Herpes and Newborn

[hope]

I was diagnosed with a primary infection of HSV-2 in 2008. (We knew it was primary because the antibody test was negative, but the swab was positive, and the first infection was fairly severe with multiple sores, swollen lymph nodes, and flu-like symptoms.) Since that time, I have been on a daily dose of 500mg of Valtrex for suppression. I am symptomatic in the genital area and have about 1 outbreak every year on the Valtrex. I am now married and recently had my first child. Before the birth of my child, I felt I had an understanding of my condition, but now that a child is in the picture, I feel like I need more information regarding herpes and online sources contradict each other. I’m hoping you can help me.

1. I have read conflicting information about autoinoculation. Can I spread herpes to other parts of my body (e.g., mouth, fingers, nipples) after the primary infection? For instance, can I spread it in the shower by touching a sore and then another part of my body during washing or using my hands to wash my genital area?

2. Is it possible that during my primary infection I could have spread herpes to my mouth, hands, and/or nipples and not know it? (I have never had a sore anywhere else on my body but my genitals.) Could I be asymptomatic in those places and symptomatic in my genitals? Could I asymptomatically spread it to my child during kissing, breastfeeding, and diaper changing if I do have it in those places?

3. I have read conflicting information about sharing bathrooms and towels. Currently, my child takes a bath in the same bathroom that I use. Could I infect him through shower water that hasn’t dried in the bathtub or a wet towel?

4. My child was born via C-Section, but I have read information that said he should have been tested at birth to see if he had acquired HSV-2. (I did have an outbreak two weeks before delivery even on daily suppressants my entire pregnancy.) He has never shown any symptoms of herpes, but should I get him tested?

5. What precautions should I take to ensure my child does not get HSV-2 from me?

[Terri Warren]

1. Autoinoculation is a concern only with primary infection. Once a person has mounted a hardy immune response (about four months after infection), this is no longer a concern. So for you, this is not a concern

2. If you’ve never had an outbreak in other places (especially during the time immediately after first infection), then you likely do not need to worry about this. The situation where someone has HSV 2 in one location and in subsequent years it shows up in another nerve group has not been seen in my clinic in 32 years of practice. I am not at all concerned about your spreading this to your child either with or without symptoms. This is GENITAL herpes and is a sexually transmitted infection, not one spread through normal social contact. I think for now you should assume you do not have it in other places on your body – there is just no evidence for that to impact you life ongoing.

3. I have absolutely no concerns about your child taking a bath in your bathtub. You will not infect him through shower water. Using a separate towel isn’t a bad idea just to be ultra cautious as the virus likes moisture and heat, but there are no documented cases of herpes transmission through a towel that I know about.

4. He should NOT have been tested at birth. Right after birth, he would have your antibody. The tests give many false positives in children and not recommended for use in children. If he has had no symptoms, he is not infected

5. Just wash your hands ONCE after using the restroom. That’s all that you need to do. The other thing you need to do is put this worry about infecting your child behind you. Just behave normally. Remember that this is an STI, and not an infection transmitted to household members.

Terri

[hope]

Thank you! I truly appreciate your responses. It is so confusing trying to sift through all the online information! I just have one follow up question –

For the last 6 years, my outbreaks have always been the same. Just one small spot on the outer portion of my labia. However, since the third trimester of my pregnancy, I have had intense burning/itching/redness in my inner labia and anal area with small red bumps on my buttocks. There are no blisters that I can see. These symptoms last for days to weeks with no let up. I’ve asked my OB/GYN and she said it could be herpes or it could be something else altogether (though she couldn’t make a diagnosis of what the something else could be.) Does this sound like my herpes is now presenting itself differently from previous outbreaks? In your experience, can pregnancy trigger herpes to act differently in a person? (Just for more information – these symptoms occur frequently, at least once a month and occur while on 500 mg of Valtrex daily. If I increase to 1g daily treating it like an outbreak, the symptoms seem to improve slightly, but do not go away.)

[Terri Warren]

In my experience, people with buttocks herpes recurrences definitely can see distinctive lesions. They are in groups and are certainly blisters. Has your clinician evaluated for or treated you for a yeast infection? The burning, itching, redness is most often associated with genital yeast infections. Sometimes at our clinic, even if we don’t see yeast under the microscope, our patients get better when they try a round of anti fungal medicines in the vagina. Just a thought.

And yes, sometimes we do see pregnancy changing things in terms of herpes – the location of outbreaks or the severity or frequency.

I suppose you could talk to your provider about increasing your daily dose to 1000 mg to see if you can avoid those episodes. 1000 mg is actually the first approved dose for suppression and 500 mg is the alternate dose, though most people do perfectly well on 500 mg. If you still got those symptoms on 1000 mg a day (or 500 mg twice a day) then I would be less inclined to think these symptoms are herpes related.

