Herpes treatment during pregnancy
DEAR DR MITCHELL, I recently had an outbreak of herpes on the skin near my mouth. I have been taking Herp Rescue, but now I am four months pregnant. Should I continue to reduce the outbreaks?
Herpes simplex virus – type 1 (HSV-1) is the virus that typically causes cold sores. There a two types of herpes simplex virus —types 1 and 2 (HSV-2)
The type that causes genital infection is HSV-2. This is spread by sexual contact, and this is the type that causes problems in pregnancy since it can be transmitted across the placenta to the foetus or can be transmitted during birth when the foetus passes through the genital tract. The chances of this occurring is significantly high during a primary (new) infection since viral shedding is highest at this time. It can, however, be passed on during a recurrence or outbreak of an old infection and can have significant adverse effects on the foetus. Herpes type 2 infection can cause losses in early pregnancy or at a more advanced stage. It can result in death of the foetus before birth; stillbirth; or can cause infection in the brain, resulting in mental retardation, blindness and deafness in the newborn offspring.
Type 1 herpes simplex virus tends to be of no significant problem or concern when compared with Type 2 in pregnancy. Both types 1 and 2 can be transmitted by sexual contact. Condom usage does not completely prevent the transmission of herpes infection since an outbreak can occur in areas that a condom does not cover, including the buttocks, the vulva area, and the scrotum and inner thighs. Any contact with areas where herpes blisters are present can result in the transmission of the virus. In some cases there is no visible blister or vesicle present since the infection can be present on the cervix, high in the vaginal walls, or the urethra, and is therefore not visible despite active infection. The vesicles or blisters tend to recur at the same sites with each outbreak and it is possible for you to have herpes infection for several years and not be aware of it, depending on the site of viral shedding. It is therefore possible to pass on the infection without knowing it. Avoiding sexual activity during an active outbreak will help to reduce the risk of transmission.
Recurrent outbreaks of herpes types 1 and 2 infection is seen when your immune system is down. Stress is a big trigger factor. Poor diet, immuno-compromised states, steroid usage and diabetes mellitus are also other common trigger factors. It is important to be screened for Herpes type 2 infection if you are pregnant and have type 1 infection because of the potential serious effect if transmitted to the foetus.
The Herp Rescue treatment is a capsule that is taken daily to boost the immune system and give you additional vitamins and amino acids. The fact that you do not have frequent cold sores suggests that you do not need this supplement. Additionally, although the components are all natural products, there are no established studies in pregnancy as it relates to its safety profile. This may be an unnecessary exposure in pregnancy with no definite benefit to either yourself or the foetus.
The standard treatment for active or recurrent herpes outbreak in pregnancy is Acyclovir. This may be used daily in advanced pregnancy to reduce the risk of an outbreak close to delivery, thus reducing the risk of transmission to the foetus. It can also be used safely in early pregnancy to treat a new or primary infection or to treat an outbreak in a patient who is known to have Herpes type 1 or type 2 infection. This has been shown to be safe for both mother and foetus.
Despite the use of anti-viral drugs and good nutritional support, herpes infection can still occur. Delivery via Caesarean section is the standard and safe recommendation in the presence of active herpes infection.
Both you and your partner should be screened for Herpes type 2 and other sexually transmitted infections such as syphilis, Hepatitis B, and HIV since these can be treated to reduce the risk of transmission to the foetus and improve the outcome for both mother and the newborn.
Consult your doctor who will advise you further.
Best wishes to you, and safe delivery.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 968-2025. All responses are published. Dr Mitchell cannot provide personal responses.
DISCLAIMER:
The contents of this article are for informational purposes only, and must not be relied upon as an alternative to medical advice or treatment from your own doctor.
