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Neo natal herpes
Good evening,
I'm interested in knowing a bit more about herpes and pregnancy. I'm GH positive and would like to become pregnant in the near future.
I'll write the question out in point form to make it easier for you to answer:
1) Is it dangerous (for the child to be) to conceive whilst having an OB and/or asymptomatically shedding?
2) I would like to have a C-section to avoid any potential complications. I know that neo-natal herpes is relatively rare. However, the relative stress of waiting/wondering if an outbreak will happen during labour is far too much to bear (and embarrassing when family members are present). Does a C-section completely eliminate the possibility of transmission in women with known infections? Or can the virus still spread through the placenta during pregnancy if I have a recurrent outbreak?
3) Is there any risk of taking suppressive therapy (Valtrex) during the final month of pregnancy? I'd prefer not to (another reason to have a C-section)
4) I've read about that I should ask my caregiver not to rupture the membranes. Can you explain this to me in a bit more detail. Is this something one should worry about in any great detail. Boy, this all sounds awfully complicated.
5) Is it true that neo natal herpes occurs in only 0.1% of women GH positive? And that 80% of these cases are in women unaware of their infections?
Much thanks in advance.
All the best.
I'm interested in knowing a bit more about herpes and pregnancy. I'm GH positive and would like to become pregnant in the near future.
I'll write the question out in point form to make it easier for you to answer:
1) Is it dangerous (for the child to be) to conceive whilst having an OB and/or asymptomatically shedding?
2) I would like to have a C-section to avoid any potential complications. I know that neo-natal herpes is relatively rare. However, the relative stress of waiting/wondering if an outbreak will happen during labour is far too much to bear (and embarrassing when family members are present). Does a C-section completely eliminate the possibility of transmission in women with known infections? Or can the virus still spread through the placenta during pregnancy if I have a recurrent outbreak?
3) Is there any risk of taking suppressive therapy (Valtrex) during the final month of pregnancy? I'd prefer not to (another reason to have a C-section)
4) I've read about that I should ask my caregiver not to rupture the membranes. Can you explain this to me in a bit more detail. Is this something one should worry about in any great detail. Boy, this all sounds awfully complicated.
5) Is it true that neo natal herpes occurs in only 0.1% of women GH positive? And that 80% of these cases are in women unaware of their infections?
Much thanks in advance.
All the best.
I was so glad to read this post. You have asked the exact same questions that have been running through my head since contracting genital HSV1. The doctors answers have made me feel so much better about getting pregnant.
MEDICAL PROFESSIONAL
Grace's advice, as usual, is on the mark. She helps moderate the MedHelp herpes community forum, which provides excellent service.
Has your husband been tested for herpes to know his status? I know getting a type specific herpes igg blood test in canada is tricky but they are available ( and you probably will have to pay out of pocket for it ). There is actually a terrific journal article by ottmar on how to obtain one in canada if your husband's provider won't order the proper test for him ( or says it can't be ordered ).
Also just as an update, all the newest pregnancy and herpes research is using valtrex 500mg 2x/day during the last month of pregnancy. if you use acyclovir, the suppressive dose for the last month of pregnancy is 400mg 3x/day. suppressive therapy during pregnancy helps to reduce the chance of having an active lesion so that you can deliver vaginally.
When you do become pregnant, please stop by the herpes patient to patient forum and we'll gladly give you more support at that time too :) We certainly understand that sometimes you just need reassurance here and there to convince that little voice in your head what your mind already knows :)
grace
Also just as an update, all the newest pregnancy and herpes research is using valtrex 500mg 2x/day during the last month of pregnancy. if you use acyclovir, the suppressive dose for the last month of pregnancy is 400mg 3x/day. suppressive therapy during pregnancy helps to reduce the chance of having an active lesion so that you can deliver vaginally.
When you do become pregnant, please stop by the herpes patient to patient forum and we'll gladly give you more support at that time too :) We certainly understand that sometimes you just need reassurance here and there to convince that little voice in your head what your mind already knows :)
grace
MEDICAL PROFESSIONAL
Sorry to have upset your world. But you'll agree that in the long run, the truth is always preferable.
