For anyone thinking about starting a family, planning a pregnancy is an emotional and deeply personal journey. For those living with herpes, it can also come with added layers of concern—worries about transmission, stigma, and what it might mean for a future baby. But having herpes doesn’t mean you can’t have a healthy pregnancy or a healthy child. With the right information, support, and care, it’s absolutely possible.
Taking time to plan ahead can ease anxiety and build confidence. Understanding how herpes may play a role in conception and delivery allows individuals and couples to make informed choices with their healthcare team. Open conversations with partners, access to accurate information, and proactive medical planning all help pave the way for safer and more empowering pregnancy experiences.
It’s also important to recognize that herpes is often misunderstood. The stigma surrounding it can be isolating, but much of that fear stems from misinformation. Learning the facts—grounded in science and guided by compassionate care—can make all the difference.
You Can Still Have a Healthy Baby
Most people with herpes who become pregnant go on to deliver healthy babies. The risk of passing the virus to a newborn is very low when the infection is known, managed properly, and precautions are taken. In fact, when herpes is recurrent (rather than a first-time infection during pregnancy), the chance of transmission during birth drops to around 1%.
Treatments like antiviral medication and options such as cesarean delivery, when medically appropriate, help further reduce risks. With thoughtful planning and support, families affected by herpes can move forward with hope and confidence.
What to Know About Herpes Before Trying to Conceive
If you’re thinking about pregnancy and have herpes—or you’re just trying to understand the basics—it helps to know how the virus behaves and what makes each type different. This knowledge supports better decisions, lowers anxiety, and helps you plan with more confidence.
HSV-1 vs. HSV-2: Understanding the Types
There are two types of herpes simplex virus: HSV-1 and HSV-2. While both can cause oral and genital infections, they tend to show up differently and behave in unique ways.
- HSV-1 is most often linked to oral herpes—those cold sores that appear around the mouth. However, it’s also becoming a more common cause of genital herpes, especially in younger people.
- HSV-2 is typically associated with genital herpes and is more likely to cause repeat outbreaks in that area.
When HSV affects the genital region, recurrence patterns depend on the type. Genital HSV-2 tends to come back more frequently and shed the virus more often, even when there are no symptoms. HSV-1, when it causes genital infection, usually leads to fewer outbreaks and a lower risk of viral shedding.
The risk of passing herpes to a baby is highest during a first-time infection, especially later in pregnancy. That’s because the body hasn’t had time to build protective antibodies. People with recurrent infections—meaning they’ve had the virus for a while—usually have a much lower risk of transmission during birth.
How Herpes Behaves in the Body
One of the key challenges in managing herpes is its ability to go quiet for long periods. After the first infection, the virus moves into a dormant state—this is called latency. It hides out in the body’s nerve cells and can stay there for life.
From time to time, the virus can become active again. This is known as reactivation, and it can be triggered by things like stress, illness, hormonal shifts, or changes in the immune system. Some reactivations cause noticeable symptoms like sores or tingling, but many happen silently.
Even when someone doesn’t have symptoms, the virus can still be present on the skin or mucous membranes. This is known as asymptomatic shedding, and it plays a big role in how herpes spreads. HSV-2 tends to shed more often than HSV-1, especially in the genital area, and is more likely to do so without symptoms.
Shedding is most common in the first few months after someone acquires a new infection. During pregnancy, the risk of shedding may also increase due to changes in the body, particularly in people with other health conditions.
Understanding these basics is a powerful first step. It helps individuals and couples talk more openly with their healthcare providers and partners, and it supports informed planning around herpes and pregnancy.
Why Timing, Testing, and Planning Are Crucial in Herpes and Pregnancy
When living with herpes and thinking about pregnancy, understanding timing is key. The risks linked to herpes in pregnancy aren’t the same for everyone—they depend largely on when the infection was acquired, whether it’s a primary or recurrent infection, and how well-informed the planning process is.
