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Infrequently, a pregnant woman can transmit HSV infection to her baby (called neonatal herpes). Transmission usually occurs at birth, when the baby comes into contact with infected secretions in the birth canal. Rarely, HSV is transmitted to the fetus during pregnancy.

Transmission during birth is more likely when the mother has recently acquired the herpes infection and when the mother has visible herpes sores in the vaginal area, although babies may become infected from mothers who have no apparent sores. When acquired at birth, the infection appears between the 1st and 4th week of life. Newborns with HSV infection become very ill. They may have widespread disease, brain infection, or skin infection. Without treatment, two thirds die, and even with treatment, many have brain damage.


HSV infection is usually easy for doctors to recognize. If unsure, doctors may use a swab to take a sample of material from the sore and send the swab to a laboratory to grow (culture) and identify the virus. Sometimes doctors examine material scraped from the blisters under a microscope. Although the virus itself cannot be seen, scrapings sometimes contain enlarged infected cells (giant cells) that are characteristic of infection by a herpes-type virus. Blood tests to identify antibodies to HSV and biopsy of the sores can also be helpful. Certain blood tests can distinguish between HSV-1 infection and HSV-2 infection. This information helps doctors determine the risk of transmission, for example, to sex partners.

If a brain infection is suspected, magnetic resonance imaging (MRI) or computed tomography (CT) of the brain, and a spinal tap (lumbar puncture) to obtain a sample of cerebrospinal fluid, may be done.


Antiviral Drugs: No current antiviral treatments can eradicate HSV infection, and treatment of a first oral or genital infection does not prevent chronic infection of nerves. However, during recurrences, antiviral drugs may relieve discomfort slightly and help symptoms resolve a day or two sooner. Treatment is most effective if started early, usually within a few hours after symptoms start—preferably at the first sign of tingling or discomfort, before blisters appear. For people who have frequent, painful attacks, the number of outbreaks can be reduced by continuous therapy (suppression) with antiviral drugs. Antiviral drugs are available by prescription only.


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