Having HSV-1 should not have any effect on this, although to my knowledge there is no research one way or the other. The initial herpes symptoms result from virus replication at the site where they are inoculated into the body. Further, HSV doesn't generally cause infection from simple contact of the virus with susceptible tissues; usually it has to be "massaged" into the tissues. And it result pretty much exclusively from genital-genital contact. Therefore, the initial infection generally is at the site(s) of greatest friction during sex: typically the labia and vaginal opening in women, the penile shaft in men, or (often) the anus.. Nerve pathways come into play only after the virus establishes "residence" in the spinal nerve ganglia, which probably doesn't occur until at least several days after acquiring the virus -- so that's only relevant to recurrent episodes.
One last caveat: I have just cited the general belief of STD and herpes experts, based on clinical experience and current beliefs about HSV pathogenesis. There could be exceptions, and I cannot guarantee that a hip-only outbreak could not be the initial one. But from all we know, it is very unlikely.
Having HSV-1 should not have any effect on this, although to my knowledge there is no research one way or the other. The initial herpes symptoms result from virus replication at the site where they are inoculated into the body. Further, HSV doesn't generally cause infection from simple contact of the virus with susceptible tissues; usually it has to be "massaged" into the tissues. And it result pretty much exclusively from genital-genital contact. Therefore, the initial infection generally is at the site(s) of greatest friction during sex: typically the labia and vaginal opening in women, the penile shaft in men, or (often) the anus.. Nerve pathways come into play only after the virus establishes "residence" in the spinal nerve ganglia, which probably doesn't occur until at least several days after acquiring the virus -- so that's only relevant to recurrent episodes.
One last caveat: I have just cited the general belief of STD and herpes experts, based on clinical experience and current beliefs about HSV pathogenesis. There could be exceptions, and I cannot guarantee that a hip-only outbreak could not be the initial one. But from all we know, it is very unlikely.
Thanks for the information. WOW!!!!!!
I almost fainted when I read your information about initial vs. recurrences---for reasons too long and complex to describe here. It's just turned my world upside down
Just two follow up question (to close this thread) in light of this totally surprising news:
1) I have HSV 1 (from childhood). Could that possibly affect the initial outbreak site, making it at least theoretically possible for the first OB to be in a non genital site? Along with the hip ulcerations I also had vaginal itching/yeast infection like symptoms during this "initial outbreak."--so I did have something happening related to herpes in the vagina at the time of the hip OB.
2) Since the nerve pathways in that region are very close together, why can't the true initial OB take place on the buttock or thigh, for example?
That's all from me.....Thank YOU very much.
I almost fainted when I read your information about initial vs. recurrences---for reasons too long and complex to describe here. It's just turned my world upside down
Just two follow up question (to close this thread) in light of this totally surprising news:
1) I have HSV 1 (from childhood). Could that possibly affect the initial outbreak site, making it at least theoretically possible for the first OB to be in a non genital site? Along with the hip ulcerations I also had vaginal itching/yeast infection like symptoms during this "initial outbreak."--so I did have something happening related to herpes in the vagina at the time of the hip OB.
2) Since the nerve pathways in that region are very close together, why can't the true initial OB take place on the buttock or thigh, for example?
That's all from me.....Thank YOU very much.
MEDICAL PROFESSIONAL
Thanks for this information. I agree with your Ob, that the diagnosis is solid based on identification of HSV-2 from the outbreak.
However, your first infection with HSV-2 was not when you had the outbreak on your hip. Initial HSV-2 infections always involve the genital are directly -- in women, the labia, vagina, cervix, and/or anal area. Non-genital "boxer shorts" outbreaks always are recurrences, not the initial infection. This is quite common; 40% of people with apparently initial HSV-2 in fact are having a recurrent oubreak; the initial infection was sometime in the past, often without symptoms. You are in that group.
This also supports my previous belief and advice that your body-wide tingling was not due to HSV-2. If it were, it would have been present since your initial infection, whenever that was. In other words, your story fits best with an emotional/psychological effect of learning you have HSV-2; which also fits with the apparent response to valacyclovir, i.e. placebo effect.
