Suppressive therapy during pregnancy

[sprocket7475]

Hi,
I am 39 years old and have had HSV-1 since I was a child.  I have been on daily suppressive therapy of 1 gram Valtrex for approximately 9 months now.  I had my first child just over a year ago, and actually we had a scare that he might have contracted HSV-1 from me, so at 3 weeks old (given the seriousness of a neonatal herpes infection) he was subjected to a spinal tap, blood work, and acyclovir administered via IV for 2.5 days while we waited for test results to come back.  Thankfully, he tested negative for the virus.  I actually did not have breakouts during my pregnancy (they had decreased in number considerably as I entered adulthood), but after he was born/while I was breastfeeding, I was having outbreaks practically one on top of the other (likely exacerbated by some dental work I had done, along with hormonal fluctuations, stress, and lack of sleep).
Anyhow, at the prompting of several doctors who cared for my son, I went on the suppressive therapy.  I have not had outbreaks while on it (although again, I was having a ton for the first 3 months of his life).  
I now think I am pregnant again.  I know Valtrex is a class B drug during pregnancy, BUT of course no drug is proven to be 100% safe.  I will talk to my OB, but I was wanting the opinion of others on this board - if I stop taking the 1 gram daily dose, is it possible my body will have developed a dependence on the Valtrex and outbreaks will run amuck again?  Or, should I theoretically revert to the same number/pattern of outbreaks that I had prior to beginning the suppressive therapy (which although the outbreaks were numerous in the first 3 months after my son's birth, they had been infrequent before then)?
I want to protect my 1 year old from the virus, but I also want to protect the new life inside me.
What is the recommendation here?
Thank you for your time!

[sprocket7475]

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.

Grace - I have been on the suppressive therapy (with no outbreaks) for the past 9 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.  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.  

I of course will not kiss him with an active outbreak, but I am concerned about asymptomatic shedding (which would have been reduced with the suppressive therapy).  Also, I never kiss him on the mouth, only on the cheek or head.

[sprocket7475]

Also, Grace, if I do go off the meds, have you seen that the likelihood of outbreaks (relative to the pre-suppressive therapy likelihood) increases?  That is, can your body develop a dependence on the drug and revert to a state where it does not fight the virus as well as it had done previously (off the meds)?

[sprocket7475]

Thank you for your response!  And believe me, I know how scary the thought of neonatal herpes can be!  I really appreciate the insight you have provided.  Good luck to you, as well!

[sprocket7475]

Thank you so much for the response!  I am waiting on my OB's nurse to call me back.  And I have oral herpes (cold sores).

[gracefromHHP]

it is generally accepted as ok to take suppressive therapy with valtrex during pregnancy. certainly discuss it with your obgyn to see what their opinion is.

do you have oral herpes or genital herpes?

grace

[MandGsMommy]

Hi! I'm not sure I can be of as much help here as some others can, since I'm new to the forum, and come here for advice myself. However, I am currently just over 34 weeks pregnant with my 3rd baby, and only recently (within the last month or so) learned of the dangers of neonatal herpes. To say it has had me concerned is an understatement! I have very frequent cold sore outbreaks when not pregnant (at least once every 3 weeks), and always several during pregnancy (this is my 3rd child in 3 years). My children, thus far, have not contracted it from me. I  was informed that newborns of mothers with long standing herpes infection do pass antibodies via the placenta, which offer some protection for the first 6 months of life. I  have never taken surpressive therapy, however, given that I,too, have even more frequent breakouts when I am stressed or lack sleep, my OB and dermatologist are fine with me starting Valtrex *after* 36 weeks of pregnancy. I was told by my OB that "Valtrex is very safe in pregnancy", but it's usually not given until after the 36th week. I would definitely speak with your OB in regard to the risks/benefits involved with stopping then restarting valtrex. He or she may want you to stay on it throughout, or restart it during your 3rd trimester. I cannot speak to the potential for more frequent breakouts if you stop now, but I can say that in my experience, I have less frequent breakouts when pregnant. Like you, I am also concerned about protecting my almost 3 year old and my 21 month old, as I know they will want to touch the baby. But thus far, I have not passed it to them. From my own research, it could be likley they have seroconverted and already have antibodies against which ever type I have (assuming hsv 1),  without having had an outbreak. I could be incorrect here, but this what I have read. It could be the same in your case. I was definitely exposed to cold sores during childhood from my mother and grandmother, but did not have an outbreak (that I can remember) until adulthood.  As a fellow mother, my heart goes out to you for having to endure a neonatal herpes scare- thank God it was negative. This is my biggest fear as I approach delivery. All the best of luck to you, and hope I was able to offer some insight.