Genital herpes living in infants

Overview

Genital herpes in infants is a serious viral infection caused by the herpes simplex virus (HSV) that an infant can catch during childbirth if the mother has an active genital herpes outbreak. The infection can affect the baby's skin, eyes, mouth, and in severe cases, the brain or other organs.

Neonatal herpes (herpes in newborns) is rare. In developed countries, about 1 in 3,000 to 1 in 20,000 live births are affected. The risk is higher if the mother has a first-time genital herpes outbreak near delivery.

It affects newborn infants, usually those born to mothers who have genital herpes. The risk is greatest if the mother has her first outbreak around the time of delivery, but it can also occur if she has recurrent outbreaks.

Symptoms

Common symptoms

• Small, painful blisters or sores on the skin, especially around the eyes, mouth, or diaper area.
• Fever or low body temperature.
• Irritability, fussiness, or poor feeding.
• Lethargy (unusual sleepiness or lack of energy).
• Breathing difficulties or grunting.

Symptoms in children

• In older infants and children, genital herpes is rare and usually caused by sexual abuse. Symptoms include blisters or sores on the genitals, buttocks, or thighs, pain when urinating, and swollen glands.

Causes

Main causes

• Genital herpes in infants is almost always caused by the herpes simplex virus (HSV) type 2 (and sometimes HSV-1) that the baby contracts during birth from the mother's infected birth canal.
• Rarely, it can be transmitted after birth through a kiss or touch from someone with an active cold sore or genital herpes.

Risk factors

• Mother has a first-time genital herpes outbreak in the late stage of pregnancy.
• Mother has recurrent genital herpes with active sores at the time of delivery.
• Prolonged rupture of membranes (water breaking more than 4-6 hours before delivery).
• Use of fetal scalp monitors during labor if the mother has herpes.

When to see a doctor

See a doctor urgently if:

• Any sign of herpes blisters on a newborn, even without other symptoms.
• Fever in a baby less than 3 months old.
• Poor feeding, unusual sleepiness, or irritability in a newborn.

Book a routine appointment if:

• If you or your partner have genital herpes, tell your midwife or doctor early in pregnancy so they can plan to reduce the risk to your baby.

Diagnosis

A doctor will examine the baby and take a sample from any blisters, sores, or from the baby’s mouth, eyes, or nose with a swab. They may also test the baby’s urine, blood, or cerebrospinal fluid (spinal fluid).

Tests that may be done

• Swab test of the blister or sore to look for the herpes virus.
• Blood test for HSV antibodies.
• Lumbar puncture (spinal tap) to check if the virus has spread to the brain and spinal cord.
• Imaging tests (such as MRI) if there are signs of brain infection.

What to expect at your appointment

The baby will need to stay in the hospital, often in a neonatal intensive care unit (NICU). Doctors will start antiviral treatment right away while waiting for test results. The process can be stressful for parents, but the care team will explain everything and support you.

Treatment

Genital herpes in infants is treated with antiviral medicines given directly into a vein (intravenously). Treatment usually lasts for at least 14 days, and sometimes longer if the infection has spread. Babies with eye infections may also receive eye drops. With early treatment, most babies recover fully.

Self-care at home

• Follow your baby’s feeding and care plan exactly as the hospital team advises.
• Keep the baby’s blisters clean and dry – do not put any creams or ointments on them unless told by a doctor.
• Wash your hands thoroughly before and after handling your baby to prevent spreading the virus.

Medical treatments

Antiviral medicines are given through a small tube in a vein (intravenous). Treatment continues for at least 14 days. If the infection has spread to the brain, treatment may be longer. The baby will be closely monitored with blood tests and sometimes repeat spinal taps to check progress. No specific medicine names or doses are mentioned here – your healthcare team will decide the best treatment.

When is surgery considered?

Surgery is rarely needed for herpes in infants. In very rare cases, if the infection causes complications in the brain (like fluid buildup), a neurosurgeon may need to place a drain.

Living with this condition

After treatment, most babies go home healthy, but they will need follow-up checkups to monitor for any long-term problems. The virus stays in the body for life but usually stays dormant. Outbreaks are very uncommon in infants after the first infection.

Lifestyle tips

• Keep your baby’s immune system strong by breastfeeding, if possible, and ensuring they get all recommended vaccinations.
• If you have active cold sores or genital herpes, avoid kissing your baby or touching their skin with the sore – wash hands thoroughly before caring for baby.

Diet and exercise

For infants, a healthy diet means breast milk or formula as recommended by your doctor. As the baby grows, a balanced diet supports overall health. For exercise, simply normal baby activity like tummy time, reaching, and crawling is perfect.

Mental health and emotional wellbeing

Having a baby with herpes can be very worrying. Parents may feel guilty or anxious about the infection. It is important to talk to your doctor or a counsellor about these feelings. Remember, you did nothing wrong – herpes can happen even with careful planning. Support is available.

Prevention

Yes, the risk can be greatly reduced. If a pregnant woman has genital herpes, her doctor can prescribe antiviral medicine during the last month of pregnancy to reduce outbreaks. If the mother has an active outbreak at the time of delivery, a cesarean section (C-section) is usually recommended to prevent the baby from coming into contact with the virus. After birth, anyone with a cold sore should avoid kissing the baby.

Screening programmes

Routine screening for herpes in all pregnant women is not recommended, but if you have symptoms or have had herpes before, tell your doctor. They will monitor you and plan the best care for you and your baby.

Complications

If left untreated

• Spread of the virus to the brain causing encephalitis (brain inflammation), which can lead to seizures, developmental delays, or even death.
• Spread to other organs like the liver, lungs, or adrenal glands, which can cause life-threatening illness.
• Severe eye infections that may lead to vision loss if not treated promptly.
• Skin infections that can become widespread and cause scars.

Long-term outlook

With early diagnosis and prompt treatment, most infants with herpes recover well. If the infection has spread to the brain, some babies may have lasting developmental or neurological problems, but many still go on to lead healthy and happy lives. Regular follow-up with a paediatrician is important to check on development. There is hope – modern medicine has greatly improved outcomes for these babies.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.