One of the most popular topics in the Life With Herpes community is how herpes affects pregnancy and fertility. We chatted with the community founder to get the scoop. Here, we’ll walk you through a stigma-free herpes 101, including why the infection might not impact your fertility, and why you shouldn’t stress too much about passing on herpes to your baby during pregnancy.
When Alexandra Harbushka was 25, she told an audience at a conference that she had herpes. The result? After her speech, many people approached her to tell her that they, too, had herpes, and that they'd never told anyone until now.
Alexandra was curious. Why weren't people talking about herpes? How could she help people with herpes meet one another, talk candidly about it, and access medically accurate, stigma-free information? She decided to start Life with Herpes an online community where people with herpes can connect.
One of the most prominent topics in the community? Fertility concerns. Alexandra says both men and women wonder how having herpes will impact their family planning. Will they have to use condoms forever to avoid transmitting herpes? Will they have to conceive via IVF in order to not infect a baby? Will herpes negatively affect pregnancy?
If you have the same questions, read on — we've got the facts.
The (stigma-free) 101 on herpes
Herpes is a sexually transmitted disease caused by two types of viruses, and is super common in the US (about 17 out of 100 people ages 14-49 have genital herpes, and 50-80% percent of Americans have oral herpes). Genital herpes most commonly caused by herpes simplex virus type 2 (HSV-2), may cause pain, itching, small red bumps or white blisters on the genitals, and ulcers. Oral herpes (cold sores or fever blisters) is most commonly caused by herpes simplex virus type 1 (HSV-1). It's spread via contact with saliva, and many people are infected with it during childhood.
"There's a stigma around genital herpes — if you have it, you did something wrong, you're a bad person,” says Alexandra. “If you have oral herpes, though, people think it's just a cold sore, but it's actually contagious and it's treated the same. Herpes is herpes."
HSV-1, which causes oral herpes, does cause some cases of genital herpes. You can spread oral herpes to the genitals via oral sex. You can contract genital herpes via vaginal, anal, or oral sex with someone who has it—even if that person doesn't have a sore, or doesn’t know that they have it because they haven't yet had an outbreak.
Testing and treatment for herpes
The only way to know if you have herpes for sure is to get tested, which you can do in your doctor's office, or a clinic like Planned Parenthood. Make sure you ask your healthcare provider to specifically screen for herpes if you're getting tested for STIs. If you have a sore or blister, the doctor will take a sample of fluid and evaluate it. There is also a blood test for herpes. Talk to a health care provider about your testing options to figure out what’s right for you.
Herpes is a virus, so it can't be cured. But it can be managed with medicine, which can prevent future outbreaks and the chance that you could give it to someone else. Your doctor can also prescribe medicine to help ease your symptoms when you're having an outbreak.
Herpes and fertility
Herpes usually doesn’t impact your ability to get pregnant
"People believe that when they're diagnosed with genital herpes that their life is over," says Alexandra. She's met people through the Life with Herpes community who don't have sex or date because they're afraid of passing the virus on, and fear that it will harm their ability to conceive.
The reality, though, is that unlike other STIs like chlamydia and gonorrhea—which, when untreated, can lead to an infection that might potentially damage the fallopian tubes and uterus—herpes usually doesn't impact your ability to get pregnant (according to some sources, like this recent review paper finding that herpes is not a leading factor in infertility).
Herpes strain HHV-6A and miscarriage
There's a rare strain of herpes known as HHV-6A (a different one from that which causes sores or blisters), which can lead to miscarriage and might be the root of unexplained infertility for some. HHV-6A infects the uterine lining and can make it an inhospitable place for an egg to implant. A biopsy of the uterine lining can be done to find out if you have this strain, but if you don't know you have herpes in the first place, you may not ask to have this done. Currently, there's no FDA-approved drug available to treat HHV-6A.
Herpes and pregnancy
Talk to your doctor if you’re pregnant and have herpes
If you're pregnant, have genital herpes, and are worried about passing it on to your baby, keep in mind that the risk is small According to the American Sexual Health Association, "While neonatal herpes is a serious condition, it is also very rare. Less than 0.1% of babies born in the United States each year get neonatal herpes. By contrast, some 25-30% of pregnant women have genital herpes. This means that most women with genital herpes give birth to healthy babies."
Don't let herpes stigma stop you from telling your doctor that you have it, urges Alexandra. Once your doctor knows you have herpes, she can monitor you for outbreaks, since it's critical to be aware of them before you give birth. If you do have an outbreak (or signs of one, like pain, tingling, or itching), it's recommended that you have a C-section, so that the baby won't come into contact with the sores.
Sex with herpes during pregnancy
If your partner has genital or oral herpes and you don't, avoid sex during outbreaks, and make sure to use barrier methods, like condoms and dental dams, every time you have any kind of sex during pregnancy. Your partner should also talk to their doctor about getting on suppressant therapy (medication that prevents outbreaks) during your pregnancy.
The risks change if you contract herpes during pregnancy
Contracting genital herpes during pregnancy is a different story; it can lead to miscarriage or early labor, especially if it occurs in the third trimester. Neonatal herpes (which is rare) can be transmitted to the baby when herpes is present in the birth canal during delivery. If it is, it can lead to damage to the nervous system and even death. This is why it's super important to visit your doctor if you suspect you might have herpes, or if you think you've been exposed — your doctor can prescribe antivirals to reduce the possibility of an outbreak.
Take a deep breath
It's completely normal to panic when you're diagnosed with herpes. Alexandra describes her experience with diagnosis and the aftermath as a thunderstorm, and it took her a long time to emerge from it.
A community like Life With Herpes can be the key to finding support and strength, and it's vital to arm yourself with accurate information about herpes and the reality of it, especially when it comes to your future. ("Be careful of which Google search results you look at," Alexandra says.) If you're interested in more herpes resources, check out our interview with Laureen HD, who started a YouTube channel to educate, destigmatize, and make relatable content for people who were going through the same thing.
The bottom line: You can get pregnant and deliver a healthy baby if you have herpes. Ultimately, you still need to prioritize your sexual health by getting tested for STIs. Then, urges Alexandra, "open the lines of communication with your healthcare provider so you can develop a game plan."