Breastfeeding and Potentially Fatal Neonatal Herpes

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HSV and breastfeeding

Herpes transmission from mother to baby through lesions on the breast can be fatal. (1)

Although most cases of neonatal herpes infection occur due to transmission of genital herpes (HSV-2) to a baby during the birthing process, HSV-1 can also “lead to fatal neonatal disease.” (1) In fact, “HSV-1 transmission by genital or extragenital means may result in greater mortality rates.” (1)

Another study showed that in up to 10% of cases, “the infection is transmitted postnatally (after birth), most often due to direct contact with an oral HSV infection.” (2)

HSV infection of the nipple or areola can be exquisitely painful and tends to present as miniature vesicles (sores) on an erythematous (skin) base. Open vesicles carry the virus, and the virus can then be transmitted to the breastfeeding infant. It is critical to rule out HSV in infants less than 3 months of age because they can develop a life threatening infection involving the central nervous system.” (3)

breastfeeding and herpes

A baby that becomes infected with herpes must be treated with an I.V. that administers the antiviral drug, acyclovir. Thus, it is very important to know if a nipple is infected.

As study authors wrote, “It is important to remember that any breast lesion is not a benign cold sore and may be an herpes infection. This presentation is little known and probably underestimated. In cases of questionable breast lesions, a sample should be urgently tested for HSV. If positive, breastfeeding should be discontinued until the resolution of local signs and negativity of samples (2).”

The bottom line?

Women with noticeable sores on their breasts, whether they are painful or not, should immediately be checked by a doctor before breastfeeding.


(1) Field SS “Fatal Neonatal Herpes Simplex Infection Likely from Unrecognized Breast Lesions.” J Hum Lact. 2015 Jul 16.

(2) Mammary herpes: a little known mode of neonatal herpes contamination. Published in September 2013.

(3) Dermatoses of the breast in lactation. Published in August 2013.

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