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Neonatal Herpes Simplex Infection - Causes, Symptoms, Diagnosis, Management, and Prevention

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Neonatal herpes simplex infection is a viral infection that can occur in newborn babies caused by the HSV-1 and HSV-2 viruses.

Medically reviewed by

Dr. Veerabhadrudu Kuncham

Published At May 17, 2023
Reviewed AtOctober 16, 2023


Neonatal herpes simplex infection is a severe and potentially life-threatening condition that can affect newborn babies. It is caused by the herpes simplex virus, which is highly contagious and can be spread from mother to child during childbirth. This article discusses the symptoms, causes, diagnosis, and treatment options for neonatal herpes simplex infection so that parents and caregivers are better informed and able to identify the infection's signs and symptoms.

What Is Herpes Simplex Virus?

Herpes simplex virus (HSV), also known as Herpes, is an infection caused by two types of viruses: Type 1 herpes ( HSV-1, or oral herpes) and type 2 herpes(HSV-2, or genital herpes). HSV-1 is the most common, and it usually causes sores around the mouth and lips, also known as cold sores or fever blisters. HSV-2 is usually responsible for genital herpes. The infected person may have sores around the genital area or rectum.

  • HSV-1 is typically transmitted through contact with saliva, skin, and mucous membranes. However, it can also spread through contact with a surface and object infected with the virus, such as sharing lip balm. In rare cases, it can spread through blood transfusions or organ transplants.
  • HSV-2 is usually transmitted through sexual contact with someone who is already infected. They include skin-to-skin contact, such as vaginal, oral, and anal sex. The virus can also be passed from mother to child during childbirth.

It is important to note that HSV can be spread even if the infected person is not experiencing any symptoms, as the virus can be shed through the skin without producing any signs or symptoms.HSV-1 and HSV-2 can cause neonatal herpes, which occurs when a baby is exposed to the virus during birth. However, neonatal herpes is not very contagious because the mother’s antibodies protect the baby from contracting the virus from her until after childbirth.

What Is A Neonatal Herpes Simplex Virus(HSV) Infection?

Neonatal herpes simplex infection is a potentially life-threatening virus that can affect newborn babies. It is caused by the herpes simplex virus, which causes cold sores in adults.

Neonatal herpes simplex infection can be spread from mother to baby during delivery if the mother is infected with the virus. In addition, babies born prematurely or with a compromised immune system are susceptible to contracting neonatal herpes simplex infection. Early diagnosis and prompt treatment are essential to prevent serious complications.

What Are the Causes of Neonatal HSV Infection?

  • Neonatal herpes simplex infection is caused by the herpes simplex virus, which is highly contagious and may be transmitted from an infected mother to her baby during delivery. In rare cases, the virus can be transmitted to the baby through blood transfusions or organ transplants. The virus can also spread through infected saliva, mucous membranes, or skin lesions.

  • A baby’s risk of developing neonatal herpes increases if the mother has had a genital herpes infection for the first time during pregnancy or has had recurrent outbreaks at any time. It is important to note that a mother carrying the virus may not show any symptoms or signs of infection(asymptomatic condition).

  • Infection can also occur if a woman develops a genital herpes infection during labor and delivery. When this happens, the newborn is exposed to the virus as they pass through the birth canal.

  • In rare cases, a baby can become infected before birth if the mother is actively shedding the virus in her genital tract at the time of delivery. This type of infection is known as congenital herpes and occurs in about one in every 3,000 babies born in the United States.

What Are the Warning Signs and Symptoms In Babies?

Regarding neonatal herpes simplex infection, it is essential to be conscious of the signs and symptoms in babies. This infection is rare, but it can have severe consequences if left untreated. Therefore, early diagnosis and treatment are essential for a successful outcome.

Signs and symptoms of neonatal herpes simplex infection in babies may include:

  • Fever: A baby with neonatal herpes simplex infection may have a fever that does not go away or worsens despite treatment.

  • Skin Rash: Some babies will develop a blistering or ulcerated rash on the skin or mouth. The rash may spread and become more severe over time.

  • Lethargy or Irritation: A baby with neonatal herpes simplex infection may be exhausted, lazy, or weak.

  • Vomiting and Diarrhea: These symptoms can also be present in babies with neonatal herpes simplex infection.

  • Eye Discharge: Babies may also experience a discharge from their eyes.

  • Respiratory Difficulties: Babies with neonatal herpes simplex infection may have difficulty breathing, or they may have a cough or rapid breathing.