Recent vs. Long-Standing Infection: Why It Matters
One of the biggest risk factors for neonatal herpes is a primary (first-time) HSV infection during pregnancy, especially in the third trimester. When the virus is newly acquired, the body hasn’t yet produced antibodies—leaving both the parent and the baby with less protection. In these cases, the chance of transmission during birth can range from 25–50%.
By contrast, people who have had herpes for a while typically have developed antibodies. These are passed to the baby through the placenta and provide a layer of defense. Even if there’s viral shedding during delivery, the risk of neonatal transmission drops to about 1% for those with recurrent infections.
A newborn exposed to herpes during delivery—particularly without the protection of maternal antibodies—can develop serious complications, such as:
- Disseminated infection, spreading to multiple organs
- Central nervous system involvement, including encephalitis
- Skin, eye, and mouth lesions, which may require long-term treatment
This is why early detection and clear planning make a real difference.
The Importance of Testing Before Conception
Knowing your HSV status before becoming pregnant helps you take control of the planning process. Many people with herpes don’t experience symptoms, so testing—especially type-specific blood tests—can reveal silent infections and inform preconception counseling.
If herpes is already part of your medical history, your provider may recommend starting suppressive antiviral therapy at 36 weeks of pregnancy to help prevent recurrences and reduce asymptomatic shedding during labor. This can also influence delivery plans, including the decision to pursue cesarean delivery if active lesions or early symptoms appear at the time of labor.
For couples where only one partner has herpes (a serodiscordant relationship), testing is also an opportunity to create a prevention strategy. Using condoms consistently and avoiding oral-genital contact during potential outbreaks can help reduce the chances of acquiring herpes during pregnancy—a time when new infections carry the highest risk for the baby.
Pregnancy planning with herpes doesn’t mean facing fear—it means moving forward with insight. With medical support, testing, and clear communication, it’s possible to reduce risk and protect both parent and child.
Planning Ahead for a Safer Pregnancy
If you’re already living with herpes and planning to become pregnant, or if you’re currently pregnant, there are proactive steps that can reduce risks:
- Suppressive antiviral therapy, typically started around 36 weeks, helps lower the chances of a recurrence or viral shedding near delivery.
- C-section delivery may be recommended if there are signs of active infection during labor, such as visible sores or prodromal symptoms.
- Partner testing and safe sex practices are important throughout pregnancy. Avoiding a new infection during this time is critical, and consistent condom use or maintaining a monogamous relationship can significantly reduce risk.
Taking these steps, with the support of a knowledgeable healthcare provider, can help ensure the best possible outcome for both parent and baby.
The Role of Testing and Medical Guidance in Herpes and Pregnancy
Testing and open communication with healthcare providers are essential parts of planning a safe pregnancy with herpes. Whether you’ve already been diagnosed or are simply trying to understand your risk, knowing your HSV status—and your partner’s—can shape important decisions about care, prevention, and delivery.
Why Type-Specific Testing Matters
Not all herpes tests are the same. Type-specific serologic testing can identify whether someone has HSV-1 or HSV-2 by detecting antibodies in the blood. This distinction is important because the two types behave differently, especially in the context of genital infections:
- HSV-2 is more likely to recur and shed the virus without symptoms, which increases the risk of transmission during birth.
- HSV-1, while increasingly found in genital infections, tends to cause fewer outbreaks and less frequent shedding.
Understanding the type of herpes involved can help healthcare providers assess the risk of neonatal transmission and tailor pregnancy care accordingly.
Testing Both Partners Supports Prevention
Testing isn’t just helpful for the person who’s pregnant or planning to be—it’s also beneficial for their partner. In serodiscordant couples (where one person has herpes and the other does not), knowing each person’s HSV status supports preventive strategies:
- Using condoms consistently and avoiding oral-genital contact during higher-risk periods can help prevent a first-time infection during pregnancy.
- Testing male partners of pregnant individuals can identify hidden risks, offering the chance to start antiviral treatment if needed.