You may not need suppressive anti-herpetic therapy at all. There are 2 main reasons for it: prevention of symptoms of recurrent oubreaks; and prevention of transmission (mostly to sex partners, perhaps to vaginally delivered babies). The first depends on frequency and severity of outbreaks; the second on current sexual practices, partners at risk, and so on.
Thanks for the thanks about the forum. I hope this additional information is helpful. Please discuss it with your ObG or, if not certain about his or her expertise in herpes, an infectious diseases specialist or other provider with substantial experience with HSV.
However, your first infection with HSV-2 was not when you had the outbreak on your hip. Initial HSV-2 infections always involve the genital are directly -- in women, the labia, vagina, cervix, and/or anal area. Non-genital "boxer shorts" outbreaks always are recurrences, not the initial infection. This is quite common; 40% of people with apparently initial HSV-2 in fact are having a recurrent oubreak; the initial infection was sometime in the past, often without symptoms. You are in that group.
This also supports my previous belief and advice that your body-wide tingling was not due to HSV-2. If it were, it would have been present since your initial infection, whenever that was. In other words, your story fits best with an emotional/psychological effect of learning you have HSV-2; which also fits with the apparent response to valacyclovir, i.e. placebo effect.
You may not need suppressive anti-herpetic therapy at all. There are 2 main reasons for it: prevention of symptoms of recurrent oubreaks; and prevention of transmission (mostly to sex partners, perhaps to vaginally delivered babies). The first depends on frequency and severity of outbreaks; the second on current sexual practices, partners at risk, and so on.
Thanks for the thanks about the forum. I hope this additional information is helpful. Please discuss it with your ObG or, if not certain about his or her expertise in herpes, an infectious diseases specialist or other provider with substantial experience with HSV.
Thanks again for your response. You're right about obsession. This entire diagnosis have made me a little hyper sensitive around many issues.
To answer your question: My first (and only) OB consisted of a few shallow ulcerations on the hip, diagnosed by swab. I did not have a blood test to confirm but it's my understanding that a swab trumps blood testing when it comes to HSV. I was told it was type 2, something I found hard to understand: an OB of HSV 2 on the hip? I was later told that OBs can indeed take place anywhere in the boxer short region.The entire body tingling started within a week of the initial OB and continued until I went on suppressive therapy one month thereafter. Haven't had subsequent OB since being on therapy (or any tingling).
Not sure if this changes anything with respect to my post.
Thanks again in advance. :) Fantastic work!
To answer your question: My first (and only) OB consisted of a few shallow ulcerations on the hip, diagnosed by swab. I did not have a blood test to confirm but it's my understanding that a swab trumps blood testing when it comes to HSV. I was told it was type 2, something I found hard to understand: an OB of HSV 2 on the hip? I was later told that OBs can indeed take place anywhere in the boxer short region.The entire body tingling started within a week of the initial OB and continued until I went on suppressive therapy one month thereafter. Haven't had subsequent OB since being on therapy (or any tingling).
Not sure if this changes anything with respect to my post.
Thanks again in advance. :) Fantastic work!
MEDICAL PROFESSIONAL
In the past 10 years in Canada or the US, I would guess not one child has developed neonatal herpes following delivery by a mother with recurrent herpes who was taking acyclovir.
1) In utero infections don't happen. NH results only from exposure to the virus in the birth canal. And outbreak during pregnancy will not be transmitted to the baby; no such transmissions occur until and unless the membranes have been ruptured.
2) I agree with your doctor's doubt about the cause of your tingling sensation. Tingling can occur in the area where outbreaks are about to occur, and lesions themselves can tingle. Otherwise, that's not a herpes symptom. I believe its improvement on valacyclovir was coincidence, or placebo effect.
In fact, if the tingling you describe is your only symptom, I have to doubt you have genital herpes at all. As I suggested above, I will be happy to comment further if you want to give more information about your symptoms and the lab tests done to confirm the diagnosis.
In the meantime, you need to get beyond your apparent obsession with neonatal herpes, which is a rare disease. (It is estimated that fewer than 1,000 cases occur each year in the US, where probably a million women with HSV-2 deliver babies every year -- and virtually all those 1,000 cases occur when matern herpes has not been diagnosed and therefore no steps taken to prevent it.)
