Breastfeeding and STDs: Assessing the Risks

Assessing the Risk of Transmission of HIV, Hepatitis and Herpes

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Photograph © Aurimas Mikalauskas

In many parts of the world, breastfeeding is the only source of nutrition for newborns and babies, and some would rightly say one of the best forms of nutrition. Under normal circumstances, breast feeding wouldn't be a concern. But breastfeeding when you do have HIV poses the risk of transmission to your baby—as high as a four-fold increase in risk among women who are untreated and have high HIV viral load..

Rates of hepatitis B, hepatitis C and herpes simplex virus (HSV) also run high in women with HIV with the potential, big or small, of transmission. Since rates of co-infection can run as high as 30% in some communities, let us take a look at some of the current recommendation regarding breastfeeding and an the avoidance of viral transmission.

Breastfeeding and HIV

Here is the bottom line: about one-third of all HIV-positive children throughout the world have been infected through breastfeeding. Risk is associated with number of factors, most importantly the treatment and viral load status of the mother. In short, viral control by way of an undetectable virus makes HIV transmission not impossible, but far less likely. Cracked or bleeding nipples can also potentiate infection by allowing direct blood contact.

In the U.S. and most developed countries, breastfeeding is not advised for mothers with newborns.

Bottle feeding with a nutritious substitute is generally recommended, whether the mother is on HIV therapy or not.

Clearly this is not possible in resource-poor countries, where most international guidelines suggest either exclusive breastfeeding or exclusive bottle feeding. The one thing that should be avoided in all circumstances is alternate breast/bottle feeding (also known as supplemental feeding) as research has shown that the practice can significantly increase HIV transmission risk.

Breastfeeding and Hepatitis B and C

Hepatitis B infection is of global concern with over 350 million carriers worldwide  But while it is estimated that 5% of mothers are chronic carriers, relevant studies have concluded that there is no hard evidence that breastfeeding poses any risk to nursing infants.

Hepatitis C transmission by blood-to-blood contact (predominately the shared use of needles) is well documented. However, unlike other forms of hepatitis, perinatal transmission can also occur, particularly in mothers co-infected with HIV. This most frequently happens while the baby is in the uterus, although cases of transmission have been reported during delivery.

By contrast, the risk of hepatitis C transmission through breastfeeding is considered negligible to nil, with no documented cases ever reported. Experts do, however, advise women with cracked or bleeding nipples to avoid breastfeeding until such time as healing is complete and the skin on and around the nipples is fully intact.

Breastfeeding and Herpes Simplex Virus

Herpes simplex virus (HSV) can be transmitted primarily by contact with an open sore or lesion, and should be considered highly contagious. While HSV cannot be transmitted through breast milk, contact with sores on the nipples pose a serious risk.

In such instances, it is advise that you bottle feed your child or use a breast pump so long as the equipment does not come into contact with a sore. Breastfeeding can be started once the sores are fully healed.


U.S. Department of Health and Human Services (DHHS). "Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States." Rockville, Maryland. Update issued May 21, 2013.

World Health Organization (WHO). "HIV Transmission Through Breastfeeding - A Review of Available Evidence."Geneva, Switzerland. Update 2007: 5-6. ISBN: 9789241596596.

American Association for the Study of Liver Disease (AASLD). "Assessing the Global and Regional Burden of Liver Disease." Washington, D.C. Press release issued November 3, 2013.

Peña, K.; Adelson, M.; Mordechai, E.; et al. "Genital Herpes Simplex Virus Type 1 in Women: Detection in Cervicovaginal Specimens from Gynecological Practices in the United States." Journal of Clinical Microbiology.January 2010; 48(1):150-153.

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