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Avatar universal

Nervous and worried



I'm currently 20wks pregnant with my first child.  The pregnancy was unexpected but nonetheless, I'm excited and anxiously waiting the baby's arrival.  I'm nervous and scared as well.  About 5 yrs ago, I had a scare with possibly being infected with HSV1, genital type.  Never had an outbreak and tested negative.  I consider myself blessed and would like to think I don't have it but now that I'm pregnant I'm concerned about it.  I've read that it's possible to have the virus without an outbreak occurring, even if I tested negative.  I've talked with my drs about this before and they didn't have any concern.  They're thoughts were that I don't have it as far as they're concerned and unless I ever have an outbreak, I shouldn't worry about it either. So, I haven't worried about it or mentioned that experience to anyone for that matter, until now.  I talked with my OB about it.  She says not to worry, and that it sounds like I'm in the clear.  She also said that if I do have it and an outbreak happens, we'll worry about it at 36 weeks and then possibly do a C-section at delivery.  So I am choosing to stay quiet for now at least until after the baby is born.  My fear is that when I go into labor, the doctor or nurses will ask about it while he is there.  So here is my question: what are my rights under HIPAA Law and can I ask my OB to keep this confidential when I go into labor? Do I have that right, for the sake of it causing problems?  Thank you in advance for a response...  
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239123 tn?1267647614
MEDICAL PROFESSIONAL
With the more detailed history, it sounds very unlikely you had genital herpes.  You could have a blood test to see if you are infected with HSV-1 (and HSV-2, for that matter).  However, if positive for HSV-1 (as is half the population in the US), you won't know whether you had an oral infection (likely in childhood) or genital.

It may seem paradoxical, but if your blood test is negative for HSV, you may be at increased risk of infecting your baby, not decreased.  This is because by far the highest risk of neonatal herpes comes when a mother first acquries genital herpes (due to either HSV-1 or HSV-2) in the last few weeks of pregnancy.  Women with longstanding genital herpes rarely infect their babies; their immune systems prevent it.

My suggestion to persons (and couples) worried about herpes issues is that an impersonal microscopic bit of DNA, which happens to exploit human intimacy for its own existance, shouldn't be permitted to interfere with love, romance, and rewarding sex -- or with having healthy babies.  However, I don't know your partner or his personality, and I don't know you -- so I cannot predict how he would react.  Therefore, I can't advise you whether or how to discuss this with your partner.  But I do think you're making a bigger deal of it than necessary.  I see no need for a "battle" with your partner.

But here is one approach to consider.  It's not the only one, but think about it. Tell him that a past partner had oral herpes, and most likely you weren't infected.  However, you know that herpes can rarely be a serious problem for the baby, and you want to do everything in your power to assure a healthy child -- and you're sure he agrees.  And that a way to do that is for both you and your partner to be tested for HSV (both virus types).  Then, depending on the results, you can take steps to assure no problem for the baby.  For example, if he as HSV-1 (remember, there's a 50:50 chance!) and you don't, you would strictly avoid him performing oral sex on you toward the end of pregnancy.  Or if neither of you has either virus, no problem and no worries.  And so on.

If you would like further advice on these aspects, consider starting a thread in the MedHelp herpes community forum.  The moderators are highly qualified herpes counselors.
Helpful - 1
Avatar universal
Thank you for the quick response dr.  The HSV-1 scare came after I learned that an ex would get cold sores and here we would have oral sex occasionally.  Sometime after the relationship had I became paranoid and at one point thought I may have had a couple lesions. The doctor attempted a swab test but it came back negative.  She said it was probably nothing but at worse could be HSV-1.  She then said to not worry about it unless an outbreak does happen.  Again, this was five years ago and nothing has since happened.  

So, can you tell me, have you heard if any situations where a woman doesn't have an outbreak but then lesions are noticed during labor? What are the chances of that happening considering that I've never had anything? And if I do take your suggestion and tell my partner, any advice how to go about it? We both have been sexually active with eachother without ever having a problem, so how should I explain? Please forgive me, I understand that ultimately I should decide on my own what to say... I'm just torn between continuing on and hoping it never reveals itself, or telling him and have it cause a serious fight, possibly a breakup.  I feel like I'm not prepared to fight this battle right now, I can't afford to pack up and go if this situation turns bad.  
Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
For forum users who may not know:  HIPAA is the federal Health Insurance Portability and Accountability Act.  HIPAA makes it a federal crime, with fines up to $5,000 or more, for health are providers to divulge confidential health-related information without a patient's consent, except to other providers involved in care (other  doctors, nurses) and of course the patient's medical insurance company.  If you have ever called a hospital to find out how a friend is doing after an accident, HIPAA explains why they refuse to say very much.
Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
Welcome to the STD forum.

As a physician, I have rough familiarity with HIPAA, but I have no legal expertise.  However, your doctor is absolutely forbidden by HIPAA to tell your partner about any medical condition you have.  There are exceptions to HIPAA in certain circumstances, including the fact that HIPAA does not prohibit providers from reporting certain STD cases to the health department -- and for some STDs, the HD might in turn seek to inform patients' sex partners.  But such reporting and partner contact are virtually never done for herpes.  And in any case, you apparently aren't infected -- so from a medical perspective, there is nothing to tell your partner about.

As you suggest yourself, the main risk might come if your Ob were to let something slip out, if your partner were to accompany you to a prentatal visit.  But if you discuss your concerns with your Ob, she undoubtedly will do her best to protect against such an error.  Or you could just not invite your partner to any such visits, and also exclude him from the labor or delivery room (in case you were planning on his presence).

Having said all that, I think you should reconsider discussing this with your partner.  If the initial "scare" was right and the later diagnosis wrong, there could be a small risk of infecting the baby, or infecting him sexually.  Both are extremely unlikely, but you should consider what the reaction would be if that were the way he learns about your infection.  And if you indeed expect and hope him to be present during labor and delivery, and if you show symptoms or a possible lesion that suggests you in fact have a herpes outbreak, and especially if a C-section therefore becomes necessary, it will be impossible to keep it a secret from him -- regardless of HIPAA.

Final comment:  there is no such thing as a "genital type" of HSV-1.  That virus is most frequently the cause of oral herpes, although it does cause a fair proportion of genital herpes -- usually acquired by oral sex.  If you have any uncertainty about either the original diagnosis or later test results, I would be happy to comment about them.

I hope this helps.  Best wishes--  HHH, MD
Helpful - 0
Avatar universal
Thank you again, Dr. Handsfield.  You're doing a great service here by giving us advice.  It's very valuable to me.  And I'll check out the forum you've mentioned.  Thanks again.  Take care & God bless:)
Helpful - 0

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