1) In utero infections don't happen. NH results only from exposure to the virus in the birth canal. And outbreak during pregnancy will not be transmitted to the baby; no such transmissions occur until and unless the membranes have been ruptured.
2) I agree with your doctor's doubt about the cause of your tingling sensation. Tingling can occur in the area where outbreaks are about to occur, and lesions themselves can tingle. Otherwise, that's not a herpes symptom. I believe its improvement on valacyclovir was coincidence, or placebo effect.
In fact, if the tingling you describe is your only symptom, I have to doubt you have genital herpes at all. As I suggested above, I will be happy to comment further if you want to give more information about your symptoms and the lab tests done to confirm the diagnosis.
In the meantime, you need to get beyond your apparent obsession with neonatal herpes, which is a rare disease. (It is estimated that fewer than 1,000 cases occur each year in the US, where probably a million women with HSV-2 deliver babies every year -- and virtually all those 1,000 cases occur when matern herpes has not been diagnosed and therefore no steps taken to prevent it.)
I appreciate your informed advice. You got me: I'm Canadian. We typically use both British and American spellings. I'm more loyal to the Queen, I guess :)
You're right: I suppose I'm overreacting, a wee bit. I need to think more about this, in conjunction with my health care provider. Even so, a CS still sounds more appealing. I worry about the asymptomatic shedding (even whilst on suppressive therapy during the last month of pregnancy).
It's my understanding that the pendulum is strongly swinging in the direction of vaginal births for women with known GH in Canada (unless, of course, there's an obvious OB). I've even heard of women having vaginal births with an overt OB on the thigh or hip. The OB is simply covered by a bandage. My concern is with the impact of the stress of wondering/worrying about a possible OB at the time of labour. I wonder if it outweighs the possible risks of a CS....food for thought, most definitely.
Anyway, here are a few additional questions, unless I've reached my limit:
1) Can the virus pass through the placenta during pregnancy in women with known infections?
2) I've never been off suppressive therapy (generic Valtrex) during the course of my infection. I went on approx one month after my first OB (approx 1 year ago). I only stay on it because it completely resolved the very intense entire body tingling I suffered from the infection. My doctor doubted this tingling was caused by the infection but the suppressive therapy resolved it completely. Strange but true. I worry about this coming back when I come off the medication. I also worry about the possible OBs. If I have (worst case) monthly OBs during pregnancy, could this possible be passed to the baby?
Thanks again in advance.
You're right: I suppose I'm overreacting, a wee bit. I need to think more about this, in conjunction with my health care provider. Even so, a CS still sounds more appealing. I worry about the asymptomatic shedding (even whilst on suppressive therapy during the last month of pregnancy).
It's my understanding that the pendulum is strongly swinging in the direction of vaginal births for women with known GH in Canada (unless, of course, there's an obvious OB). I've even heard of women having vaginal births with an overt OB on the thigh or hip. The OB is simply covered by a bandage. My concern is with the impact of the stress of wondering/worrying about a possible OB at the time of labour. I wonder if it outweighs the possible risks of a CS....food for thought, most definitely.
Anyway, here are a few additional questions, unless I've reached my limit:
1) Can the virus pass through the placenta during pregnancy in women with known infections?
2) I've never been off suppressive therapy (generic Valtrex) during the course of my infection. I went on approx one month after my first OB (approx 1 year ago). I only stay on it because it completely resolved the very intense entire body tingling I suffered from the infection. My doctor doubted this tingling was caused by the infection but the suppressive therapy resolved it completely. Strange but true. I worry about this coming back when I come off the medication. I also worry about the possible OBs. If I have (worst case) monthly OBs during pregnancy, could this possible be passed to the baby?
Thanks again in advance.
MEDICAL PROFESSIONAL
Welcome to the STD forum. Congratulations for a level-headed, analytical approach to your genital herpes and protection of future children from neonatal herpes. The bottom line, though, is that you are somewhat overreacting. The chance you will infect your baby is vanishingly small.
The main risk for neonatal herpes is from genital herpes first acquired toward the end of pregnancy. During longstanding infection, the mother's immune system keeps the virus in check well enough to protect the baby -- not quite 100% protection, but very high. And with awareness of the ObG that herpes is a potential problem, s/he can take precautions that are 100% successful in prevening NH.
