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Pregnant and HSV2 outbreaks on valacyclovir
Good morning Ma'am,

I am 16 weeks pregnant and have had HSV2 for 7 years. I have been on an off valacyclovir for about 5 years or so. Due to my recurrent outbreaks during my pregnancy I have been put on Valcyclovir for daily suppression. 500mg daily and 1000mg during outbreaks. Outbreaks last about 3-4 days. A recent outbreak has just about healed and yesterday was the fourth day of 1000mg. However, yesterday afternoon I noticed what I thought were prodrome symptons although I thought I could be wrong due to the increased dose of medication. However, low and behold, I woke up in the early hours of this morning with a definite start of another outbreak. This will be the fourth one back-to-back in the space of two weeks or so (I only went back on the daily suppression at the beginning of last week or so). They each heal in a few days but have had another one to take its place...is my immune system that bab due to the baby?

Do breakthrough outbreaks occur on this medication, even after 4 days of the increased dose? This is driving me crazy. Also, from my research I don't think these outbreaks can hurt the baby as the cycle is from the nerves near the base of my spine and not through my circulation system, thus it can't reach the baby in-utero. Is this the case as I am concerned that somehow these recurrent outbreaks will reach the baby and cause congenital neonatal herpes. I am aware of the requirements closer to the birth and not using invasive procedures for monitoring or delivery assistance.

Also, is it okay to dab a bit of isopropyl alcohol on the lesion (then use a cool hairdryer) as before I was pregnant this seems to help dry them out, but I am not sure during pregnancy.

Thank you for your patience and guidance is sincerely appreciated Ma'am.

Sammie
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603463 tn?1220630455
Hi!
If you were my patient, I would advise you that you should definitely continue with your suppression, and I would continue through delivery.  I don't know what your doctors will decide, but I would probably just deliver you by c section at 39 weeks and not risk ruptured membranes since you have had so much difficulty. Your immune system does become somewhat suppressed during pregnancy and that is possibly why you have had the increased number of outbreaks.
I would also suggest that you ask your doctors for some topical lidocaine which can numb the lesions for awhile (it burns a bit at first).  
Hope this helps!
Dr B
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239123 tn?1267651214
Welcome back.  But really, this is a question for your obstetrician, or whoever is your main doctor at this time; and perhaps, if she or he recommends it, an infectious diseases specialist or other herpes expert.

As you mentioned in your other thread, the natural immune suppression of pregnancy could result in increased frequency of herpes outbreaks.  However, the extreme frequency you report would be very unusual even in pregnancy or other immune deficiency, and I am not as certain as you are that you are having such frequent herpes outbreaks.  Recurrent episodes rarely if ever occur more often than once a month, even without valacyclovir.

My advice is that you NOT treat this episode with valacyclovir and see a doctor ASAP, preferably in the next day or so.  The apparent outbreak can be tested to confirm the diagnosis.  If I'm wrong and herpes is the main problem, you should discuss the possibility of taking valayclovir continuously to suppress or prevent outbreaks, instead of treating each one as it comes along ("episodic treatment").

None of this implies an increased risk of the virus infecting your baby.  The ONLY risk to your baby could come at the time of delivery; the virus cannot reach the uterus or the baby at this stage of pregnancy.

Treating individual lesions as you have don't won't hurt the pregnancy.  However, it will alter the appearance of the lesions and make diagnosis more difficult, so I would urge you not to do it until this outbreak has been professionally examined and the diagnosis confirmed.

Best wishes--  HHH, MD
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239123 tn?1267651214
Apolgies to the forum moderator for jumping in. SammieSammie posted the identical question on the STD expert forum, and I thought I was responding there.

HHH, MD
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Avatar universal
Hi Dr Brown,

Thank you kindly for your response. I am now on daily suppression so will see how that goes. I will ask about the lidocaine. Also, thank you to Dr HHH for his guidance. Just 2 quick questions if I may:

Can you please confirm that the outbreaks do not affect the baby in the womb? I don't think so but it is constantly on my mind and is very worrisome for me. I read that there is a small risk, but perhaps this is related to a primary infection during pregnancy?

Also, with one of the outbreaks, I accidentally busted the small blister when I was looking to see what it was. It was not an internal blister, more on the edge of the inner labia. I showered and washed the area straight away and it is now healed, but I am concerned that the clear liquid inside the blister has somehow increased my chances of infecting the baby in the uterus. I guess sometimes the blisters bust when you simply move and sit down, but because it busted when I was inspecting it, I am now more worried.

Please feel free to tell me I am being silly, as I seem to respond better to that!

Your help is appreciated Ma'am.
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