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STDs (Expert Forum)
5 months pregnant and HSV
Answered by
University of Washington
Seattle - WA
Welcome to the STD Forum, which is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.
5 months pregnant and HSV
by newmom07, Feb 04, 2007 12:00AM
Thanks for the response to my wife's initial post (from newmom07 on 1/10) We had some follow up questions that we hope you can answer
My wife is now 21 weeks pregnant. Before her pregnancy she had a blood test for HSV, positive HSV1 negative HSV-2. I was exposed to herpes 10 years ago. Shortly after, I had a lesion on my genitals which was cultured & came back herpes, but not typed. The person I was with at the time thought she had HSV-2. I had several blood tests, including a Western Blot from the U of Washington. Both tests were negative for both HSV1&2
Since then, I had no actual outbreak. However, Several weeks ago, I had an outbreak in the same area as the first one; Cultured positive as HSV-1.
Q1: Is there any possibility that I could have contracted HSV2 genitally 10 years ago and acquired HSV1 from my wife recently?
As far as risk goes, my understanding is that there are three types of risk, I'll call S1, 2, and 3.
S1: The virus crosses the placenta.
S2: Active lesions are identified pre-delivery and a C-Section is required
S3: Active lesions are present but missed and the baby gets infected during a vaginal delivery.
Q2 - Can you comment on the likelihood of each scenario and the relative risk (S1,S2,S3) to our baby assuming vaginal intercourse and that I'm on Valtrex 500 mg once daily.
a) Me HSV1 genitally, my wife HSV1 orally (Most likely?)
b) Me HSV1 genitally, my wife HSV1 vaginally
c) Me HSV2 and HSV1 genitally, my wife HSV1 orally
d) Me HSV2 and HSV1 genitally, my wife HSV1 vaginally
Thanks
My wife is now 21 weeks pregnant. Before her pregnancy she had a blood test for HSV, positive HSV1 negative HSV-2. I was exposed to herpes 10 years ago. Shortly after, I had a lesion on my genitals which was cultured & came back herpes, but not typed. The person I was with at the time thought she had HSV-2. I had several blood tests, including a Western Blot from the U of Washington. Both tests were negative for both HSV1&2
Since then, I had no actual outbreak. However, Several weeks ago, I had an outbreak in the same area as the first one; Cultured positive as HSV-1.
Q1: Is there any possibility that I could have contracted HSV2 genitally 10 years ago and acquired HSV1 from my wife recently?
As far as risk goes, my understanding is that there are three types of risk, I'll call S1, 2, and 3.
S1: The virus crosses the placenta.
S2: Active lesions are identified pre-delivery and a C-Section is required
S3: Active lesions are present but missed and the baby gets infected during a vaginal delivery.
Q2 - Can you comment on the likelihood of each scenario and the relative risk (S1,S2,S3) to our baby assuming vaginal intercourse and that I'm on Valtrex 500 mg once daily.
a) Me HSV1 genitally, my wife HSV1 orally (Most likely?)
b) Me HSV1 genitally, my wife HSV1 vaginally
c) Me HSV2 and HSV1 genitally, my wife HSV1 orally
d) Me HSV2 and HSV1 genitally, my wife HSV1 vaginally
Thanks
Doctor's Answer
by H. Hunter Handsfield, M.D., Feb 04, 2007 12:00AM
, Feb 04, 2007 12:00AM
Sorry to make a doctor-typical CYA statement, but I take no responsibility, regardless of my replies, for protecting you and your baby against HSV transmission.
1) The chance you or your wife has HSV-2 is very low. But you are an illustration of the occasional false-negative blood test results for HSV, and I cannot say for sure that your infection 10 years ago was not HSV-2. However, the odds that 2 people would both have false-negative results is statistically very low. Yes, it is possible you acquired your genital HSV-1 infection from your wife, but more likely you have had it since your event 10 years ago.
2) Sorry, these issues are too complex for either me to give clear replies without writing a 10 minute paragraph on each question and subquestion. You need to be addressing these questions with your wife's obstetrician or, if that person doesn't seem to be up to speed on herpes, ask for consultation by an expert--and not rely on me or any other distant, online source as the main information to help you prevent transmission of HSV to your baby. The biggest risk for neonatal transmission occurs when mom catches a new genital HSV infection late in pregnancy. Since your infection status is uncertain, you should consider the 100% protection strategy: to not have sex with your wife for the remainder of her pregnancy. (I mean genital intercourse and cunnilingus; of course fellatio carries no risk.)
Good luck-- HHH, MD
1) The chance you or your wife has HSV-2 is very low. But you are an illustration of the occasional false-negative blood test results for HSV, and I cannot say for sure that your infection 10 years ago was not HSV-2. However, the odds that 2 people would both have false-negative results is statistically very low. Yes, it is possible you acquired your genital HSV-1 infection from your wife, but more likely you have had it since your event 10 years ago.
2) Sorry, these issues are too complex for either me to give clear replies without writing a 10 minute paragraph on each question and subquestion. You need to be addressing these questions with your wife's obstetrician or, if that person doesn't seem to be up to speed on herpes, ask for consultation by an expert--and not rely on me or any other distant, online source as the main information to help you prevent transmission of HSV to your baby. The biggest risk for neonatal transmission occurs when mom catches a new genital HSV infection late in pregnancy. Since your infection status is uncertain, you should consider the 100% protection strategy: to not have sex with your wife for the remainder of her pregnancy. (I mean genital intercourse and cunnilingus; of course fellatio carries no risk.)
Good luck-- HHH, MD
