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Recurring viral meningitis & herpes II
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Recurring viral meningitis & herpes II


  I have endured four episodes of viral meningitis within the past two years.  The first time I had the meningitis symptoms I was 28 weeks pregnant with my son; the doctors had no idea how or why I had contracted the illness.  I was told it was a possible complication due to a viral sinus infection?  My lumbar puncture was positive for viral meningitis, but the reason was unclear.  My son was born almost three months later, healthy, although he did show signs of distress while still in utero.  Six days after my son was born, I had the same meningitis symptoms.  Once again I had all of the tests done including another lumbar puncture, and once again, I was given no reasonable explaination as to how or why this was happening.  Four months later, I went to my OB/GYN with a genital sore, she did a herpes culture and it came back positive for HSV 2.  I was shocked since I'd been with my husband for over two years (we were both faithful, I believe that with all my heart).  I could only assume that I contracted it from my husband during oral sex since he had a minor history of cold sores (one or two in the years I knew him, but never one during intamacy)  Beside, all of the literature I've read on oral HSV 2 is that it seldom if ever has recurrances?  Two weeks later, I was back in the hospital with meningitis again.  I was given all of the same procedural tests and another lumbar puncture.  I informed my Neurologist of my recent herpes diagnosis; he ran a PCR test on my spinal fluid and said the HSV 2 virus was indeed present, and at that point he diagnosed me with "Mollaret's Meningitis."  I was placed on oral Acyclovir for a one year period to see if the meningitis would remain dormant if the herpes virus did.  By the way, that was the one and only outbreak I can ever remember having, I didn't experience any herpes symptoms with my first two meningitis episodes, it wasn't even suspected at that time.  I remained both herpes and meningitis free for the entire year.  I moved to Hawaii during that time frame, but I contacted my Neurologist by e-mail a few times to ask questions.  I was desperately wanting another baby, but I was terrified to remain on the Acyclovir and do so.  I was instructed to discontinue the medication since a year had passed, and that it should be safe for me to get pregnant if I chose to do so.  I spoke to a few specialists here in Hawaii and no one thought that herpes could actually be the cause of my recurring viral meningitis?  I had my fourth episode of meningitis in June of this year.  I went to the ER and I was told that since I had a history of viral meningitis, no tests would be run, and that Acyclovir wasn't an option.  I was given some pain medication and sent home.  My husband and I had decided that we wouldn't risk having another child eventhough we both wanted one, when all of the sudden I found out I was pregnant.  I am three and a half months along now and terrified of having another episode of meningitis.  I have had one severe outbreak of herpes since my pregnancy began and it lasted for three weeks!  I don't know what to do.  Will it be safe for me to take pain medication if I do have another meningitis episode this early on?  If the HSV 2 virus is causing my recurrances, WHY is it happening?  There are millions of people with this virus and they don't have this complication!  I've been told this is extremely rare, but I have found a few others that have recurring meningitis though most are due to other things like head trauma.  What about this virus only causes this to happen in certain people.  I don't have any other immune disorders, and my immune system has always been strong.  PLEASE help me.  I am so afraid for me and my unborn baby.  I can't imagine haveing this illness for the rest of my life if it is being caused my the incureable herpes virus, I am miserable everyday in fear.  I pray someday someone will take an interest in people like me and try to find a cure.  I know there is no present cure for herpes, but I would hope it would stop the recurring meningitis if there were.  Thank you for listening.
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Dear Kim:
1.  It is reasonably well-established in the last few years that herpes simplex virus 2 (HSV-2) is the commonest cause of recurrent viral meningitis (Mollaret's meningitis). Most such cases occur in "normal" individuals, not immunosuppressed ones, and the cause of this occurence is not known. HSV-2 certainly appears to be the cause of meningitis in your case. Although treatment of this problem is debatable, prophylactic long-term use of oral acyclovir (or valacyclovir) may have fair efficacy and is an acceptable option if spells are frequent.
2.  Recurrent genital herpes has very significant obstetrical/neonatal risks associated with it, and probably may merit treatment with acyclovir as an independent problem. A recent study addresses this question (Brocklehurst P, Kinghorn GA et al. randomised placebo controlled trial of suppressive acyclovir in late pregnancy in women with recurrent genital herpes infection. Br J Obstet Gynaecol, Mar 1998, 105(3) p275-80 ). The use of acyclovir in pregnancy may not be unacceptably unsafe in late pregnancy.
3.  Symptomatic control of a bout of meningitis (with painkillers such as tylenol#3) during your pregnancy may actually be relatively trivial as compared to the problem mentioned in point 2 above.
You need expert care from an obstetrician and an infectious diseases specialist. A neurologist has a secondary role in your case.
Good luck!





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