With approximately 26 percent of American teens and young adults infected with genital herpes, herpes is one of the most common sexually transmitted infections. That means 1 in 4 pregnant women may potentially carry the virus, and since it can affect a developing baby and the way a woman gives birth, it is important to understand how herpes affects pregnancy management.

Herpes is caused by the herpes simplex virus, or HSV. There are two strains: HSV-1 and HSV-2. HSV-2 is usually the culprit in genital herpes, but HSV-1 (which is usually associated with cold sores on the mouth) can cause it too. It spreads through direct contact, such as kissing, sharing a glass with someone who has a cold sore, and sex (including oral sex). Most people who have the virus aren’t aware that they have it and can spread it unknowingly.

Classic symptoms of genital herpes include one or more painful blisters around the mouth or genitals. Having a sensation of burning or pain before the blisters appear can happen as well, and these are called prodromal symptoms. Initial outbreaks can be accompanied with flu-like symptoms. Remember, many people are asymptomatic or have such mild symptoms that they think it is a pimple or ingrown hair.

Herpes infection can increase a pregnant woman’s chance of having a miscarriage as well as going into preterm labor. Neonatal herpes is when a pregnant woman has a herpes outbreak in pregnancy and it spreads to her baby. It can cause various problems, including disseminated disease, central nervous system disease, and infection limited to the eyes, mouth, and skin. About 20 percent of babies who survive neonatal HSV will have long-term neurologic issues from it.

Women who know they have HSV are given antiviral medication if they have any outbreaks in pregnancy. They are also put on antiviral medication to suppress any outbreaks usually starting around 36 weeks gestation. The goal is to prevent any outbreaks around the time of delivery. If a pregnant woman does have prodromal symptoms or active genital herpes lesions when she is in labor, a C-section is recommended to decrease the risk of transmission to her baby and thus prevent neonatal herpes.

Women who are pregnant and have HSV should not be ashamed to disclose this to their doctor or midwife. It is highly important that they let their providers know if they have any outbreak symptoms so they can be treated as quickly as possible.

Lastly, women whose sexual partners have herpes should avoid sex in the third trimester to decrease the risk of transmission. Condoms can decrease the risk of transmission but do not prevent it completely. And remember—herpes can be spread even if no active lesions are present.

Reviewed by Dr. Jen Lincoln, April 2020


  • Approximately 26 percent of Americans have herpes.
  • The majority of people don’t know they have herpes, as many outbreaks can be asymptomatic.
  • Herpes infection increases a woman’s chance of miscarriage and preterm labor and can cause neonatal herpes.
  • If active lesions are present when a woman goes into labor, a C-section is recommended to decrease risks to the baby.


  1. The American College of Obstetricians and Gynecologists. PB#82: Management of herpes in pregnancy.
  2. Centers for Disease Control and Prevention. Genital herpes—CDC fact sheet.


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