Herpes and Breastfeeding

Herpes simplex virus (cold sores and genital herpes)

There are two herpes simplex viruses Herpes simplex 1 (HSV-1) and Herpes simplex 2 (HSV-2). Herpes simplex 1 (cold sore or fever blister) usually appears as an open sore on the mouth area. Herpes simplex 2 (genital herpes) is usually transmitted through sexual contact, producing blisters on the skin and the moist lining of the sex organs. The small, painful, red-rimmed blisters containing viral material dry and form a scab after a few days (similar to chicken pox lesions). They can appear anywhere on the body including the breast e.g. genital herpes sores can be spread by touching the sores and then touching the breast.

Can you breastfeed with herpes?

If a mother has herpes, she can still breastfeed as long as the newborn will not come in contact with any of the herpes lesions or sores. Sores can be covered with a dressing to protect the baby 1. If you think you have herpes consult with your doctor to get a positive diagnosis as blisters on nipples can have other causes.

If herpes sores are on the nipple or breast

If the sores (blisters) are on the nipple or on the breast where baby could come into contact with them; breastfeeding should be avoided from that breast until the lesions heal. The milk from the affected breast can be expressed to maintain supply and prevent engorgement or mastitis. If milk can be expressed without it coming into contact with a herpes sore (or any breast pump part or hand that has been in contact with a sore), the expressed milk can be given to the baby. However if the milk has been in contact with a sore it should be thrown away. (Mohrbacher, 2010).

Strict hygiene

Observing strict hygiene by washing hands thoroughly with soap before breastfeeding and sterilising breastpump parts after each use will help prevent spreading the infection.

Prevent your baby touching the sores

As these viruses are spread by simply touching the sores, it is important that your baby doesn’t come into contact with them, particularly a newborn up to three weeks of age for whom herpes can be very dangerous:

Herpes infection can be very dangerous (even fatal) to a newborn up to 3 weeks of age (Sullivan-Bolyai, Hull, Wilson & Corey, 1983). If a pregnant woman or her partner has recurrent herpes, she should talk to a healthcare provider knowledgable about herpes and breastfeeding to decide what precautions to take. If a sore on the nipple or breast is suspected of being herpes, a culture can be done and the results should be available in a few days.

Herpes and breastfeeding

The following short article summarises the main points to be aware of when breastfeeding with herpes.

Breastfeeding a toddler with herpes

Discuss with your doctor if your breastfed toddler has active mouth sores as there is a risk of transferring HSV-1 from child to mother’s nipples by breastfeeding 2.

Is herpes passed on through breastmilk?

The risk of catching herpes from breastmilk is very low. Wambach & Riordan state it is doubtful that breastmilk can transmit herpes:

It is doubtful that this infection is transmitted through human milk. A single report describes detection of HSV DNA in human breastmilk (Kotronias & Kapranos, 1999), and one report proposes transmission to a newborn via breastmilk (Dunkle, Schmidt, & O’Connor, 1979). Transmission during breastfeeding is more likely due to occur from direct contact with a herpetic lesion on the breast.

The following paper also states the risk of viral transmission via breastmilk is very low and that breastfeeding ought not be interrupted unless the sores are on the breasts:

The risk of viral transmission via breastmilk is very low. In nursing mothers with herpes, breastfeeding should not be interrupted, except when the herpetic vesicles are located on the breasts. Active lesions in other body parts should be covered, and the nursing mother’s hygiene should not be overlooked so that breastfeeding can be maintained.

Breastmilk can provide protection against viruses. Lauwers & Swisher say that secretory IgA and Lactoferrin in breastmilk are said to be active against herpes simplex virus (HSV) (Counseling the Nursing Mother, Lauwers & Swisher, 2011, p198/9). However Wambach and Riordan, 2015 say that there aren’t any factors in human milk that are known to protect against HSV.

Herpes and kissing your baby

A mother with a cold sore on her lip can breastfeed but should be warned not to kiss her newborn and should wash her hands often and be careful about hygiene while the blister is active.

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Herpes treatment and breastfeeding

Nancy Mohrbacher discusses antiviral drug treatment options for herpes:

Treatments for herpes simplex 1 and 2 and breastfeeding. Antiviral drugs can be used to treat these herpes viruses (AAP, 2009b). The topical antiviral penicilovir has been found to be undetectable in the milk after application, making it “extremely unlikely that detectable amounts would transfer into human milk or be absorbable by an infant” (Hale, 2008, p747). Two oral antiviral drugs, acyclovir3 and famciclovir, are rated L24 (safer) in Medications & Mothers’ Milk. Another commonly used antiviral, valacyclovir is rated L1 (safest).

The compatibility of the latest antiviral drugs with breastfeeding can be checked in the resources listed in Medications and Breastfeeding e.g. Lactmed or Medsmilk and others.

Varicella-zoster virus

Varicella-zoster virus belongs to the herpesvirus family, it affects the central nervous system and causes chickenpox (varicella) and shingles (zoster).

Breastfeeding and chickenpox (herpes varicella)

Chickenpox is generally a mild contagious childhood illness 5. Most adults will have immunity to it as they will already have had it as a child or been immunised against it in some countries. If a mother develops chickenpox for the first time while breastfeeding, she can continue to breastfeed because her baby will have already been exposed to the infection before the blisters came out, and immune factors in breast milk can help the baby’s recovery 6 7 8.

Caution for the newborn baby

However, if a mother develops chickenpox for the first time a few days before or after her baby’s birth 9, this could be very dangerous for her baby and she should seek urgent medical advice from her health professionals 10. Breastfeeding can continue in this situation, but the baby may require treatment with antibodies against the virus (varicella zoster immune globulin) or other preventative medication and the mother is advised to take special hygiene precautions and avoid her baby being in contact with any skin lesions until they are fully crusted 11 12.

Infected babies should be given zoster immune globulin (antibodies against the virus) immediately at birth and acyclovir or a similar drug to prevent the baby from getting very sick. The baby and mother should not be separated. The baby should be breastfed to get the immune factors present in the milk that will help protect his mucous membranes from invasion by the virus.

Shingles and breastfeeding

If you have already had chickenpox, the virus can sometimes flare up again years later as shingles (herpes zoster virus). It causes a painful rash that develops into blisters usually affecting just one area of the body which may include the breast. It is possible to catch chickenpox from someone with shingles if you have not had it before—by skin to skin contact with the blisters. Canadian paediatrician Jack Newman explains that the baby of a mother with shingles will already have some immunity to chickenpox from his mother and breastfeeding can continue:

So, if the mother gets shingles, should she stop breastfeeding? Absolutely not. She is immune. She had chicken pox in the past and the baby got antibodies from her during pregnancy. These antibodies remain in the baby’s blood for about six months; plus, he will receive immunity through breastfeeding. If the mother is treated with acyclovir or a similar drug and painkillers, she does not have to interrupt breastfeeding.

The Academy of Breastfeeding Medicine advise against breastfeeding from a breast with shingles lesions until they have healed:

Exposure to these [shingles] lesions can result in chicken pox (varicella zoster) in unimmunized infants. In most situations, it should be treated similarly to a Herpes simplex infection and women should not breastfeed or use expressed breast milk from an affected breast until the lesions have healed. Infants may be given Zoster immunoglobulin if appropriate.

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