Except in very rare instances and special circumstances, herpes simplex virus is not life threatening. However, herpes can cause significant and widespread complications in people who don't have a fully functioning immune system.
Herpes and HIV
People infected with herpes have an increased risk for acquiring and transmitting HIV, the virus that causes AIDS. The CDC recommends that all people diagnosed with herpes simplex virus 2 (HSV-2) get tested for HIV.
Most people with HIV are co-infected with HSV-2 and are particularly vulnerable to its complications. When a person has both viruses, each virus increases the severity of the other. HSV-2 infection increases HIV levels in the genital tract, which makes it easier for the HIV virus to be spread to sexual partners.
Herpes and Pregnancy
Pregnant women who have genital herpes due to either HSV-2 or HSV-1 have an increased risk for miscarriage, premature labor, inhibited fetal growth, or transmission of the herpes infection to the infant in the uterus or at the time of delivery. Herpes in newborn babies (herpes neonatalis) can be a very serious condition.
Fortunately, neonatal herpes is rare. Although about 25 to 30% of pregnant women have genital herpes, less than 0.1% of babies are born with neonatal herpes. The baby is at greatest risk during a vaginal delivery, especially if the mother has an asymptomatic infection that was first introduced late in the pregnancy. In such cases, 30 to 50% of newborns become infected. This is because:
- During a first (primary) infection, the virus is shed for longer periods.
- An infection that first occurs in the late term of pregnancy does not allow enough time for the mother to develop antibodies that would help her baby fight off the infection at the time of delivery.
- Recurring herpes, or a first infection that was acquired early in the pregnancy, pose a much lower risk to the infant.
The risk for transmission also increases if infants with infected mothers are born prematurely, there is invasive monitoring, or instruments are used during vaginal delivery. Transmission can occur if the amniotic membrane of an infected woman ruptures prematurely, or as the infant passes through an infected birth canal. This risk is increased if the woman is having or has recently had an active herpes outbreak in the genital area.
Very rarely, the virus is transmitted across the placenta, a form of the infection known as congenital herpes. Also rarely, newborns may contract herpes during the first weeks of life from being kissed by someone with a herpes cold sore.
Infants may get congenital herpes from a mother with an active herpes infection at the time of birth. Aggressive treatment with antiviral medication is required.
Most infected pregnant women do not have a history of symptoms, so herpes infection is often not suspected or detected at the time of delivery. Fortunately, if a woman does have genital lesions, rapid diagnostic blood tests can quickly determine her chances of transmitting the virus to her baby during delivery.
In general, if there is evidence of an active outbreak, doctors usually advise a cesarean birth to prevent the baby from contracting the virus in the birth canal during delivery. Some women with new or recurrent herpes may also be prescribed antiviral medication during pregnancy. A woman with herpes can usually safely breastfeed her baby, as long as she does not have a lesion on her breast or nipple.
Herpes and Newborn Infants
Herpes infection in a newborn can cause a range of symptoms, including skin rash, fevers, mouth sores, and eye infections. If left untreated, neonatal herpes is a very serious and even life-threatening condition. Neonatal herpes can spread to the brain and central nervous system, causing encephalitis and meningitis. It also can lead to intellectual disability, cerebral palsy, and death. Herpes can also spread to internal organs, such as the liver and lungs.
Infants infected with herpes are treated with acyclovir, an antiviral drug. They usually receive several weeks of intravenous acyclovir treatment, followed by several months of oral acyclovir. It is important to treat babies quickly, before the infection spreads to the brain and other organs.
Herpes Encephalitis and Meningitis
Herpes Encephalitis: Herpes simplex encephalitis is inflammation of the brain caused by either HSV-1 or HSV-2. It is a rare but extremely serious brain disease. Untreated, herpes encephalitis is fatal most of the time. Respiratory arrest can occur within the first 24 to 72 hours. Fortunately, rapid diagnostic tests and treatment with acyclovir have significantly improved survival rates and reduced complication rates. Nearly all who recover have some impairment, ranging from very mild neurological changes to paralysis.
Herpes Meningitis: Herpes simplex meningitis is inflammation of the membranes that line the brain and spinal cord. It is mainly caused by HSV-2. Like encephalitis, meningitis symptoms include headache, fever, stiff neck, vomiting, and sensitivity to light. Fortunately, herpes meningitis usually resolves after about a week without complications, although symptoms can recur.
Herpes Eye Complications
Ocular herpes is a recurrent infection that affects the eyes. It is mainly caused by HSV-1, but can also be caused by HSV-2. Ocular herpes is usually a simple infection that clears up in a few days, but in its more serious forms, and in severe cases, it can cause blindness.
Types of ocular herpes include:
Superficial Keratitis: This condition involves infection and inflammation of the cornea. It is the most common form of ocular herpes. It only affects the upper layer (epithelium) of the cornea and heals with scarring.
Stromal Keratitis: This condition involves deeper layers of the cornea. Corneal scarring develops, which may result in blindness. Although rare, it is a leading cause of blindness in the U.S.
Iridocyclitis: Iridocyclitis is another serious complication of ocular herpes, in which the iris and the area around it become inflamed. Iridocyclitis is related to the eye condition uveitis. It can cause increased sensitivity to light. If left untreated, it can result in vision loss.
Herpes Skin Complications
Eczema Herpeticum: A rare form of herpes infection called eczema herpeticum, also known as Kaposi varicelliform eruption, can affect people with skin disorders and those with a weakened immune system. The disease tends to develop into a widespread skin infection that resembles impetigo. Symptoms appear abruptly and can include fever, chills, and malaise. Clusters of dimpled blisters emerge over 7 to 10 days and spread widely. They can become secondarily infected with staphylococcal or streptococcal bacteria. With treatment, lesions heal in 2 to 6 weeks. Untreated, this condition can be extremely serious and possibly fatal.
Gingivostomatitis: Oral herpes can cause multiple painful ulcers on the gums and mucus membranes of the mouth, a condition called gingivostomatitis. This condition usually affects children ages 1 to 5. It nearly always subsides within 2 weeks. Children with gingivostomatitis commonly develop herpetic whitlow (herpes of the fingers).
Herpetic Whitlow: A herpetic whitlow is an infection of the herpes virus around the fingernail. In children, this is often caused by thumb sucking or finger sucking while they have a cold sore. It can also occur in adult health care workers, such as dentists, because of increased exposure to the herpes virus. The use of latex or polyurethane gloves prevents herpes whitlow in health care workers.