Herpes and Pregnancy

[Mom2B]

Hello.
I am currently 7 months pregnant with my first child. I had a blood test which resulted positive for HSV2 four years ago and was wondering if there could be any risks posed to my baby during childbirth.

A little background: I’ve not had an outbreak since my initial one. And even then, my case was not so cut and dry as my symptoms never manifested visibly except–orally, twice, and with an extended period of more vaginal discharge. The discharge was tested numerous, numerous times over the course of 2 years, always coming up negative. Lesions were never found genitally. Nor did I experience any pain below. At the time I lived in desert climate, perhaps that could’ve been a factor? Is it possible that I could just have oral 2?

Most importantly, should I start Acyclovair as preventative measure and if so, at what month and dosage? Is it harmful to the fetus? I read that as it’s not an initial outbreak, I’m less likely to pass it on to the infant.

Lastly, what is the possibility of asymptomatic shedding for oral 2? I also read that types don’t like to manifest outside their typical location. Could I accidentally pass it on to my child with a kiss?

Thank you so much for your reply.
Sincerely,
Anxious and Hopeful New Mom

[Terri Warren]

Do you know what test was used to determine that you had HSV 2? Do you know what the index value was associated with the positive result? I have some questions about your diagnosis, given what you’ve told me. Was it by antibody test only? Was there an oral swab done that was positive?
Let’s get very clear on the diagnosis part.

If you have HSV 2 infection truly, and there was an oral swab to prove it, we still don’t know if you also have it genitally. I believe that most OB providers would put you on suppression (daily therapy) during the last month or so of your pregnancy. It is not harmful to the fetus, no. And the dose is different than in the non-pregnant woman, but I”m sure your OB provider will help you with that.

If you do have oral HSV 2, it sheds infrequently. The issue is that the screening antibody test, if that was all that was done, misses 1-2 out of 10 HSV 1 infections so you could have HSV 1 orally without a positive antibody test.

But for right now, I need to know more details about the diagnosis please.

Terri

[Mom2B]

Dear Terri,
Sorry for the lateness in my reply. I had to track down my blood test results. I could only find one set, as I had two blood tests to verify; one from where I was living abroad and the other in the U.S.

The test abroad was my first blood test. I can’t find those results. I can’t remember if they swabbed the cold sore on my mouth, but I did have a blood test and it turned up negative for HSV1, but positive for HSV2.

The second blood test taken in the U.S. is what I have on hand. This was administered over a month after my first test. According to the document, the following was ordered: HSV 1 & 2 IGG and HERPESELECT.

Under the HSV-1 IgG heading, it reads:
0.07 <0.90 Negative. An index value of <0.90 indicates no IgG antibodies to HSV-1 were detected.

Under HSV-2 IgG:
1.72 H >=0.90 and <=1.10 Equivocal. An index value of >=0.90 but <=1.10 is considered equivocal result.

Specimen Source: Serum
Method such as Western Blot.
>1.10 Positive. An index value of >1.10 is presumptive for the presence of IgG antibodies to HSV-2

This molecular assay detects herpes simplex virus DNA by PCR.

Negative for intraepithelial lesion or malignancy. Mild inflammation. Shift in vaginal flora suggestive of bacterial vaginosis. (Just a note: I am not including the numerous subsequent tests I had on the discharge, itself, following those initial blood tests as each time they were negative or had the precedent conclusion “suggestive of BV.” Four years out and no longer living in the same environment, I do not have that particular issue anymore.)

I hope this answers some questions. In light of your reply, should I:
* assume that I will never know if I have HSV2 genitally?
* retake a blood test now to make sure both prior tests did not miss an HSV 1 infection?
* and if so, which one? I am now currently living in Europe…though I do return stateside for holidays.

Thank you so much for your patience and reply.

[Terri Warren]

Your HSV 2 value, as I read it, 1.72, is in the low positive range. At that value, there is less than a 50-50 chance that you actually have HSV 2 infection. I would very strongly suggest that you obtain a herpes western blot. There is mention of the blood in your test results, but it is not a western blot. I’m guessing that your provider is unaware of the false positive problem with these low index values. Please – with your pregnancy, there is a lot at stake. Let’s find out if you actually have HSV 2 because your initial infection symptoms sound iffy to me.

You can either contact the University of Washington directly for a test kit to be shipped to you or our clinic can order the test for you through our clinic, to be drawn at a Quest lab near you. Time is of the essence here.

You have one more question on this subscription.

Terri

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