Last update July 16, 2023

Maternal Herpes Simplex (HSV)

High Risk

Poorly safe. Evaluate carefully. Use safer alternative or interrupt breastfeeding 3 to 7 T ½ (elimination half-lives). Read the Comment.

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.


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Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Group

Maternal Herpes Simplex (HSV) belongs to this group or family:

References

  1. CDC. Centres for Disease Control and Prevention. Herpes Simplex Virus (HSV) and breastfeeding. Breastfeeding and Special Circumstances. 2023 Full text (link to original source)
  2. Van de Perre P, Molès JP, Nagot N, Tuaillon E, Ceccaldi PE, Goga A, Prendergast AJ, Rollins N. Revisiting Koch's postulate to determine the plausibility of viral transmission by human milk. Pediatr Allergy Immunol. 2021 Jul;32(5):835-842. Abstract Full text (link to original source)
  3. (Red Book). AAP. Kimberlin DW, Barnett ED, , Lynfield R, Sawyer MH eds. Red Book: 2021-2024. Report of the Committee on Infectious Diseases. 32th ed. Elk Grove Village, - 2021
  4. Agarwal R, Maharana PK, Titiyal JS, Sharma N. Bilateral herpes simplex keratitis: lactation a trigger for recurrence! BMJ Case Rep. 2019 Mar 9;12(3). pii: e223713. Abstract Full text (link to original source)
  5. D'Andrea MA, Spatz DL. Maintaining Breastfeeding During Severe Infant and Maternal HSV-1 Infection: A Case Report. J Hum Lact. 2019 Nov;35(4):737-741. Abstract
  6. Renesme L. [Neonatal herpes: Epidemiology, clinical manifestations and management. Guidelines for clinical practice from the French College of Gynecologists and Obstetricians (CNGOF)]. Gynecol Obstet Fertil Senol. 2017 Dec;45(12):691-704. Abstract
  7. Field SS. Fatal Neonatal Herpes Simplex Infection Likely from Unrecognized Breast Lesions. J Hum Lact. 2016 Abstract
  8. OWH-Oficina para la salud de la mujer. Infecciones de transmisión sexual, embarazo y lactancia materna. Folleto informativo. 2015 Full text (link to original source) Full text (in our servers)
  9. Garcia-Loygorri MC, De Luis D, Torreblanca B, March GA, Bachiller MR, Eiros JM. La leche materna como vehículo de transmisión de virus. [Beast Milk as vehicle of transmission of virus]. Nutr Hosp. 2015 Abstract Full text (link to original source) Full text (in our servers)
  10. OWH-Office on Women's Health. Sexually Transmitted Infections, Pregnancy, and Breastfeeding. Fact Sheet. 2015 Full text (link to original source) Full text (in our servers)
  11. Lawrence RM. Circumstances when breastfeeding is contraindicated. Pediatr Clin North Am. 2013 Feb;60(1):295-318. Abstract
  12. Parra J, Cneude F, Huin N, Bru CB, Debillon T. Mammary herpes: a little known mode of neonatal herpes contamination. J Perinatol. 2013 Abstract
  13. Jaiyeoba O, Amaya MI, Soper DE, Kilby JM. Preventing neonatal transmission of herpes simplex virus. Clin Obstet Gynecol. 2012 Abstract
  14. Lawrence RM, Lawrence RA. Breast milk and infection. Clin Perinatol. 2004 Sep;31(3):501-28. Review. Abstract Full text (link to original source)
  15. Henrot A. [Mother-infant and indirect transmission of HSV infection: treatment and prevention]. Ann Dermatol Venereol. 2002 Abstract
  16. [No authors listed] ACOG practice bulletin. Management of herpes in pregnancy. Number 8 October 1999. Clinical management guidelines for obstetrician-gynecologists. Int J Gynaecol Obstet. 2000 Abstract
  17. Kotronias D, Kapranos N. Detection of herpes simplex virus DNA in maternal breast milk by in situ hybridization with tyramide signal amplification. In Vivo. 1999 Abstract
  18. Brown H, Kneafsey P, Kureishi A. Herpes simplex mastitis: Case report and review of the literature. Can J Infect Dis. 1996 Abstract
  19. Ruff AJ. Breastmilk, breastfeeding, and transmission of viruses to the neonate. Semin Perinatol. 1994 Abstract
  20. Sealander JY, Kerr CP. Herpes simplex of the nipple: infant-to-mother transmission. Am Fam Physician. 1989 Abstract
  21. Dekio S, Kawasaki Y, Jidoi J. Herpes simplex on nipples inoculated from herpetic gingivostomatitis of a baby. Clin Exp Dermatol. 1986 Abstract
  22. Sullivan-Bolyai JZ, Fife KH, Jacobs RF, Miller Z, Corey L. Disseminated neonatal herpes simplex virus type 1 from a maternal breast lesion. Pediatrics. 1983 Abstract
  23. Grossman JH 3rd, Wallen WC, Sever JL. Management of genital herpes simplex virus infection during pregnancy. Obstet Gynecol. 1981 Abstract
  24. Freymuth F, Daon F, Langeard MM, Venezia R, Laloum D, Kobilinski G. [Maternal buccal herpes simplex : contamination of the newborn. A case]. Nouv Presse Med. 1980 Abstract
  25. Kibrick S. Herpes simplex virus in breast milk. Pediatrics. 1979 Abstract
  26. Dunkle LM, Schmidt RR, O'Connor DM. Neonatal herpes simplex infection possibly acquired via maternal breast milk. Pediatrics. 1979 Abstract
  27. Quinn PT, Lofberg JV. Maternal herpetic breast infection: another hazard of neonatal herpes simplex. Med J Aust. 1978 Abstract

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