Other Symptoms with the First Genital Herpes Outbreak In addition to a rash in the genital area, women can also get swollen lymph nodes in the groin and burning with urination. Complications of the first outbreak in women include difficulty urinating in 10 percent to 15 percent of women and meningitis, an inflammation of the fluid surrounding the brain in up to 1 out of 4 women. Confusing Symptoms with Genital Herpes in Women Even though women may have more severe disease, they may have symptoms that are not attributed to herpes. A woman who has herpes lesions inside the vagina or on the cervix may have pelvic pain and discharge that may be misdiagnosed as a yeast infection, cervicitis (an inflammation of the cervix), or pelvic inflammatory disease. Herpes lesions that involve the urethra may be misdiagnosed as a urinary tract infection or bladder dysfunction. With recurrent infections, women may experience only irritation in the genital area without a rash. It is important that women with vaginal discharge or recurrent vaginal symptoms be tested for herpes.

Laboratory testing is often used to confirm a diagnosis of genital herpes. Laboratory tests include: culture of the virus, direct fluorescent antibody (DFA) studies to detect virus, skin biopsy, and polymerase chain reaction (PCR) to test for presence of viral DNA.

Genital Herpes in Pregnancy

This document is mainly based on the Royal College of General Practitioners (RCGP) 1 and genitourinary medicine (GUM) guidance.2 It should be read alongside the main, separate article Genital Herpes Simplex. Aetiology, epidemiology, transmission, presentation, complications and differential diagnosis of infection with herpes simplex virus (HSV) are dealt with in the main article and will not be discussed here. This article concentrates on the management issues specific to genital herpes infection during pregnancy.

Management of genital herpes simplex virus in pregnancy1,2,3

If you see a pregnant woman with genital herpes, the most important questions to ask are: 1. Is this a first episode (primary infection) or a recurrence? See table below. 2. What trimester of pregnancy is the woman in?

Note: always inform the obstetric team. If it is the first episode, refer to genitourinary medicine (on the same day if possible).
Symptoms of primary infection vs. recurrence in genital herpes
Primary infection Bilateral skin lesions (blisters, ulcers or fissures). Flu-like prodrome 5-7 days; tender inguinal lymph nodes; local oedema; tingling pain in genitals, buttocks or legs. Untreated episodes last 3 weeks. Shorter episodes 10 days. Secondary infection Unilateral lesions.

Both may be asymptomatic; may be hard to distinguish primary from secondary; secondary episodes tend to be milder and of shorter duration.

Management of first episode

1st and 2nd trimester presentation Refer to a genitourinary medicine (GUM) clinic- same day referral if possible. Confirm the diagnosis (take viral swabs if not seen on the same day by a genitourinary department). Diagnosis is by viral culture or polymerase chain reaction. Manage symptomatically according to the patient's need. Follow the same procedure as that with primary infection in a non-pregnant person, as outlined in the main article. Use of antivirals in pregnancy: o Aciclovir has a good safety record in pregnancy (although not licensed for this use). It should be used with caution if <20 weeks' gestation, but there is no evidence of teratogenicity. o The dose in pregnancy is either 200 mg five times daily or 400 mg three times daily.3 o Start within 5 days of onset of symptoms, or if new lesions are still forming. o Disseminated infection requires treatment with aciclovir. o Valacyclovir has also been used in pregnancy.4 Inform other people involved in the woman's antenatal care (midwife, obstetrician). Aim for a vaginal delivery but consider offering Caesarean section. Consider daily suppressive aciclovir from 36 weeks - to reduce the likelihood of herpes simples virus (HSV) lesions at term and the need for Caesarean section.3 A dose of aciclovir 400 mg three times daily may be appropriate because of the altered pharmacokinetics of the drug in late pregnancy.2 The same points regarding counselling and contact tracing as are listed in the main genital herpes simplex article should also be covered as part of your management. 3rd trimester presentation Refer, diagnose and treat as for 1st trimester, and also: This scenario carries the greatest risk of neonatal infection. The quoted risk of neonatal herpes, calculated from five studies, when the baby is delivered vaginally was 41% in a 2002 RCOG document.3 Refer to an obstetrician.

