How Does Herpes Spread? New Mothers Who Died of Virus May Have Caught It From Same Surgeon

Two mothers in the United Kingdom who died as a result of herpes may have reportedly been infected by the same surgeon.

The BBC reported on Monday that the women received cesarean sections from the same doctor in 2018. Their families were informed that there was no connection between the two deaths, but are now calling for an inquest.

The East Kent Hospitals Trust stated that it could not identify the source of the infection, adding that the surgeon had no history of the virus, the BBC added.

The deaths were extremely unusual as, not only is maternal death rare in the U.K, with just 191 deaths of women within six weeks of giving birth out of 2.1 million births recorded between 2017 and 2019, but deaths from herpes are even rarer.

Officially known as herpes simplex, herpes is a virus that is divided into two types, herpes type 1 (HSV-1) also known as oral herpes, and herpes type 2 (HSV-2) or genital herpes, according to WebMD.

Both mothers, Kimberley Sampson, 29, and Samantha Mulcahy, 32, died as a result of HSV-1 infections. Sampson received her cesarean section at Queen Elizabeth the Queen Mother Hospital in Margate in May 2018, with Mulcahy undergoing the same procedure at William Harvey Hospital in Ashford in July of the same year. Neither woman's child was found to be suffering from the virus.

According to the World Health Organisation (WHO), HSV-1 is a highly contagious infection, that is common and endemic throughout the world. The majority of HSV-1 infections occur during childhood with the virus lying dormant throughout a person's lifetime.

This means that oral herpes is usually asymptomatic, with blisters or ulcers that can periodically recur after the initial infection which is often marked by tingling, itching or burning sensation around an infected person's mouth.

The WHO says that the most common way for HSV-1 to spread is through mouth-to-mouth contact, as this is where herpes infection is usually located. Like HSV-2, which is mostly spread via sexual intercourse, HSV-1 can also spread via genital to genital contact. This spread can even occur when the skin of a sufferer appears completely clear.

Johns Hopkins estimates that in the United States around one in every 6 people aged 14 to 49 has genital herpes. It adds that it is rare for mothers to infect their infants with herpes during childbirth, but that pregnant women with an active outbreak of the virus may be advised to undergo a cesarean section.

The WHO adds that transmission of this kind, neonatal herpes, is extremely rare occurring in an estimated 10 out of every 100,000 births globally. Despite this, it can be a serious condition as it can lead to lasting neurologic disability or death. The risk of neonatal herpes is greater in women who contract HSV late into their pregnancy.

WebMD says that herpes symptoms can often be brought about by a trauma to the body like surgery. Outbreaks are also more common in people with weakened immune systems as a result of conditions like HIV or when receiving chemotherapy.

Sexual health consultant, Peter Greenhouse, suggested to the BBC a possible scenario in which a surgeon may have passed herpes to Sampson and Mulcahy during their procedures.

"The only common source here, in a hospital-based scenario, would be the surgeon who performed the operations," he says.

Greenhouse continued, adding that it is possible the surgeon may have had a herpetic whitlow, a herpes infection on the finger, that could have "directly seeded herpes into the abdomen of the women."

Greenhouse told the BBC that this would allow the infection to spread through the abdomen rapidly, and would explain the lack of external signs of herpes in the two women.

Though herpetic whitlows are often painful and cause blisters and sores, the NHS says they can also lie dormant, as in other examples of conditions caused by herpes simplex.

"Many of these will occur without any obvious signs, or they'll be so minuscule that you can't identify them," Greenhouse added, suggesting the infection could have occurred if the surgeon's gloves had split during the procedure. "It's a very rare but a very biologically plausible method of transmission."

Greenhouse is currently investigating the circumstances behind the deaths of the women, suggesting that if a connection is discovered it could mean new mothers with unexplained sepsis-like symptoms will be tested for herpes in the future.

"I hope that the research will eventually change the guidelines, so more people will benefit from earlier diagnosis," he told the BBC. "It is the only constructive outcome that one could hope for, after such a tragic scenario."

In a statement Dr. Rebecca Martin, chief medical officer for East Kent Hospitals, the authority that operates both hospitals, said: "Our deepest sympathies are with the families and friends of Kimberley and Samantha.

"East Kent Hospitals sought specialist support from Public Health England (PHE) following the tragic deaths of Kimberley and Samantha in 2018. The investigations led by the Trust and the Healthcare Safety Investigation Branch took advice from a number of experts and concluded that it was not possible to identify the source of either infection.

"The surgeon who performed both Caesarean sections did not have any hand lesions that could have caused infection, or any history of the virus.

"Kimberley and Samantha's treatment was based on the different symptoms showed during their illness. Our thoughts are with their families, and we will do all we can to answer their concerns."

Herpes Simplex
A stock illustration of herpes simplex cells. Two women died as a result of herpes infections after giving birth in separate hospitals. Their families are requesting an inquest to discover if they were infected by their surgeon. Dr_Microbe/Getty