Maternal Herpes Simplex (HSV)

Herpes simplex virus (HSV) causes oral (HSV type I) and genital lesions (HSV types II and I). It is considered a sexually transmitted virus. The neonatal infection is more common in case of primary infection of the mother than in case of recurrent herpetic lesions (50% vs. 5%).

Most transmissions occur at the time of the partum by contact with genital lesions (Tremolada 2008).

During the neonatal period the disease can be very serious; beyond this period it does not usually have serious consequences. ^{(Red Book 2021-24)}

Although HSV DNA 1 and 2 are frequently found in breast milk ^{(Kotronias 1999)}, HSV is not transmitted through breast milk ^{(Red Book 2021-24)}. There is only one allegedly documented case of transmission of HSV-1 through breast milk in the absence of skin, oral or genital lesions in the mother. ^{(Dunkle 1979)}

In other cases the transmission was due to herpetic lesions in the breast. ^{(Field 2016, Parra 2013, Sullivan 1983, Quinn 1978)}

There are also published cases of reverse infection: oral lesions of an infant with herpetic gingivostomatitis were transmitted to the nipple of the mother ^{(Sealander 1989 Dekio 1986)} and a sexually transmitted herpetic mastitis. ^{(Brown 1996).}

Breastfeeding is contraindicated only if there are lesions on the breast, but it should be allowed to breastfeed a baby from the unaffected breast ^{(Red Book 2021-24 p.108-112, Garcia-Loygorri 2015, Lawrence 2013 y 2004, Henrot 2002, Grossman 1981)}. It is possible to maintain breastfeeding by pumping and discarding the milk until the breast lesions heal. ^{(D'Andrea 2019)}

In other locations, breastfeeding is not contraindicated ^{(CDC 2023, Agarwal 2019, Renesme 2017)}; standard preventive measures should be taken: thorough hand washing, covering the lesions so that the infant does not come into contact with them; wear masks and avoid lip contact (kissing) if the mother has herpes in the lips or stomatitis.

Acyclovir treatment is compatible with breastfeeding.

See below the information of this related product:

• Acyclovir; Aciclovir (Safe substance and/or breastfeeding is the best option.)