  • Cyanosis: Bluetongue and skin.

  • Has difficulty waking up from sleep.

  • Baby is unable to feed properly.

What Are the Clinical Manifestations?

The clinical manifestations of neonatal HSV infection can range from localized infections to disseminated infections, depending on the severity of the case.

Symptoms usually appear between the first and third weeks of life, but they can appear as late as the fourth week.

  • Localized Neonatal HSV Infection: This can cause skin lesions and mouth sores. These lesions may present as vesicles, pustules, maculopapular eruptions, or eczematous plaques on the face, scalp, or skin. In severe cases, the skin lesions may become ulcerated and start bleeding. Mouth sores may also appear on the gums and lips.

  • Disseminated Neonatal HSV Infection: This is a more severe disease that affects multiple organs and systems, including the central nervous system, eyes, liver, kidney, and lungs. Disseminated neonatal HSV infection symptoms can include:

    • Pneumonitis ( it is an inflammation of lung tissue).

    • Fever.

    • Seizures.

    • Irritability.

    • Lethargy.

    • Hypotonia (decreased muscle tone).

    • Respiratory distress.

    • Jaundice - A condition that causes the skin, mucous membranes, and sclera (the whites of the eyes) to turn yellow.

What Is the Diagnosis of Neonatal HSV Infection?

The most common methods for determining newborn herpes simplex infection are HSV culture or polymerase chain reaction (PCR). These techniques require taking samples of cells or fluid from the infected site. In addition, immunofluorescent testing may be used to detect antibody activity that helps identify the virus.

1. HSV culture:

It is a fairly standard method to detect the presence of HSV in cells or tissue. It involves placing the sample on a growth medium, such as agar plates, which allow the virus to multiply if it is present. Then, antibodies are added to the culture, which will cause a color change in the cells if the virus is present.

2. Polymerase Chain Reaction(PCR):

PCR is a more sensitive technique to detect the virus's genetic material. It involves amplifying the DNA and RNA sequences so the virus can be detected even if only trace amounts are present. PCR is also particular, meaning it can differentiate between herpes viruses.

3. Immunofluorescence Testing :

It detects specific antibodies in the patient’s blood or other body fluids. Antibodies are created by the body when exposed to foreign substances like viruses. By detecting these antibodies, doctors can identify the presence of HSV in the patient’s system. All three techniques are helpful for accurately diagnosing neonatal herpes simplex infection. However, PCR and immunofluorescence testing are considered more reliable because they can detect trace amounts of the virus. Additionally, both PCR and immunofluorescence tests are less invasive than taking samples for HSV cultures.

What Is the Treatment for Neonatal HSV Infection?

When treating neonatal herpes simplex infection, it is essential to act quickly. Early diagnosis and prompt treatment can significantly reduce the risk of serious complications or death. In addition, treatment may involve antiviral medications and supportive care, depending upon the infection’s severity.

Antiviral medications are commonly used to treat neonatal herpes simplex infections. These medications can help shorten the duration of symptoms, reduce the risk of complications, and decrease the potential for spreading the infection to others. Common antiviral medications used to treat neonatal herpes include Acyclovir, Valacyclovir, and Famciclovir.

In addition to antiviral medications, supportive care is essential in treating neonatal herpes simplex infections. They may include providing fluids, nutrition, antibiotics, and oxygen therapy. In severe cases, babies may require hospitalization, intravenous fluids, and mechanical ventilation if needed.

How Can Neonatal Herpes be Prevented?

The best way to prevent neonatal herpes simplex infection is for pregnant women to avoid infection. Women should abstain from sexual contact if they or their partner have active herpes simplex virus infection, including cold sores and genital herpes. In addition, any pregnant woman with a history of genital herpes should talk to her doctor about taking antiviral medications during the last trimester of pregnancy.

Women should also reduce their risk of contracting the virus from another source, such as avoiding contact with someone with an active herpes simplex virus infection. In addition, proper handwashing, using condoms during sex, and avoiding personal sharing items like razors and lip balm are all essential steps to reduce the risk of infection.


When it comes to neonatal herpes simplex infection, early diagnosis is critical. While the virus can be severe, prompt medical treatment can significantly reduce the risk of serious long-term complications. Therefore, in addition to taking preventative measures to help avoid infection, such as avoiding contact with anyone who may be infected, it is essential to be conscious of the signs and symptoms of neonatal herpes infection to seek prompt medical attention if necessary.

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Dr. Veerabhadrudu Kuncham
Dr. Veerabhadrudu Kuncham



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