Concerned about HSV transmission to 4mth old

[Joplin44]

Hello,

I have had HSV-2 for over 10 years. My third child (first daughter) was born 4 months ago. I was on Valtrex pretty much for the entire pregnancy (on and off early in the pregnancy) but without fail I took 1000mg daily for the entire last trimester. I have remained to this day on this dose since she was born. From the start of the third trimester to now I have only had one very, very mild outbreak. I have never had lesions anywhere else on my body and tests while I was pregnant revealed that I am only HSV-2 positive, but not HSV-1.

I recently had dinner with a girlfriend of mine who has frequent oral cold sores. On this occasion she had a healing sore. I hugged her and kissed her cheek but of course we didn’t kiss on the lips or anything. That was about a month ago. Yesterday I noticed a sore spot on the side of my lip. It does not look like a blister and it is sore (almost like a blind pimple) but not itchy nor was there any tingling like I have experienced with HSV-2. However, I am having horrible thoughts that I have somehow got HSV-1 on my mouth or transmitted HSV-2 to my mouth and could somehow give it to my daughter. Ordinarily, I am very aware of this disease and its transmission but today I had an incident with my girl that has me terrified.

Due to a diaper explosion I gave her a bath at lunchtime. I think I may have inadvertently touched the spot on my lip and then changed her diaper. I don’t think I actually touched her skin during the initial cleaning with the wet wipes. However, when I put her in the bath (she is not submerged in the water – I lay her on a thick towell that is wet with the warm water and then pour water over her). During this bath I had to make sure all of the poop (massive explosion!) was cleaned away from the lower region. I also had to clean away the desitin diaper rash ointment from the previous night that can accumulate. Is there any chance at all that I could transmit this virus from touching my lip (whether that sore is from HSV-1 or 2) to her in the course of cleaning her in the bath? The possible order was touch lip, clean as well as I could with wet wipes and then the bath tub. Please remember that she is not submerged in the water – just lying on a warm, wet towell.

Like I said, I don’t even know if the spot on my lip is HSV. I did test negative for it during the pregnancy, I didn’t kiss my friend on the lips, and I am on 1000mg a day of Valtrex, but I would like to please request a response based on the theory that the spot on my lip is in fact HSV and I cleaned my daughter soon after touching it. I am petrified that the hand that I touched the spot with is the same hand that I commenced cleaning her diaper area with in the bath. She is just the most precious thing in the world and I could not stand the thought that I could have somehow transmitted HSV (of either type) to her. I would never,ever, ever want her to go through what I did in the early years after I first learnt that I had HSV-2. Her good health and happiness are everything to me.

Any help would be so welcomed. Thank you.

[Terri Warren]

The great news in this situation is that the person who has HSV 2 almost never acquires HSV 1 subsequently. First, there’s that, and second, I doubt very much that you acquired HS 1 from the kind of contact that you had with your visitor. Third, since your symptoms showed up a month after the contact, if you have HSV 1, then it wasn’t from that contact. Fourth, it doesn’t really sound like a cold sore to me, from the way that you describe it.

But the first point of people with HSV 2 not getting HSV 1 is the most important.

You did NOT infect your daughter.

Terri

[Joplin44]

Hello ma’am,

Thank you so much for your quick reply. There is so much information on the Internet that it is immensely comforting to know that someone of your expertise, experience, knowledge and compassion is so willing to help people who are frightened and unsure of this virus. Your empathy and assistance is greatly appreciated – more than you will ever know.

If I may, I would also like to ask a couple more questions based on my current subscription.

1. Do we know why people with HSV-2 are unlikely to subsequently acquire HSV-1 and is the opposite true? Are people with HSV-1 less likely to acquire HSV-2 or does it not work like that? This is just for my own bank of knowledge.