 Serology (HSV antibody testing) can be useful, to help distinguish primary and secondary infection and to type the virus. These may influence management decisions. A Caesarean section is recommended for women who develop primary genital herpes within 6 weeks of delivery.3 (The woman can still be shedding the virus at delivery, even if there are no visible lesions.) Caesarean section for the prevention of neonatal herpes has not been evaluated in randomised controlled trials and may not confer complete protection. If the baby is delivered vaginally, avoid rupture of membranes and invasive procedures (which increase the risk of neonatal herpes). Consider intravenous aciclovir for the mother intrapartum and for the neonate. Inform the paediatrician.

Management of recurrent infection

Recurrent genital herpes is associated with a much smaller risk of neonatal herpes. 3 One study reported a transmission rate of 3%5 while another study reported a rate of 0%.6 Confirm the diagnosis. Maternal antibodies will give some protection to the baby but neonatal infection can still occur.1 Antiviral treatment is not usually indicated. Aim for vaginal delivery if there are no genital lesions present at the time of labour. Refer to an obstetrician for assessment. They may consider continuous aciclovir during the last 4 weeks of pregnancy, to reduce the risk of clinical recurrence at term. Regular viral swabs and culture in late pregnancy do not predict viral shedding at term and are not recommended. If there are genital lesions present at the onset of labour, current UK practice is that a Caesarean section be performed. In the Netherlands, vaginal delivery has been permitted in such cases since 1987 with no increase in neonatal infection.7 If the woman has a history of recurrent genital herpes, she should be reassured that the risk of transmitting the infection to her baby is very small, even if she does have active lesions at delivery. If vaginal delivery did take place and there were HSV lesions present, the GP and community midwife should be informed so that they can monitor for signs of neonatal HSV.

Neonatal herpes simplex viral infection4

The main concern with maternal herpes simplex viral (HSV) infection during pregnancy is the risk of neonatal infection as this can lead to severe neurological impairment and to death. Neonatal herpes occurs in fewer than 2 per 100,000 live births.8 It usually results from maternal viral shedding during delivery, which may be asymptomatic, but may also rarely be acquired in utero. It is most likely to occur if the mother develops HSV for the first time during the final trimester. 1 If this is the case, the baby is likely to be delivered before the development of protective maternal antibodies. HSV-2 neonatal infection has a worse prognosis than HSV-1.

Be aware of neonatal herpes:

Early diagnosis and prompt treatment are essential.

There may be no obvious symptoms in the mother - neonatal HSV can be transmitted from asymptomatic maternal HSV.

Clinical features
These appear in the neonate 2 to 28 days after delivery. Many infected infants present with nonspecific signs and without mucocutaneous involvement. There is rarely a history of maternal infection. The infection may follow three different clinical courses: 1. Localised infection - skin, eyes or mouth. The vesicles are often at the presenting part or at sites of minor trauma, such as a scalp electrode. 2. Encephalitis with or without skin, eye or mouth involvement. 3. Disseminated infection which can cause jaundice, hepatosplenomegaly and disseminated intravascular coagulation.9

Congenital HSV infection: This is rare, but is more likely in mothers who have disseminated herpes infection. Intrauterine transmission is greatest during the first half of pregnancy. Most congenital herpes infections are due to HSV-2. Congenital HSV can cause miscarriage, stillbirth, microcephaly, hydrocephalus, chorioretinitis and vesicular skin lesions. There is a high perinatal mortality (50%).

Treatment of a baby considered to be at risk of neonatal herpes

Take urine and stool cultures and swabs from the oropharynx, eyes and surface sites for viral culture and typing. Intravenous aciclovir is given by many whilst waiting for the results and is the treatment of choice in confirmed infection. The child should be isolated. Breast-feeding is recommended unless the mother has herpetic lesions around the nipples. Aciclovir is excreted in breast milk but there is no evidence of harm. Parents should be warned to report any early signs of infection such as poor feeding, lethargy, fever or any suspicious lesions.