Terri

[hope]

I purchased three more questions online.

First, I wanted to follow-up and thank you for your last response. I saw my PCP instead of my OB/GYN, and he diagnosed me with a yeast infection and prescribed a topical treatment. The burning, itching, and redness are now gone.

However, I am still getting small bumps on my buttocks. When I visited my PCP, there were none visible so he could not look at them. However, since that visit a week ago, I know have three of these bumps. I’ll describe my symptoms, and then get to my questions.

Since my pregnancy, I have been getting small red bumps on my buttocks. They occur often. These bumps are about the size of a pinhead and are red. They never occur in the same spot twice. To the naked eye, they look like small, flat red marks, but when I look at them using a 10x magnifying mirror, I can see what look like very tiny bumps that could be blisters. Because they are so small, I can’t tell if they are filled with clear fluid. They do not crust over or scab over, but last about 3 days and then fade away. They do not occur in groups, but are single bumps about ½ to 1 inch apart. They do not itch or burn, but I may have felt subtle tingling before they occurred. (or it could just be me over analyzing normal feelings.) However, the symptoms are so subtle that if I wasn’t obsessing over the bumps, I wouldn’t even know they were there.

I normally wouldn’t worry about them, but we have managed to keep my partner herpes free for almost four years. (He gets tested regularly.) We have done this by taking suppressive medication and watching for prodome signs and not having sex during prodome or outbreaks. (My outbreaks have always been the same for the last 6 years.) I’m worried that after 6 years, my outbreaks have changed and that I no longer have the same knowledge of them, and these bumps could infect my partner. Like I said, I don’t even know when they are occurring unless I look everyday.

My questions are:

1. Do these symptoms sound like a herpes outbreak to you?

2. Is there a test that can be done to determine if these bumps are herpes sores? How would I go about getting that test done?

Also, just one more curiosity really. I’ve been reading that there are trials for therapeutic vaccines. In your professional opinion, do you think we’ll have a therapeutic vaccine or at least a better treatment anytime soon?

[Terri Warren]

These bumps sound nothing at all like genital herpes to me. Not even a little bit. I would say that the vast majority of the patients that I see in clinic have bumps on their bottoms. Who knows what causes them but it really doesn’t matter as long as they are not infectious to others, which they do not appear to be. They are likely just a little skin bacteria that is normal in the population.

You could use PCR swabs to see if they are herpes if you really want to. You could ask your health care provider for swabs to take home, gather when you see the bumps, then return to them for transport to the lab. We send home swabs with patients all the time for this purpose. However, not all clinicians will do this. If you really want to swab them, you can obtain swabs from the clinic and gather than and return them to us for processing. But honestly, I don’t think it is necessary at all.

I do think we will have a therapeutic vaccine in the future yes. The clinical trials are going very well indeed!

You have two more questions now so feel free to post.

Terri

• This reply was modified 7 years, 9 months ago by Terri Warren.

[hope]

I want to use my two more questions as a follow-up to a different scenario that has occurred.

We put my child in a day care center when he was 3 months old. Last week, after he had been attending for about a month, we noticed one of his teachers had a bright red blemish by her mouth. At first, I could not tell if it was a cold sore or another type of blemish such as acne. He continued to go to daycare for three more days. During this time, i contacted the director of the center and expressed my concerns about a possible cold sore on one of the teachers and asked to know what precautions were being taken. I did not find out until the third day that is was probably a cold sore (and at this point, I saw it again and it definitely looked like a healing cold sore) and that they were washing hands, using gloves when diapering, etc. However, this teacher was still allowed to hold, feed, diaper the babies and did not cover the sore on her face. I’ve kept him home the last few days, but I can’t continue to keep him home every time this teacher happens to get a cold sore.

My questions are:
1) How likely is it that my child contracts oral herpes from a provider who has an active sore? She was told not to kiss our child, but I’m not there all day, and he is in the squirming phase so there is a high probability that he touched her face with his head or his hand at some point. I also don’t know how careful she is being about washing hands.
2) As a healthcare professional, what precautions would you ask a parent with an active cold sore to take to protect a child?

[Terri Warren]

I think it is extremely unlikely that your child will contract oral herpes from this day care provider. If they are washing hands, using gloves while diapering and not kissing the children, there is not a risk for your child. I would ask these same precautions of a parent with a cold sore, nothing more. If your child touches the face of the person with the cold sore, your child will likely not becoming infected anyway because virus cannot easily enter hand skin. I also think since you have talked with the director of your day care center, they are on high alert about the behavior of this provider and are likely being very cautious.

Terri

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