2. As I mentioned previously, I have been on Valtrex for many years, but specifically I was on 1000mg daily in the last trimester of pregnancy up until now. I am breast-feeding my daughter and supplementing with formula. In the first month after she was born I was taking 500mg twice daily (hospital directions). In the last six weeks or so I have been taking 1000mg once daily. This was inadvertent and I think in my tired state was based more on habit than anything else, as during my pregnancy and before I was pregnant I always took 1000mg once daily, which is how it has always been prescribed to me. My questions are as follows:

a.What is the difference between 500 mg twice daily or 1000mg once a day?

b. Will the fact that I have been taking 1000mg at once have an adverse affect on my daughter as it is more concentrated at once (or are the dosages something that affect me, as opposed to the effect on my girl through the breast milk)?

c. Are there any long time effects on my daughters development from this drug (and this dosage) in my breast milk given that I am on daily Valtrex and plan to breast-feed until she’s at least 6 to 8 months old? I’m worried about the long-term impact on her if I take this drug daily and continue to breast-feed. Not having outbreaks greatly reduces my stress and obsessive thoughts that I will somehow infect her, however I will discontinue the drug if it somehow affects her long term.

Thank you again Ma’am. You provide such a wonderful service.

[Terri Warren]

1. Do we know why people with HSV-2 are unlikely to subsequently acquire HSV-1 and is the opposite true? Are people with HSV-1 less likely to acquire HSV-2 or does it not work like that? This is just for my own bank of knowledge.

We don’t know why this is, really. And the opposite is not true. However, it is possible that having genital HSV 1 may offer some protection against acquiring genital HSV 2, but that research is not complete.

2. As I mentioned previously, I have been on Valtrex for many years, but specifically I was on 1000mg daily in the last trimester of pregnancy up until now. I am breast-feeding my daughter and supplementing with formula. In the first month after she was born I was taking 500mg twice daily (hospital directions). In the last six weeks or so I have been taking 1000mg once daily. This was inadvertent and I think in my tired state was based more on habit than anything else, as during my pregnancy and before I was pregnant I always took 1000mg once daily, which is how it has always been prescribed to me. My questions are as follows:

a.What is the difference between 500 mg twice daily or 1000mg once a day? The difference? Some people just need more drug to suppress adequately. I’m not sure what else you mean by what is the difference.

b. Will the fact that I have been taking 1000mg at once have an adverse affect on my daughter as it is more concentrated at once (or are the dosages something that affect me, as opposed to the effect on my girl through the breast milk)?

I am not aware of long term side effect from taking any dose of antiviral medicine for nursing children. It does go through to the baby in breast milk, but as far as I know there are no ill effects seen in nursing babies from Valtrex.

c. Are there any long time effects on my daughters development from this drug (and this dosage) in my breast milk given that I am on daily Valtrex and plan to breast-feed until she’s at least 6 to 8 months old? I’m worried about the long-term impact on her if I take this drug daily and continue to breast-feed. Not having outbreaks greatly reduces my stress and obsessive thoughts that I will somehow infect her, however I will discontinue the drug if it somehow affects her long term.

We do know that when newborns are given acyclovir (which is what Valtrex breaks down to), they may have a transient drop in white cells which is reversed when the medicine is stopped. Giving the medicine directly to a baby would ensure a far greater dose than coming through breast milk. Again, I think you can talk to your baby’s doc about this. A wonderful reference for information about babies and antivirals is Dr. David Kimberlin at the University of Alabama, Birmingham.

Terri

[Joplin44]

Thank you again Ma’am.

What I mean in terms of the ‘difference’ with the valtrex is taking 1000mg once a day versus spreading that same dose 12 hours apart, 500mg each time. My question about the difference is the timing of the complete dose – one full dose once, or taking it twice a day. Is there a difference in doing this or does it not really matter? Hope this clarifies it.

And thank you for the reference. Funnily enough, I did find some articles by Dr Kimberlin, so that is fortuitous!

I understand that this is my last question on my current subscription. Again, thank you so much.

[Terri Warren]

OK I get it now. Actually I like 500 mg twice a day as then there are no troughs in the dosing – no time when there is a big dip in the amount of drug that is circulating in the blood stream.
Terri

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