Prevention of acquisition of herpes simples virus for the mother and neonate2,3
All women should be asked at antenatal booking if they, or their partner, have ever had genital herpes. If the male partner has a history of genital herpes simplex virus (HSV) and the female is asymptomatic, the couple should be advised not to have sex during a recurrence. Avoid sexual promiscuity during pregnancy. Condom use throughout pregnancy may help to reduce the risk of HSV infection. The risk of HSV-1 infection during orogenital contact should be discussed and contact avoided if there are oral lesions evident. All women should have careful vulval inspection at the onset of labour to look for HSV lesions. Anyone with an active oral HSV lesion or herpetic whitlow who comes into contact with the neonate should be advised about the risk of postnatal transmission and avoid direct contact between the lesion and the neonate.

Herpes Simplex Genital

Note: there is a separate article covering genital herpes simplex in pregnancy.

Aetiology
Genital herpes simplex is caused by infection with the herpes simplex virus (HSV). Herpes simplex virus (HSV) is sub-divided into HSV type 1 (HSV-1) and HSV type 2 (HSV-2). Type 1 usually affects the oral region and causes cold sores (herpes labialis). Type 2 is associated with genital infection (penis, anus, vagina). However, both can infect the mouth and/or genitals due to oral sex or autoinoculation. In some developed countries, the prevalence of genital HSV-1 is increasing.

Epidemiology1
Serological prevalence of HSV in adults is: HSV-1: 70% in developed countries and 100% in developing countries. HSV-2: varies, e.g. 7-40% in pregnant women and 60-95% in sex workers and HIV-positive persons in different parts of the world.

However, the majority of those with HSV-2 antibodies are unaware of their infection. In the UK in 2004, there were 19,180 cases of a first episode of genital herpes.2

Transmission
Genital herpes is acquired from contact with:2 Infectious secretions on oral, genital, or anal mucosal surfaces. Contact with lesions from other anatomical sites, e.g. eyes, skin or herpetic whitlow. Therefore the infection is transmitted through vaginal, anal and oral sex, close genital contact and contact with other sites such as the eyes and fingers. Note: The individual transmitting the infection may be asymptomatic but still shedding the virus. This is how most transmission of genital HSV occurs. Transmission from asymptomatic individuals in monogamous relationships can occur after several years and can cause considerable distress.

Risk factors for acquiring infection

Sexual promiscuity. Unprotected sexual encounters. Female sex. HIV - there is evidence that genital HSV increases the risk of acquiring HIV infection and that people with both HSV and HIV are more likely to transmit HIV infection.2

Presentation3,4
Usually presents as multiple painful ulcers.

Primary infection
This is the first time the virus is acquired. May be asymptomatic (common). If this is the case, the first symptomatic episode is called a non-primary first episode. Evidence of previous infection is shown by the presence of typespecific antibodies at the time of presentation. Symptoms include: o Febrile flu-like prodrome (5-7 days). o Tingling neuropathic pain in genital area/buttocks/legs. o Extensive bilateral crops of blisters/ulcers in the genital area (including the vagina and cervix in women). o Tender lymph nodes (inguinal). o Local oedema. o Dysuria. o Vaginal or urethral discharge. Can last up to 4 weeks if not treated.

Recurrent infection
Following primary infection, the virus becomes latent in local sensory ganglia. There is periodic reactivation which can cause symptomatic lesions or asymptomatic, but still infectious, viral shedding. Episodes are usually shorter (up to 10 days). Symptoms may be mild and self-limiting. Lesions tend to be unilateral. Median recurrence rate after a symptomatic first episode is: o HSV-2: 0.34 recurrences per month (roughly 4 attacks in the subsequent 12 months). o HSV-1: 0.08 recurrences per month (roughly 1 attack in the subsequent 12 months). 5 Attacks usually become less frequent over time. Genital HSV caused by type 1 infection recurs less often.2

Investigations
Detection and identification of virus:4 Suitable tests are: o Viral culture o DNA detection using polymerase chain reaction (PCR) of a swab from the base of an ulcer. The choice of test depends on local availability, practicalities (e.g. the need for careful handling and a 'cold chain' for culture specimens), cost and other factors.