It would be helpful to know more about your genital herpes. Is it due to HSV-1 or HSV-2? What tests were used to document the diagnosis itself and the virus type?
To your specific questions:
1) Symptomatic outbreaks of HSV-2 at the time of delivery can result in transmission. Asymptomatic shedding might do so, but the risk appears to be small.
2) If your obstetrician is wise, s/he will not agree to delivering you by C-section simply because you have GH or because you request it. If there is no overt HSV outbreak at term, CS is unnecessary. ("Whilst" instead of "while" suggests you are in the UK or a commonwealth country, yes? In the US, some Ob's permit patients to have CS simply upon request. But most experts believe this is not wise, and the pendulum now is swinging away from CS on request. But I cannot say what the usual approach is outside in other countries.)
3) Most Ob's treat their patients with HSV-2 with acyclovir (usually not valacyclovir [Valtrex]) during the last month of pregnancy, which is effective in preventing outbreaks that can require CS, and also probably reduces the risk of transmission to the baby from asymptomatic viral shedding. In any case, your priorities are misplaced. The health risks, both to you and the baby, are far higher from CS than anti-herpetic therapy. There are no side effects from acyclovir (and probably not from valacyclovir) during late pregnancy, either for mom or baby.
4) As I understand (as a non-ObG), artificial membrane rupture is generally not recommended for several reasons. I'm not an ObG and cannot explain all the reasons, but preventing herpes is only one of them. In theory, early membrane rupture allows more time for exposure of the baby to the virus in the event the woman has an unrecognized GH outbreak or asymptomatic shedding, increasing the chance of transmission.
5) I don't recall the exact statistics, but your figures sound about right.
Bottom line: Discuss the options with your Ob then follow his or her advice. Consider printing out this discussion; probably s/he will agrees with most or all I have said.
I hope this helps. Best wishes-- HHH, MD
The main risk for neonatal herpes is from genital herpes first acquired toward the end of pregnancy. During longstanding infection, the mother's immune system keeps the virus in check well enough to protect the baby -- not quite 100% protection, but very high. And with awareness of the ObG that herpes is a potential problem, s/he can take precautions that are 100% successful in prevening NH.
It would be helpful to know more about your genital herpes. Is it due to HSV-1 or HSV-2? What tests were used to document the diagnosis itself and the virus type?
To your specific questions:
1) Symptomatic outbreaks of HSV-2 at the time of delivery can result in transmission. Asymptomatic shedding might do so, but the risk appears to be small.
2) If your obstetrician is wise, s/he will not agree to delivering you by C-section simply because you have GH or because you request it. If there is no overt HSV outbreak at term, CS is unnecessary. ("Whilst" instead of "while" suggests you are in the UK or a commonwealth country, yes? In the US, some Ob's permit patients to have CS simply upon request. But most experts believe this is not wise, and the pendulum now is swinging away from CS on request. But I cannot say what the usual approach is outside in other countries.)
3) Most Ob's treat their patients with HSV-2 with acyclovir (usually not valacyclovir [Valtrex]) during the last month of pregnancy, which is effective in preventing outbreaks that can require CS, and also probably reduces the risk of transmission to the baby from asymptomatic viral shedding. In any case, your priorities are misplaced. The health risks, both to you and the baby, are far higher from CS than anti-herpetic therapy. There are no side effects from acyclovir (and probably not from valacyclovir) during late pregnancy, either for mom or baby.
4) As I understand (as a non-ObG), artificial membrane rupture is generally not recommended for several reasons. I'm not an ObG and cannot explain all the reasons, but preventing herpes is only one of them. In theory, early membrane rupture allows more time for exposure of the baby to the virus in the event the woman has an unrecognized GH outbreak or asymptomatic shedding, increasing the chance of transmission.
5) I don't recall the exact statistics, but your figures sound about right.
Bottom line: Discuss the options with your Ob then follow his or her advice. Consider printing out this discussion; probably s/he will agrees with most or all I have said.
I hope this helps. Best wishes-- HHH, MD
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