Studies have even shown that universal type-specific testing during pregnancy could be cost-effective in the long run. By identifying risks early, it can help reduce both neonatal herpes cases and the number of emergency cesarean deliveries.
The Importance of Discussing Antiviral Therapy
One of the most effective tools in managing herpes and pregnancy is suppressive antiviral therapy. Medications like acyclovir or valacyclovir, typically started around 36 weeks, can significantly reduce the chances of having lesions or shedding the virus during delivery.
This not only improves outcomes for the baby but can also:
- Lower the likelihood of needing a C-section
- Reduce emergency interventions
- Offer peace of mind to the birthing parent
Discussing antiviral options well before the third trimester gives individuals time to understand the benefits, ask questions, and collaborate with their care team on a plan that feels right.
Testing, medical guidance, and open conversations are all powerful tools. They provide clarity, reduce anxiety, and give people the ability to make informed, confident choices throughout their pregnancy journey.
Understanding the Risks of Herpes During Pregnancy
While herpes and pregnancy can safely coexist, understanding the potential risks—especially during a first-time infection—can help expecting parents and providers plan for the safest outcomes. The timing of infection, the body’s immune response, and the type of care received all play important roles in reducing risks for both parent and baby.
Primary Infection in Late Pregnancy: The Highest Risk Scenario
The most concerning situation is when a pregnant person contracts herpes for the first time in the third trimester. Without existing antibodies, the body hasn’t had time to develop protective immunity—and that leaves the baby more vulnerable to infection during delivery.
In these cases, the risk of neonatal transmission can be as high as 25–50%. This elevated risk is linked to several factors:
- No maternal antibodies are available to transfer to the baby in time for birth
- Higher viral loads and the presence of active lesions increase the likelihood of the virus being passed during labor
- No prior immunity means fewer internal defenses to contain the infection, particularly if antiviral treatment isn’t started quickly
This is why early diagnosis and timely medical support are so critical when a new HSV infection is suspected during pregnancy.
Neonatal Herpes: A Rare but Serious Concern
Although neonatal herpes is uncommon, it can be extremely serious when it does occur. Estimates suggest it affects between 1 in 3,000 and 1 in 20,000 live births, depending on the population studied.
There are three main forms of neonatal HSV, varying in severity:
- Localized infections affect the baby’s skin, eyes, or mouth and are typically less severe
- Central nervous system infections (such as herpes encephalitis) can lead to long-term neurological damage
- Disseminated infections spread to internal organs and are the most dangerous, with a high risk of fatal outcomes if not treated quickly
Most cases of neonatal herpes—up to 80%—happen when the birthing parent contracts HSV for the first time near delivery, often without noticeable symptoms. This makes routine testing and open dialogue with care providers even more important.
Lowering Risk with a Known Herpes History
The good news is that people with a known, long-term HSV infection have a much lower risk of passing herpes to their baby—about 1% or less. That’s because the immune system has already produced antibodies, which are shared with the baby through the placenta.
With proper management, this risk can be lowered even further:
- Antiviral suppressive therapy started at 36 weeks (such as acyclovir or valacyclovir) reduces the chances of an outbreak or shedding during labor
- Cesarean delivery may be recommended if lesions or early symptoms appear near the time of birth
- Vaginal delivery is often safe if there are no signs of active infection and the history of HSV is well understood and well managed
Having herpes during pregnancy doesn’t mean a cesarean is automatically required. In many cases, with good prenatal care and no active symptoms, a vaginal birth is both safe and encouraged.
Understanding the risks doesn’t mean expecting the worst—it means being informed and prepared. With medical support, awareness, and timely treatment, the vast majority of people with herpes go on to have safe, healthy pregnancies and births.
Talking to Your OB-GYN: What to Ask and How to Prepare
Your OB-GYN plays a key role in supporting a healthy pregnancy, especially when managing herpes. Bringing up your HSV status early—whether you’re planning to conceive or already pregnant—sets the stage for clear, personalized care.
