My one-year-old niece has been diagnosed with genital herpes. What are the chances of the infection being spread to her caretakers? What can be done to prevent the spread of infection?

W.

Genital herpes is usually caused by a virus called herpes simplex 2, with some cases caused by herpes simplex virus 1. The infection creates vesicles (small blisters) in the genital area that open to form painful ulcers. The severity of the illness varies from person to person. The frequency of recurrent outbreaks of blisters also varies widely.

Genital herpes is a sexually transmitted disease, but there are many cases of non-sexual transmission, including during the birth process. It can also be transmitted to a caregiver who has direct contact with patient's genital area. The caregiver could develop painful blisters on the fingers, a condition called "herpetic whitlow." The risk of this type of transmission is difficult to estimate. In general, the risk is highest when there are active vesicles or ulcers, but the virus can also be spread between outbreaks, when the patient has no lesions. Using gloves can decrease the risk of spread, just as using condoms decreases the risk during sex with an adult with herpes.

While it is certainly most likely that your niece acquired this infection from her mother during birth, cases do occur in children who are victims of sexual abuse. It can be very difficult to determine whether child abuse has occurred. Consider discussing this possibility with the baby's mother and pediatrician. Although abuse may be unlikely, it is tragic to miss a single case.