Role of serology in HSV detection:4 Type-specific serology tests can identify those with asymptomatic infection and can distinguish between the two types of HSV. Serological tests may take up to 12 weeks to become positive after primary infection. It may be useful:

o o o o

If the patient's partner has genital herpes and the patient wants to know if they have been infected. If there are recurrent/atypical genital ulcers with negative culture or PCR results. For pregnant women and/or their partners, where relevant. Possibly, to screen people at high risk of sexually transmitted infection. 2

Differential diagnosis3
Candida and scabies produce excoriation but not vesicles. The ulcers of syphilis are painless. Reiter's syndrome, Behet's syndrome, drug reactions, chancroid, lichen planus, lichen simplex, lichen sclerosus, trauma (including dermatitis artefacta), and malignancy can cause genital ulceration. Herpes zoster is usually unilateral and confined to one dermatome.

Management3
There is no cure for genital HSV. Infection is lifelong although most people will eventually stop having recurrences.

Primary infection
Guidance from the Royal College of General Practitioners document states:3 Refer a patient with suspected genital HSV infection to a genitourinary medicine (GUM) clinic the same day (ring to arrange). If a same/next day appointment is not possible, then: o Confirm diagnosis: swab base of ulcer or ulcer fluid for HSV (gently deroof blister if necessary using sterile needle2). A special swab with transport medium is required discuss this with your local laboratory. For culture specimens, maintenance of the cold chain and rapid transport of specimens within 24 hours is needed. PCR has a highest detection rate and does not require such careful handling of samples. 2,4 o Supportive treatment: advise saline bathing (1 teaspoon of salt in 1 pint warm water). Prescribe analgesia and consider topical lidocaine 5% ointment if very painful. Micturition whilst sitting in a bath can help prevent urinary retention. o Antiviral therapy: There is no role for topical antivirals. Give oral anti-herpes viral treatment if there are early symptoms - i.e. within 5 days of onset of symptoms, or if new lesions are still forming. The standard treatment is aciclovir (at a dose of 200 mg orally 5 times daily OR 400 mg 3 times daily) for 5 days. Continue the treatment for longer if new lesions appear during treatment or if healing is incomplete. 6 Higher-dose and longer courses are used for treating patients with HIV.4,6 Other antivirals (valaciclovir, famciclovir) are also licensed for genital herpes but are much more expensive. Antiviral therapy reduces the severity and duration of episodes but does not alter the natural history of the disease.4 o Arrange follow-up: arrange an appointment at a GUM clinic in 2 to 3 weeks to allow patient education and a full sexually transmitted infection screen. Advise the patient to report to a GUM clinic sooner if the symptoms are not resolving. Provide written self-help information to the patient if possible.

Recurrent infection

 Supportive treatment only may be required (saline bathing, Vaseline prn to ease pain due to friction, analgesia). Episodic treatment for each attack: o Antiviral treatment (as for management of primary infection, above). o It is helpful to give the patient a prescription so that they can start taking the treatment at first signs of a recurrence. o Diary keeping of attack frequency may be helpful. Suppressive treatment: o May be needed (usually if >6 attacks per year). o Usual treatment is aciclovir (various possible doses - see BNF6). o Consider the frequency of attacks and symptoms vs the cost and inconvenience of treatment. o Discontinue after 12 months to reassess attack frequency. o Minimum period of reassessment should include 2 further attacks. o If the recurrence rate is unacceptably high, suppressive treatment can be restarted. o Suppressive treatment also reduces the risk of asymptomatic shedding.