Making the Most of Your Appointment
You don’t need to have all the answers, but there are a few topics worth raising during prenatal visits:
- Medication planning – Ask how your care team approaches antiviral therapy in late pregnancy and whether it might be recommended in your case.
- Birth planning – Talk through how decisions around delivery method are made if symptoms or concerns arise late in pregnancy.
- Monitoring and coordination – Find out how your provider works with pediatric staff or adjusts monitoring if HSV symptoms show up as you near your due date.
By starting these conversations early, you’re helping your provider prepare for your specific needs—and giving yourself space to ask questions, weigh options, and avoid surprises later on.
Why Open Communication Matters
Herpes is more common than many people realize, and a trusted provider will treat it as a routine part of reproductive health—not a source of shame. Sharing your history allows your OB-GYN to tailor your care and avoid unnecessary risks, especially in the final weeks of pregnancy.
In fact, most cases of neonatal herpes happen when no one knew to plan ahead. Disclosure isn’t about judgment—it’s about safety, preparation, and peace of mind.
What to Include in a Birth Plan
If you’re creating a birth plan, consider including:
- Your openness to antiviral medication if recommended
- A plan for delivery preferences, with flexibility for unexpected changes
- Notes on communication—who you’d like to be informed and how you’d like updates during labor and delivery
Planning with your provider doesn’t just protect your baby—it helps you feel more in control, supported, and informed throughout the process.
Emotional Support While Planning for Pregnancy
Planning a pregnancy while living with herpes can stir up a mix of emotions—hope, nervousness, even self-doubt. For many, a diagnosis of HSV brings feelings of fear, shame, or guilt, particularly when thinking about becoming a parent. These reactions are not only common—they’re completely valid.
You Are Not Alone in How You Feel
Many people worry about passing the virus to a baby, how others might respond, or what it means for their role as a parent. The weight of stigma—especially in a world that still misunderstands herpes—can intensify these feelings. But it’s important to remember: emotional distress doesn’t reflect your worth or your ability to be a loving, capable parent.
With time, information, and support, these fears often ease. Talking openly with healthcare providers, getting clear answers, and hearing affirmations that you can still have a healthy pregnancy can go a long way toward restoring confidence.
The Role of Support Systems
You don’t have to navigate this alone. The right support systems can make all the difference:
- Trusted medical care offers both medical guidance and emotional reassurance. A provider who listens and responds with compassion can help counter fear and misinformation.
- Supportive partners provide emotional grounding and shared decision-making. When both people feel informed and involved, planning becomes a team effort, not a solitary burden.
- Accurate information helps shift fear into clarity. Learning how herpes behaves, how low the risk of neonatal transmission is with proper care, and how treatment works can replace anxiety with understanding.
Emotional health matters not just for peace of mind—it plays a role in physical well-being, too. Chronic stress during pregnancy has been linked to immune changes and adverse outcomes. Taking care of your mental and emotional health is a vital part of preparing for parenthood.
This chapter of life may come with extra questions and feelings, but it also offers a chance for strength, connection, and trust—in yourself, your body, and those supporting you. You’re not broken, you’re not alone, and you’re more than capable of starting or growing your family.
Planning Parenthood with Confidence
Planning a pregnancy while living with herpes brings unique questions, but it also opens the door to thoughtful, informed decisions that support both your well-being and your baby’s. With accurate information, compassionate healthcare, and supportive relationships, herpes doesn’t have to stand in the way of building the family you envision.
From understanding risk factors to knowing when and how to talk to your provider, each step you take helps reduce uncertainty and increase confidence. Most importantly, it reminds you that you are not alone—and that a safe, healthy pregnancy is entirely within reach.
If this guide helped you feel more grounded or prepared, we invite you to join our mailing list. You’ll receive future updates on herpes and pregnancy, birth planning, parenting with HSV, and more—all delivered with clarity, warmth, and support.
References
Aggerholm, B. S., Ostenfeld, E. B., Andersen, L. H. J., Krogh, R. A., Arendt, L., & Sandager, P. (2020). Genital herpes simplex virus infection in pregnancy. Ugeskrift for Laeger, 182(5).
