One Year Old Child - Herpes Risk

[sprocket7475]

Hi,
I had posted previously asking about suppressive therapy during pregnancy...I would like to ask a follow-up question now.

My OB has advised that I go off the suppressive therapy for the first and second trimesters.  He said that I can start taking the Valtrex again in the third trimester if I want to safeguard against having a cold sore outbreak at the time of delivery.

I have been on the suppressive therapy (1 gram daily, with no outbreaks) for the past 10 months in order to protect my son from the virus.  The experience of him being in the hospital for a possible case of neonatal herpes was very traumatic (again, he ultimately tested negative).  During the first 3 months of his life, I had nearly constant cold sore outbreaks.
He is now 13 months old, and I am really worried about the outbreaks I may now experience with going off the meds.  If he were to get the virus now, is he safe/out of the danger zone?  Please let me know.  

Also, I of course will not kiss him with an active outbreak, but I am VERY concerned about asymptomatic shedding (which would have been reduced with the suppressive therapy).  I didn't kiss him for nearly the entire first 6 months of his life, and I am worried that I am going to need to refrain from kissing him throughout the first and second trimesters of this pregnancy, while I do not have the meds for protection.  Note:  I never kiss him on the mouth, only on the cheek or head.

Thank you!

[ConnieS123]

Good to know I'm not the only mom with littles who works diligently to keep them from getting cold sores :) I try so hard to be careful and it makes me crazy when I see other parents (and family members) being reckless and possible exposing their kids. I would say that while you're off the meds during this pregnancy, just continue being careful with your toddler. If you should get an outbreak, ask you doctor if you could use a topical antiviral cream. I used this during both pregnancies when I felt an outbreak starting. 99% of the time, it completely stops the outbreak within 15 minutes! If you have a cold sore, I would recommend covering it with a bandaid or cloth if your toddler sleeps with you, and don't use towels on your face (use paper towels) to help prevent the spread. My biggest worry is when my kids go to school and might pick it up from kids whose parents are idiots and send them to school with outbreaks. I can't remember a time in my life when I didn't have them. I hate it!

[sprocket7475]

Yes, I realize that having oral hsv is not an issue for the actual pregnancy.

My concern with this thread has been any risk to my 13 month old son from contracting hsv.  I have spent the past 12 months (since the time he was discharged from the hospital after the neonatal herpes scare) vigilantly protecting him from exposure - with the main tool being the fact that I was put on suppressive therapy and no longer had outbreaks (and any shedding would have been greatly reduced).  

Now, my dr wants me to go off the suppressive therapy for the first and second trimesters of my current pregnancy, and given the fact that I have frequent cold sore outbreaks, I am just wanting to make sure that an hsv infection of a 13 month old would not be serious, as he will have a much greater likelihood of exposure than he did when I was on the meds.  (If it could be serious, that might be a reason for staying on the meds, since they are category B, although we would have to weigh risk versus benefit overall, considering my unborn child, as well).

Thanks for your help.  I will try to talk to my son's pediatrician.

[Life360_Dave]

Any herpes  infection to a baby is not good but again realize that we are talking about oral hsv not genital. Having oral hsv is not an issue when pregnant.Upwards of 65% of the adult population would test positive for hsv1 oral and if your concerns that its a big risk for those around you, its not as more children would be infected and there are not. Just work with your doctor but dont be overly concenred about oral hsv1.

[sprocket7475]

Thanks for your reply!

I understand that the majority of neonatal herpes cases are related to HSV2 and transmission during a vaginal delivery.  However, there is a small percentage of cases of post-natal transmission of herpes via a kiss/cold sore, which can be just as deadly.  The possibility of post-natal HSV1 transmission is what landed my child in the hospital at 3 weeks old.  And yes, thankfully he should have had antibodies that I passed to him via the placenta, as I have a long-standing oral HSV-1 infection.  I understand that those temporary antibodies provide protection for approximately 6 months of life.