Counselling4,2
Diagnosis can cause distress. Contact tracing is needed (offer serological testing to asymptomatic contacts). Written information should be given to the patient. Need to cover:2 o Natural history of genital herpes simplex virus (HSV). o The role of asymptomatic viral shedding in sexual transmission (more common in genital HSV-2 and in the first year after infection). o The fact that a first episode of genital HSV does not necessarily imply recent infection. (Relationship issues need to be addressed.) o Inform current or new sexual partners. o Use of antiviral drugs for symptom control including prescription in reserve for recurrent attacks and possible longer-term suppressive treatment. o If in a stable relationship, the other partner may not necessarily be infected. The daily use of valaciclovir by the infected partner can reduce the risk of transmission of HSV2. Other antiviral drugs may be effective but have not been investigated in this scenario.4 o Avoid sexual contact during symptomatic recurrences. o Condoms reduce (but do not completely prevent) the risk of transmission. o Pregnancy - all women with a diagnosis of genital herpes, or whose partner has genital herpes, should advise their GP and midwife of this at their first antenatal appointment, to consider how best to reduce the risk of neonatal infection. For more details see separate article Genital Herpes in Pregnancy.

Management in people with HIV

This requires specialist advice. More detailed information is given in the British Association for Sexual Health and HIV (BASHH) guidelines.4

Children
Recent National Institute for Health and Clinical Excellence (NICE) guidance on child protection states that sexual abuse should be suspected if a child has a sexually transmitted infection, including genital herpes. However, the guidance mentions that few published studies exist to inform whether sexual abuse is likely to be the mode of transmission in cases of genital herpes. 7

Another review concluded that "child protection clinicians should be aware of the weakness of the evidence on the likelihood of sexual transmission of genital herpes in prepubertal children. The US guidance that child sexual abuse is 'suspicious' reflects the evidence better than the UK guidance that it is 'probable'."8

Complications
Autonomic neuropathy, resulting in urinary retention. (Suprapubic catheterisation is preferred due to reduced risk of ascending infection, less painful procedure, allows normal micturition to be restored without multiple removals/recatheterisations.) 4 Aseptic meningitis.4 Spread to extra-genital areas (in theory through self-inoculation). Secondary infection. Perinatal transmission if the woman is pregnant - may cause serious complications in the neonate (see separate article dealing with genital herpes and pregnancy). Psychological and psychosexual problems. HIV patients with primary infection and no HIV therapy - these patients may develop severe/prolonged mucocutaneous lesions. Other serious or life-threatening complications have been reported in this scenario, e.g,fulminant hepatitis, pneumonia, neurological disease and disseminated infection.4

Prevention
Transmission of herpes simplex virus (HSV) may be reduced by the following: Reduce the number of sexual partners. Use of condoms reduces, but does not completely prevent, transmission. Avoid sex with someone who has active genital herpes or active oral herpes (although viral shedding and transmission also occur from asymptomatic infections) Antiviral drugs may reduce transmission to partners (see Recurrent infection under Management section, above). Avoid sharing towels and flannels with a person who has active herpes infection (although it is unlikely that the virus would survive on an object long enough to be transmitted

Understanding STDs in Pregnancy -- Treatment

What Are the Treatments? HIV HIV, the virus that causes AIDS, is spread through sexual fluids, or through sharing needles with, or exposure to blood from, an infected person. A baby can contract it from the mother before or during birth, or through breast milk. It's recommended that all pregnant women not just those at risk be screened for HIV. If you are HIVpositive, you can significantly reduce the potential for transmission to the baby by taking the right