Anzivino, E., Fioriti, D., Mischitelli, M., Bellizzi, A., Barucca, V., Chiarini, F., & Pietropaolo, V. (2009). Herpes simplex virus infection in pregnancy and in neonate: status of art of epidemiology, diagnosis, therapy and prevention. Virology Journal, 6(40).
Badell, M., & Raynor, D. (2011). Herpes Simplex Virus and Pregnancy. Postgraduate Obstetrics & Gynecology, 31, 1–6.
Baker, D. (2007). Consequences of herpes simplex virus in pregnancy and their prevention. Current Opinion in Infectious Diseases, 20, 73–76.
Baker, D., Brown, Z., Hollier, L., Wendel, G., Hulme, L., Griffiths, D. A., & Mauskopf, J. (2004). Cost-effectiveness of herpes simplex virus type 2 serologic testing and antiviral therapy in pregnancy. American Journal of Obstetrics and Gynecology, 191(6), 2074–2084.
Boedeker, D., & Shaddeau, A. K. (2022). Herpes simplex meningitis presenting as headache in pregnancy: A case report. Case Reports in Women’s Health, 36.
Chatroux, I. C., Hersh, A. R., & Caughey, A. (2020). Herpes Simplex Virus Serotyping in Pregnant Women With a History of Genital Herpes and an Outbreak in the Third Trimester of Pregnancy: A Cost-Effectiveness Analysis. Obstetrics & Gynecology.
Corey, L., & Ashley, R. (2004). Prevention of herpes simplex virus type 2 transmission with antiviral therapy. Herpes, 11(Suppl 3), 170A–174A.
Forsgren, M., & Malm, G. (1996). Herpes simplex virus and pregnancy. Scandinavian Journal of Infectious Diseases. Supplementum, 100, 14–19.
Gardella, C., Brown, Z. A., Wald, A., Selke, S., Zeh, J., Morrow, R. A., & Corey, L. (2006). Risk factors for herpes simplex virus transmission to pregnant women: A couples study. Obstetrical & Gynecological Survey, 61, 360–362.
Groves, M. J. (2016). Genital Herpes: A Review. American Family Physician, 93(11), 928–934.
Guleria, K., & Sethi, N. (2020). Herpes in Pregnancy. Journal of Fetal Medicine, 7, 49–55.
Hammad, W., & Konje, J. (2021). Herpes simplex virus infection in pregnancy – An update. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 259, 38–45.
Healy, S., Mohan, K., Melvin, A., & Wald, A. (2012). Primary Maternal Herpes Simplex Virus-1 Gingivostomatitis During Pregnancy and Neonatal Herpes. Journal of the Pediatric Infectious Diseases Society, 1(4), 299–305.
Hollier, L., & Wendel, G. (2008). Third trimester antiviral prophylaxis for preventing maternal genital herpes simplex virus (HSV) recurrences and neonatal infection. Cochrane Database of Systematic Reviews, 1, CD004946.
James, S., Sheffield, J., & Kimberlin, D. (2014). Mother-to-Child Transmission of Herpes Simplex Virus. Journal of the Pediatric Infectious Diseases Society, 3(Suppl 1), S19–S23.
Koelle, D. M., Benedetti, J., Langenberg, A., & Corey, L. (1992). Asymptomatic Reactivation of Herpes Simplex Virus in Women after the First Episode of Genital Herpes. International Journal of Gynecology & Obstetrics, 39.
Legoff, J., Saussereau, É., Boulanger, M., Chemin, C., Si‐Mohamed, A., Bélec, L., & Maisonneuve, L. (2007). Unexpected high prevalence of herpes simplex virus (HSV) type 2 seropositivity and HSV genital shedding in pregnant women. International Journal of STD & AIDS, 18, 593–595.
Leung, D., & Sacks, S. (2003). Current treatment options to prevent perinatal transmission of herpes simplex virus. Expert Opinion on Pharmacotherapy, 4(10), 1809–1819.
