Is it reasonable to ask women to avoid oral sex during pregnancy to help stop the spread of herpes?
In recent weeks, several outlets have published articles about the dangers of oral sex and the transmission of genital herpes during pregnancy.
If a woman contracts genital herpes when she’s pregnant, she can potentially pass the virus onto her developing fetus in utero or her newborn infant during childbirth.
To lessen this risk, some medical practitioners and health writers have advised women to avoid oral sex entirely during the third trimester of pregnancy.
For example, an article published in Tonic included the following advice for pregnant women: “Ask questions, get tested each trimester, have any sexual partners (no shame in your game) tested each trimester, and avoid oral sex with every partner — monogamous or otherwise — at least for the final three months (I know, sorry).”
But according to Dr. Denise Jamieson, blanket recommendations against oral sex in the third trimester of pregnancy may not be balanced or justified.
Jamieson is a member of the Practice Bulletin Obstetrics Committee of the American College of Obstetricians and Gynecologists (ACOG).
According to Jamieson, sex during pregnancy can not only be enjoyable but may also help a couple “feel close and intimate at a special time in their lives.”
“Oral sex can be part of a healthy sex life during pregnancy,” Jamieson told Healthline. “As the body changes during pregnancy, some types of sex may become more uncomfortable and oral sex may be a great way for couples to express themselves sexually.”
While sexual abstinence can help prevent the spread of herpes, the psychosocial benefits of sexual intimacy may outweigh the risks for many women.
Ultimately, it’s important for pregnant women and their partners to communicate their sexual preferences to each other.
“Sex drive may wax and wane during pregnancy and couples need to communicate clearly about their desires,” Jamieson said.
Neonatal herpes is rare but serious
Genital herpes is a sexually transmitted infection (STI) caused by two types of viruses: herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2).
According to the Centers for Disease Control and Prevention (CDC), 1 in 6 Americans between the ages of 14 and 49 has genital herpes.
The ailment can be transmitted from one person to another through vaginal, anal, or oral sex.
It can also be passed from a pregnant woman to her newborn infant during childbirth or, in rare cases, to her fetus in utero.
ACOG reports that an estimated 1,200 to 1,500 cases of neonatal herpes infection occur every year in the United States, representing about 1 in 3,000 births.
When a fetus or newborn infant contracts herpes, it can cause severe complications, such as brain inflammation and even death.
New infections are more dangerous
Compared to women who already have herpes when they become pregnant, those who contract it during pregnancy are more likely to pass it on to their fetus or newborn child.
“A new infection with herpes during pregnancy increases the risk that the neonate will be infected,” Jamieson said. “New infections around the time of delivery are particularly risky.”
Approximately 2 percent of pregnant women test positive for new herpes infections during pregnancy, ACOG reports.
In cases when women experience their first outbreak of herpes at the time of delivery, there is a 30 to 60 percent chance of passing the virus onto their infants.
In contrast, women with a past history of herpes are significantly less likely to pass the virus on to their infants during childbirth.
Among those who have a past history of herpes and visible lesions at the time of delivery, the transmission rate with vaginal delivery is 3 percent.
Among those who have a past history of the disease and no visible lesions at the time of delivery, the transmission rate is estimated to be less than 2 in 10,000.
Risk reduction strategies are available
To lower the risk of contracting herpes, ACOG encourages people to avoid sexual contact with partners who have lesions or pain in their lower back, buttocks, thighs, or knees that might be caused by herpes until a few days after their symptoms have resolved.
Using a condom during vaginal, anal, or oral sex can also help prevent the spread of herpes, whether lesions are visible or not.
A “dental dam” can also provide some protection against herpes and other STIs during oral sex.
If a woman contracts genital herpes, her doctor can prescribe antiviral medications during pregnancy to help lower the risk of transmission to her fetus or newborn infant.
If she shows signs of an active genital herpes outbreak at the time of childbirth, her doctor may advise her to undergo cesarean delivery.
Women with herpes who give birth through cesarean delivery are much less likely to pass the virus on to their newborn infant than those who give birth vaginally.