herpes 1 (cold sore virus)

[Mistysmom]

I am in my last trimester of pregnancy and my 2 year old daughter has just contracted PRIMARY HERPETIC GINGIVOSTOMATIS (herpes type 1). I am terrified that she may pass this on to my newborn baby who is due in 6 weeks! I read that a person is contagious for MONTHS after the primary attack and a sore need not be present to be contagious. How likely is it that the virus will be in her saliva after the baby is born? What if my husband and I get it from her? Does this mean we have to all avoid touching the newborn baby for months since we will be contagious for months with or without sores? I woke up with a bad sore throat 2 days after her initial exposure, does this mean I probably have it now? (I read this is a symptom in adults of a primary infection) HELP! I'm scared for my newborn baby, as the infection could kill a newborn.

[Alan Rockoff, MD]

I don't know where you're getting your information, but herpes gingivostomatitis generally heals in 10-14 days.  Once the sores are dried over, contagion is no longer an issue.  Herpes can appear in saliva after minor cold sores, not just acute gingivostomatitis, but isn't a factor in contagion--if it were, everyone who has cold sores (and there are a lot of them(, would be spreading herpes all over the place all the time, and they don't.  I advise you to plan on touching the newborn with pleasure and comfort.  If you're still uneasy, feel free to consult the doctor who diagnosed and treated the gingivostomatitis.

Take care.

Dr. Rockoff

[Terri Warren, RN, Adult Nurse Practitioner]

Actually, I would like to post a different thought about the asymptomatic shedding of HSV 1 from the oral cavity.  Though I would strongly agree that your child is not going to infect your unborn baby, because there is no contact between the two that would make that possible, I would disagree that people are not infectious between cold sore outbreaks.  The most recent study at the Univeristy of Washington about asymptomatic oral shedding of HSV 1 (the giving off of virus without symptoms) found that people who have a history of recurrent cold sores, shed virus without symptoms from the oral area on 18% of the non-lesional days sampled.  This study was done by swabbing the oral area, both inside and lips, daily on days without symptoms,  with a very sensitive test called PCR.  This is not the first study to look at this issue, but it does reinforce that virus can and is given off between outbreaks, particularly because swabbing is done with such a sensitive test as PCR.  Now in terms of your child and the newborn.  It is very unlikely that the two year old would infect the baby if she does not have any sores and should kiss the baby (which I suspect you are concerned about).  That's because the kind of kissing that the two year old would do with the baby is more like a peck than a wet kiss like adults might share.  However, newborns are very susceptible to HSV virus, and you should be absolutely certain that no one with a cold sore kisses your new baby. That includes parents, grandparents, and children - anyone!  Perhaps 5% of new cases of neonatal herpes in the US is attributable to post natal infection with HSV 1 due to oral-newborn transmission.  For more information about the University of Washington study, I think you could write to their website, http://depts.washington.edu/herpes/ and depending on how busy they are, they might write to you about this.  These most recent numbers were discussed on a conference call between myself, Dr. Larry Corey, Dr. Anna Wald, and several other clinicians as we discussed a new study that we will be doing, looking at similar issues.  So I'm not sure that these numbers are in anything published yet.  

Terri Warren

[Mistysmom]

Thank you Terri.  I appreciate all that information.  Yes, I am worried about my 2 year old kissing the new baby or grabbing a pacifier and sharing it with the baby.  Anything can happen with a toddler and I feel so out of control.  For how long is the newborn baby at risk of dying from the herpes infection?  At what age does it just become a regular childhood illness?  Do I have to watch my toddler with my baby constantly for months and months?

Thanks very much.

[Terri Warren, RN, Adult Nurse Practitioner]

Well, first of all, if this was a common happening, we would see many many more cases of neonatal herpes from toddlers sharing pacifiers, etc.  It just rarely  happens.  So don't be too wary, you could negatively impact the relationship between the two siblings.  Rather, be aware but not in a panic.  I can't tell you the exact time when the baby could get herpes and not be severely impacted, but somewhere around 12 months, perhaps earlier.  It would be interesting to know if you are positive for HSV 1.  If you are, you will pass antibody to your newborn to HSV 1.  Even if you have never had a cold sore, you could have HSV 1, and, in this case, that would be a good thing.  If you are interested, you can get a type specific antibody test and find this out.

Terri

[Mistysmom]

Thanks for the fast reply!  When my daughter got diagnosed I went ahead and got tested.  It was negative.  So, no antibodies for my unborn baby.  I am most concerned about the asymptomatic shedding.  Obviously if my 2 year old has a cold sore I will keep her far away from the baby.  But, I read on a website that shedding occurs quite heavily for a long, long time after the primary infection.  THIS is what is scaring me.  I will never know when my 2 year old is shedding the virus, since her primary outbreak just ocurred.  UGH!

[Terri Warren, RN, Adult Nurse Practitioner]

Its true that you won't know when she is shedding, but again, aside from the pacifier example that you gave, there is little chance that there will be a physical opportunity for transmission to occur from 2 year old to baby.  I know you are worried, but I honestly think that the chances of transmission are very low.