Malkin, J. E., & Beumont, M. G. (1999). Herpes simplex virus infection in pregnancy. Herpes, 6.
Mostad, S. B., Kreiss, J. K., Ryncarz, A. J., Mandaliya, K., Chohan, B. H., Ndinya-Achola, J. O., Bwayo, J. J., & Corey, L. (2000). Cervical shedding of herpes simplex virus in human immunodeficiency virus-infected women. The Journal of Infectious Diseases, 181(1), 58–63.
Paquet, C., & Steben, M. (2024). Management of Genital Herpes Simplex Virus Infection for the Pregnant Woman. Canadian Journal of Midwifery Research and Practice.
Patel, R. (2004). Antiviral agents for the prevention of the sexual transmission of herpes simplex in discordant couples. Current Opinion in Infectious Diseases, 17(1), 45–48.
Patel, R. (2004). Educational interventions and the prevention of herpes simplex virus transmission. Herpes: The Journal of the IHMF, 11(Suppl 3), 155A–160A.
Plunkett, M., Neville, C. T., & Chang, J. G. (2024). Genital Herpes: Rapid Evidence Review. American Family Physician, 110(5), 487–492.
Remmelts, H., van den Brink, J. W., Laan, R., & Bac, D. (2011). Herpes simplex virus oesophagitis in a pregnant woman. The Netherlands Journal of Medicine, 69(2), 76–78.
Robertson, L. (1987). Management of herpes during pregnancy. Health Care for Women International, 8(1), 55–63.
Sauerbrei, A., & Wutzler, P. (2006). Herpes simplex and varicella-zoster virus infections during pregnancy. Medical Microbiology and Immunology, 196(2), 89–94.
Shi, T.-L., Huang, L., Xiong, Y.-Q., Zhong, Y., Yang, J.-J., Fu, T., Lei, X., & Chen, Q. (2018). The risk of herpes simplex virus and human cytomegalovirus infection during pregnancy upon adverse pregnancy outcomes: A meta-analysis. Journal of Clinical Virology, 104, 48–55. https://www.sciencedirect.com/science/article/abs/pii/S1386653218301082
Simanek, A., Uddin, M., Yolken, R., & Aiello, A. (2016). Use of Archived Neonatal Bloodspots for Examining Associations Between Maternal Herpesvirus Infection and Offspring Anxiety Disorders. Frontiers in Environmental Science, 4.
Stankiewicz Karita, H. S., Moss, N. J., Laschansky, E., Drolette, L. M., Magaret, A., Selke, S., Gardella, C., & Wald, A. (2017). Invasive Obstetric Procedures and Cesarean Sections in Women With Known Herpes Simplex Virus Status During Pregnancy. Open Forum Infectious Diseases
Tumanyan, L., Isaeva, F., Aidamirova, K., Ibragimova, N., & Zakharova, P. (2023). The effect of the herpes simplex virus on the mother and fetus during pregnancy. Gynecology.
Urman, J., & Meginnis, S. (1980). The process of problem pregnancy counseling. Journal of the American College Health Association, 28(6), 308–315.
van Hal, S. J., & Dwyer, D. E. (2009). Herpes Simplex: Viruses and Infections.
Wald, A., Langenberg, A., Link, K., Izu, A., Ashley, R., Warren, T., … & Corey, L. (2001). Effect of condoms on reducing the transmission of herpes simplex virus type 2. JAMA, 285(24), 3100-3106.
Wald, A., Langenberg, A., Krantz, E., Douglas, J., Handsfield, H., DiCarlo, R., … & Corey, L. (2005). The relationship between condom use and herpes simplex virus acquisition. Annals of Internal Medicine, 143(10), 707-713.
Wang, L., Zhang, Y., & Wang, X. (2023). A Meta-Analysis on the Correlation Between Herpes Simplex Virus Type II Infection and Adverse Pregnancy Outcomes in China. Journal of Clinical and Nursing Research.
