Nipple herpes and shingles

Why do I suddenly have painful blisters on my areolas?

A virus called herpes simplex sometimes infects the nipples and areolas. It causes blisters and can be painful. Mothers with herpes simplex can be treated with an oral antiviral medication. It can also cause a devastating infection in younger babies. If their baby is under six months of age, mothers should not breastfeed until the blisters have dried, should express and discard their breast milk, and see their health-care providers immediately. Older babies can have a herpes simplex infection of the mouth that they then pass onto the mother’s nipples. They can continue to breastfeed. A different type of herpes, herpes zoster, causes an infection called shingles, which results in a band of blisters on one side of the body. It is also treated with antiviral medications. Breastfeeding can continue as long as the baby can avoid being in contact with the blisters until they have dried.

A) Herpes simplex infections

Nipple herpes infection.

1) Describing nipple herpes

Herpes simplex is a virus. It can cause blisters on various parts of the body. There are two types of herpes simplex:

  1. Type 1 generally causes cold sores and fever blisters around the mouth.
  2. Type 2 generally causes genital herpes.

However, both types can affect various parts of the body. It is acquired from contact with another person.

People who are infected will have the virus in their body for the rest of their lives. Some will experience regular outbreaks and others only one episode.

Herpes infections are treated with antiviral medication. 

a) Infection of the mother's breasts

Nipples and areolas can be infected by herpes simplex by breastfeeding an infected baby or by the infected mouth of a sexual partner (D’Andrea 2019; Brown 1996; Dekio 1986; Gupta 2008; Kingdon 2019).

Nipple herpes causes one or more blisters to form on the nipple and areola with varying amounts of pain. The blisters usually dry within 10 days.

b) Infection of the baby 

Babies can become infected by contact with herpes simplex blisters as the liquid in the blisters contains active viruses. This can happen during travel through an infected birth canal or when the baby breastfeeds on an infected nipple and areola. Sometimes the mother and baby are infected around the same time making it difficult to know where the infection started.

A herpes simplex infection of a baby younger than six months can cause major health effects, even death (Field 2016). This is most common in the first month after delivery (Curfman et al. 2016). 

Older babies and children can develop a very painful mouth infection that may affect feeding for several days along with a fever and swollen lymph nodes.  

2) Breastfeeding with nipple herpes

If you develop nipple herpes and you are breastfeeding a baby under six months of age, please see your health-care providers immediately. You should not breastfeed until the blisters have opened and dried. The milk should be expressed and discarded until the baby can resume breastfeeding (D’Andrea and Spatz 2019). While the milk is safe, expressing will likely allow the virus to contaminate it. 

Nipple herpes is quite rare and our clinic has only seen three cases. All were in babies older than six months of age and the infection was first seen in the mouth and on the face of babies who were otherwise healthy and who presumably passed the infection to the mother through breastfeeding. In this situation, babies and children can continue to breastfeed.

3) Breastfeeding future babies

There is a chance that a mother who had a nipple herpes simplex infection of the breast with one baby, will have another outbreak with the next baby. Mothers may wish to consider taking antiviral medication temporarily after the birth of the next baby to prevent infection of the new baby.   

B) Herpes zoster (shingles)

Shingles on the lower half of the right breast.

Mothers can also develop shingles, an infection with a different type of herpes, herpes zoster. This results in a band of blisters on one side of the body or face in a narrow stripe. It is a re-emergence of the virus that causes chicken pox from one nerve.

Mothers with shingles can be given antiviral medications to treat pain and limit the infection.

There is no need to stop breastfeeding as long as the baby can avoid being in contact with the blisters until they have opened and dried.

References

Brown H, Kneafsey P, Kureishi A. Herpes simplex mastitis: Case report and review of the literature. Can J Infect Dis. 1996 May;7(3):209-12

Curfman AL, Glissmeyer EW, Ahmad FA, et al. Initial Presentation of Neonatal Herpes Simplex Virus Infection. J Pediatr. 2016 May;172:121-126.e1

D'Andrea MA, Spatz DL. Maintaining Breastfeeding During Severe Infant and Maternal HSV-1 Infection: A Case Report. J Hum Lact. 2019 Mar 6:890334419830994
 
Dekio S, Kawasaki Y, Jidoi J. Herpes simplex on nipples inoculated from herpetic gingivostomatitis of a baby. Clin Exp Dermatol. 1986 Nov;11(6):664-6

Field SS. Fatal Neonatal Herpes Simplex Infection Likely from Unrecognized Breast Lesions. J Hum Lact. 2016 Feb;32(1):86-8  

Gupta S, Malhotra AK, Dash SS. Child to mother transmission of herpes simplex virus-1 infection at an unusual site. J Eur Acad Dermatol Venereol. 2008 Jul;22(7):878-9
 
Kingdon T, Aita-Levy J. An Unknown Mode of Transmission of Oral Ulcers in a Neonate. Clin Pediatr (Phila). 2019 Jul;58(8):921-923