Anyhow, I definitely agree that suppressive meds are a great idea in my case.  Again, I have taken them for 10 months in order to reduce outbreaks and shedding, in the interest of protecting my now-13 month old from the virus.  And I will definitely take them again close to and after delivery of my next child, in order to guard against cold sore outbreaks and shedding.  

However, my question right now is - if I go off the suppressive meds for the first/second trimesters of my current pregnancy and get a cold sore outbreak, and my now-13 month old contracts herpes, could the infection be serious?

Thanks so much for your time and patience!

[Life360_Dave]

Its ok to ramble as you have a concern. Firstly when we talk about neonates and herpes its with those that have genital hsv and most often hsv2 and the concern is passing during the birthing process.
If youve had hsv1 oral for quite some time (and most likely is in your case) temporary antibodies would have been passed to the child prior to birth.
Since you do have oral outbreaks suppressive meds would be a good idea as would reduce outbreaks and shedding considerably.

[sprocket7475]

Also, Grace had told me (in another thread) that it is generally accepted as ok to take Valtrex as suppressive therapy in pregnancy.  It is classified as a category B drug.  And I know some OBs are ok with the mother continuing to take the drug.
However, as long as there is no risk of a major complication if my 13 month old were to contract the virus (protecting him is the main reason for the suppressive therapy), then in terms of risk versus benefit analysis, my OB would prefer I don't take the Valtrex for the first and second trimesters.  Although category B drugs are generally considered safe during pregnancy, no drug is proven 100% safe, of course.  And I want to do what is best, in terms of protecting both my 13 month old and my unborn child.
Thanks again!

[sprocket7475]

I mean safe from any major complications associated with contracting the herpes virus.  Children (neonates) have died (or suffered major brain damage) from contracting herpes via a kiss/cold sore, as their immune systems are not mature enough to handle the virus.

My son was hospitalized at 3 weeks old (had to undergo spinal tap, blood work/PCR analysis, and IV acyclovir administered every 8 hours for 2.5 days while we waited on test results to come back) due to possible HSV-1 exposure.  I actually had a lesion on my breast (I was breastfeeding) - long story but it was never cultured and we are not sure if it was herpetic (however, I also came down with a cold sore very soon after the lesion on my breast appeared, indicating that the virus was very active in my system at the time).  Given an abundance of caution and the serious, often deadly nature of neonatal herpes, my son was tested and treated (as a precaution) until the test results came back negative.  If the results had been positive, he would have continued the acyclovir for the full (recommended for SEM infection) course of 14 days.  

I know the risk associated with herpes infection is most serious for neonates, still serious for newborns up to 3 months, and that most of the newborns infected and treated are still followed/monitored up to 6 months...but again, given our prior experience, I want to be sure that a (primary) herpes infection would not be serious for a 13 month old.

Aside from the consideration of the possible herpetic lesion on my breast (which had NEVER occurred prior to having my son, may have been brought on by friction due to breast pump, prior to this possible lesion I had NEVER had herpetic lesions anywhere but my mouth/chin), the infectious disease doctors at Arkansas Children's Hospital and my son's pediatrician recommended that I go on suppressive therapy - especially given how many cold sore outbreaks I was experiencing at the time - in order to protect my then-infant from exposure to/contracting the virus.  I have remained on the suppressive therapy since, and have had no outbreaks (and felt confident that any asymptomatic shedding was greatly reduced), allowing me to kiss my child without worry, and not have to worry about constantly washing his hands (as I did in the first three months of his life) anytime he touched my mouth.

I will go on suppressive therapy just prior to and when my next child is born, as well - as obviously post-pregnancy I had a ton of outbreaks with my last child - and I want to be sure that my infant is protected from the virus.  I understand that most cases of neonatal herpes occur in situations of a primary infection of the mother late in pregnancy (no time to build antibodies to pass on to the child via the placenta), but there is a small percentage due to post-natal transmission via contact with cold sores.

Thanks, and I apologize for this rambling post and any confusion!

[Life360_Dave]

Hi, your issue is a bit confusing. If you have oral hsv1 that would not be any risk to the baby during labor. Follow your doctors advise. What do you mean safe out of the danger zone?