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Herpes simplex virus in Infant/Neonate
See also in: Cellulitis DDx,Anogenital
Other Resources UpToDate PubMed

Herpes simplex virus in Infant/Neonate

See also in: Cellulitis DDx,Anogenital
Contributors: Susan Burgin MD, Eric Ingerowski MD, FAAP, Belinda Tan MD, PhD, Craig N. Burkhart MD, Dean Morrell MD
Other Resources UpToDate PubMed


Herpes simplex virus (HSV) infection in the infant typically occurs when the virus is acquired from caregivers, family members, or other children. Those with preexisting dermatitis can be predisposed to infection.

Characteristic skin lesions are vesicles, pustules, crusts, or erosions. Rarely there can be coinfection of the skin with Staphylococcal aureus and HSV together.

Other symptoms of primary HSV infection in an infant include feeding problems, fever, and/or lethargy. In infants with atopic dermatitis, HSV can spread widely (eczema herpeticum).

See neonatal herpes for discussion of perinatal infection.


B00.1 – Herpesviral vesicular dermatitis

88594005 – Herpes simplex

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Last Reviewed:01/28/2023
Last Updated:02/01/2023
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Patient Information for Herpes simplex virus in Infant/Neonate
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Contributors: Medical staff writer


Herpes infections are caused by both herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). HSV-1 more commonly causes sores in and around the mouth. HSV-2 more commonly causes genital and anal sores. Both types of infections can appear anywhere on the body. Primary herpes is defined as the first outbreak of lesions and is usually more severe than recurrent episodes.

Herpes simplex virus (HSV) is highly contagious and is easily transmitted through direct contact with the lesions of an infected person. However, the virus can also spread in the absence of symptoms or visible lesions. Affected individuals carry the virus in their bodies for the rest of their lives.

In newborns (babies in the first month of life), HSV infection, known as neonatal herpes, can potentially be life threatening, and symptoms almost always accompany infection. The virus is able to enter the brain and spinal fluid and can cause seizures and even death.

Who’s At Risk

HSV infections in newborns are usually the result of the virus being passed from mother to baby during childbirth. The highest risk of passing herpes to a newborn occurs when a pregnant individual develops primary herpes during the third trimester of pregnancy. In contrast, the risk of transmitting herpes to a newborn is much less (about 3%) in those who have recurrent herpes during their pregnancy. Vaginal delivery also increases the risk of transmission if active lesions are present in the genital area at the time of delivery. Neonatal herpes (within the first month of life) can be very severe, affecting the brain and other internal organs. Even with treatment, newborns have a very high risk of death.

Infants can also become infected with HSV through direct skin-to-skin contact with someone who has an active lesion. For instance:
  • Kissing a child when you have an active lesion.
  • Changing a diaper when there is a lesion on your hand.
  • Breastfeeding with a lesion on the breast.
These infections are far less severe in nature and usually result in only sores on the mouth, lips, or other area of skin of the infant.

Signs & Symptoms

For infections right after birth, small fluid-filled bumps (vesicles) are seen on the scalp, Vesicles can be quite few, scattered, or widespread.

Most commonly, primary herpes in infants involves painful blisters and erosions of the gums and the skin around or lining the mouth. There may also be fever, swollen lymph nodes in the neck, irritability, and a poor appetite. If HSV is introduced on other body sites, there may be painful blisters and sores in that location (eg, the finger, face, genitals), with swelling and similar symptoms affecting the entire body, such as fever and swollen lymph nodes.

Self-Care Guidelines

Herpes that is acquired at birth requires care in the hospital and may require intensive care unit care.

For primary herpes in infants, the goal of treatment is to make your child as comfortable as possible. They may have difficulty eating, drinking, and sleeping if they are in pain.
  • Encourage your child to drink as much fluid (milk, water, or juice) as possible to avoid dehydration.
  • You can give over-the-counter acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) for pain.
  • Avoid contact with other children (especially newborns or those with eczema or a weak immune system) until the sores are healed.

When to Seek Medical Care

See your pediatrician or other medical professional if you think your baby has primary herpes and for any skin condition that is present immediately after birth.


For herpes infections in newborns, intravenous antiviral treatment with acyclovir (Zovirax) is given along with supportive care.

For primary HSV acquired in infancy, your child's medical professional may prescribe an antiviral medication to speed recovery of the sores. Acyclovir (Zovirax) is the only antiviral medication that is available as a liquid and that is approved for use in infants. If your child is unable to eat or drink because of mouth sores, they are at risk of becoming dehydrated. If this occurs, they may need IV (intravenous) fluids.
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Herpes simplex virus in Infant/Neonate
See also in: Cellulitis DDx,Anogenital
A medical illustration showing key findings of Herpes simplex virus : Grouped configuration, Recurring episodes or relapses, Umbilicated vesicle
Clinical image of Herpes simplex virus - imageId=111180. Click to open in gallery.  caption: 'A close-up of grouped cloudy vesicles on an erythematous base.'
A close-up of grouped cloudy vesicles on an erythematous base.
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