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I have herpes. Will I need a C-section?

Only pregnant women with active herpes, says Dr. Judith Reichman, may need a cesarean. But many don't even know they are infected.

Q: I’m pregnant and have a history of herpes. Does this mean I’ll need a C-section?

A: It mostly depends on the state of your herpes. The American College of Obstetricians and Gynecologists (ACOG) currently recommends that only women with active herpes lesions or symptoms that a lesion is about ready to erupt should undergo a cesarean section to prevent the virus from infecting the baby during a vaginal delivery. In addition, as discussed later in this article, there are ways to reduce the amount of viral shedding associated with active herpes. It is this shedding that increases the risk of transmission.

Doctors differ on adviceDoctors vary as to how they are handling the ACOG recommendation. Some simply ask the patient about her symptoms or do a visual check for the presence of an active lesion (which, as you probably know, looks like a cold sore and can range from slightly uncomfortable to very painful). Other doctors will do cultures for active viral secretions in the last month of pregnancy.

The chances that a baby will contract herpes is low — about 1 in 2,000 babies who have a mother with herpes. However, up to 70 percent of newborn herpes transmission occurs in women who have the virus with no outward symptoms and no lesions around time of delivery.

What is herpes?Herpes is a contagious viral infection that affects the mouth and/or genitals. The genital infection is characterized by recurrent clusters of vesicles — sacs or small bladderlike cells — and lesions in the genital area. These can vary in severity. About one in five American adults has herpes, but only one third of them are aware of it.

Neonatal herpes is contracted when an infant comes into contact with the virus as it passes through the brith canal. Babies usually acquire herpes antibodies through the mother’s blood from women who have had herpes for a while or who have developed herpes during the first two trimesters. This provides a natural protection so that many babies do not acquire the virus during delivery. Premature babies have a slightly greater risk, though, because they may not have fully developed the antibodies. If babies do contract neonatal herpes, the consequences can vary from minor skin infections to serious damage, such as problems with the brain, eyes, neurological damage, mental retardation or death. Many of these results can be minimized if the baby is immediately treated after birth.

Treatments to prevent transmissionWe know that the use of specific antiviral medication such as Zovirax (acyclovir) and Valtrex (valacyclovir) can shorten the duration of a herpes lesion and viral shedding. Many women effectively use these medications to both reduce their chance of giving the virus to a partner and to reduce their own risk of recurring lesions.

Some new studies indicate that this also may work to prevent active lesions and the infection of a newborn if the medication is given in the last month of pregnancy. One study showed that among pregnant women treated with Valtrex, there was a 69 percent reduction in the rate of C-sections performed because of the presence of the herpes virus.

Researchers have generalized these numbers to suggest that 11 women would need to be treated in order to prevent one C-section for herpes. That’s considered pretty good odds, and since there has been no documentation of adverse effects from prophylactic use of these drugs, I’d suggest you discuss this therapy with your obstetrician. The recommended treatment dosage is 500 milligrams twice daily starting at 36 weeks of gestation.

Dr. Reichman’s Bottom Line: Having herpes does not mean an automatic C-section. Consult with your doctor about the possibilities of reducing your risk of surgical delivery.

Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," which is now available in paperback. It is published by William Morrow, a division of .