Sixty to 80% of all infants who develop neonatal [herpes] are born to infected women who are completely asymptomatic during pregnancy as well as at the time of birth. These women have no past history and their current partner is free of genital lesions. Only 27% of infected women whose babies become ill have a history of recurrent lesions during the current pregnancy. Transplacental communication or infection which ascends from the lower genital tract are both possible options for intrauterine infection, which can occur with both primary and recurrent infection. Infection via virus crossing the placenta or membranes is rare. The most common route of infection occurs during labor and birth when the baby has direct contact with infected maternal secretions. After birth, the baby can acquire herpes via contact with lesions on the breasts or lips of an infected person; babies born to seronegative mothers are most at risk from such exposures.
In the absence of internal examination or other invasive procedures, there is no evidence that external perineal lesions result in ascending infection in the presence of ruptured membranes, although such infection is probably more likely when the cervix is colonized.
-Anne Frye, Understanding Diagnostic Tests in the Childbearing Year, 6th ed, Labrys Press, 1997
Reprinted from Midwifery Today E-News (Vol 1 Issue 36, Sep 7, 1999)
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