medicines. But to get treatment and prevent infection, you need to know that you are infected. If your doctor or midwife hasn't offered you HIV testing, ask for it. Chlamydia Chlamydia is caused by bacteria spread through sexual contact with an infected partner. In pregnant women, it's routinely tested for by checking the vaginal and cervical secretions and is easily treated with antibiotics such as erythromycin, amoxicillin or azithromycin. During pregnancy you should not use the antibiotic doxycycline because it can discolor your baby's teeth. Ointment is now routinely put in the eyes of newborns to prevent conjunctivitis, which can lead to blindness if not treated. Genital Herpes Genital herpes is caused by the herpes virus. It is transmitted through sexual contact with someone in whom the virus is active. There is no cure for genital herpes, but it can be managed. If tests show the virus to be active or you have a herpes genital lesion close to your delivery date, your doctor may recommend having a cesarean section instead of a vaginal birth. This will cut down the chance of the baby contracting the virus by contact with lesions in the birth canal. Acyclovir, valacyclovir and famciclovir are all considered safe to take in pregnancy and there are no studies that show an increase in birth defects among women that have taken these drugs. It appears that they are safe and may be prescribed if medically indicated by your doctor. Genital Warts The human papillomavirus that causes genital warts is spread during sexual contact with an infected partner. Many women discover that they have been infected by HPV when they have an abnormal Pap test. Other women may notice the warts. Although the virus never leaves the body, the warts can be treated with surgery or medications. Several other, extremely rare, problems related to HPV and pregnancy: During pregnancy, warts may occasionally get larger. This is probably due to increasing levels of pregnancy estrogens. But they can be surgically removed even in pregnancy and preferably before labor to ensure a normal labor and delivery. If warts on the external female genitalia, such as the labia, grow very large, this may sometimes prevent the baby from passing through the birth canal. Occasionally, cesarean section is required. Warts located inside the vagina may make the vagina less elastic. This wart-infected tissue can fracture and hemorrhage during a vaginal delivery. Small warts require no treatment, while larger, more bothersome, ones may be treated by chemical burning with acids or by cutting them away. During pregnancy, medications such as podophyllin or podofilox should be avoided since they are absorbed by your skin and can cause birth defects in your baby. Imiquimod should be used only if potential benefits outweigh the risks. Babies rarely contract warts from their mothers, so the CDC generally does not recommend cesarean delivery for women with HPV. However, your doctor will suggest a cesarean if warts block the birth canal or if there is a danger of warts rupturing and bleeding during delivery. Some women find that their warts go away after childbirth. Because HPV may increase the risk of cervical cancer, be sure to get regular Pap smears if you have been infected even if you've had the visible warts removed. Gonorrhea Bacteria spread through sexual contact with an infected partner cause gonorrhea. Oral antibiotics can get rid of the bacteria. Both you and your sexual partners must be tested and treated, or the infection can recur. Routine pregnancy testing includes screening for gonorrhea in the vaginal and cervical secretions because it is such a common STD. Because gonorrhea can be present without symptoms, most doctors automatically treat the eyes of all newborns to prevent infection.

Hepatitis B The transmission of hepatitis B virus occurs most commonly through sexual contact. However, it can be passed through all bodily fluids. This means you can catch it from kissing or sharing the toothbrush or IV drug needles of an infected person. A mother may carry the virus to her fetus during pregnancy or childbirth. A simple blood test done routinely in pregnancy can detect whether you are carrying the virus. If a baby is born to a mother with the virus, the baby is given an injection of gamma globulin after birth, a vaccine within 12 hours of birth, and follow-up vaccines during the first six months of life. A mother who carries the virus should not breastfeed her child. In many areas, newborns are routinely vaccinated against hepatitis B along with other immunizations given during infancy and childhood. Anyone who works in a high-risk setting and is exposed to blood should get a vaccine against hepatitis B to prevent infection. Syphilis Syphilis is caused by bacteria spread through intercourse and other forms of sexual contact with an infected partner, such as oral sex and kissing. All pregnant women have routine blood screening for syphilis at the first prenatal visit. If you test positive, you can protect your baby from infection by taking a course of penicillin, which your doctor will prescribe for you. Women allergic to penicillin usually can be treated after a series of steps to make their bodies and immune system accustomed to the antibiotic. In order to avoid reinfection during your pregnancy and afterward, abstain from sexual relations with infected partners.