Pass on genital hsv 1 first trimester, risk of birth defects-neonatal herpes

[factual_basis]

Hi,

I have ghsv1, without ever having oral/PIV sex. I was wrestling, got a whole lot of pimples on my torso. I thought it was due to sweat or some thing simple. Had fever and lethargy and woke up at night.Looked at the mirror and popped the pimples. The took a pee (man here, held my penis), 3 days later pimples on penis too. Got a NAAT PCR on torso and penis pimples, both were HSV 1.

Now, leave disclosure etc. The only conseqential risk is neonatal herpes simplex in future when I marry, say 2-3 years from now.

I know 3rd trimester primary infection for pregnant partner is dangerous. I will abstain from sex after 18 weeks pregnancy. What are the odds of neonatal herpes/trans-placental infection/abnormal placenta leading to fetal growth constriction if I were to pass on ghsv1 to partners genitals from conception of pregnancy to 18 weeks term?
I am aware of the low risks of ghsv1 vaginal transmission. Nonetheless risk is risk, someone wins the lottery.
How does the risk matrix change if I take Valtrex 1000 mg everyday for 4 years. (Want 2 kids, will do that in 4 years).

I am done with emotions, now the Process Engineer in me wants to understand the risks in designing the system.

Sorry for being upfront, I have designed my life to what I wanted it to be, this problem has to be managed. I am doing my PhD at Univ, read many papers on neonatal herpes simplex, very few case analysis on 1st trimester acquisition.

The Gods crafted a beautiful harp and threw it away the mud to rot.

Kindly help.

-The Harp

[Terri Warren]

So let me ask this question: was a separate swab done of the torso and the penis?
Let’s assume that you are infected in both locations
Since about half the population in the US has HSV 1, it is certainly possible that you would be with someone who already has HSV 1 infection.
There is no benefit for the future of you taking antiviral medication now. When you meet someone if they are negative for HSV 1 and you want to manage a pregnancy, you might want to start suppression then.
The odds of your HSV 1 infection causing intrauterine problems for a fetus are just incredibly low! They are already so very very low for those with HSV 2 infection. Of all the things for you to worry about, I think this should be very low on your list.

Terri

[factual_basis]

Hi Terri,

Separate swabs.So confirmed ghsv1.
Thanks for reassuring me. Honestly this has caused me so much mental pain. Constant rumination. Catastrophizing. Having a loving wife and to cherish my children has always been a big aim in my life. I think I am going to worry till I have my children and they cross 24 days of life. The next 6-7 years of my life is going to be agonizing. I wonder how I will manage being with a wife and trying for pregnancy. My life was going well and this has put a stop on living itself. Maybe I should never marry and give up. I am planning on getting an arranged marriage with an Indian girl.

[factual_basis]

Hi Terri,

Sorry for getting emotional.

My question more clearly is -If I pass on genital hsv 1 to my partner whilst getting pregnant i.e. first trimester. Such that primary infection is in the first few weeks of pregnancy, what is the risk to gravida and neonate?

[factual_basis]

I read that if primary infection occurs during initial pregnancy then mother can get disseminated hsv 1 and the developing neonate could suffer significant neurological sequelae.

I am sure I will not pass on ghsv1 during last trimester and if ghsv1 is transmitted before conception, the risk of reccuring outbreak has a low chance of infection. Elective Caesarean is also an option combined with Valacyclovir.I am concerned primarily with primary infection in first trimester or first half of second trimester.

[Terri Warren]

First of all, the transmission of GHSV 1 to a partner through intercourse is rare – I’ve not seen it. And if your partner gets it in the first trimester, there would be plenty of time for her to make antibody as well as pass it to the neonate. If you take daily valacyclovir, transmission is going to be even lower! Also since about half the population has HSV 1, most of it oral, the chances that you will send up with someone who also has HSV 1 is about 50-50 and then you’ll be fine!

Terri

[factual_basis]

Hi Terri,

I am glad I got to interact with you. The doctor I initially consulted told me HSV1 or 2 did not make a difference and that genital spread would be same for both. That sent me on a spiral and that doctor visit became a PTSD inducing event, that I am going to therapy for.

I have done a risk assessment here in terms of neonatal herpes simplex, please see if it makes sense to you.

Conditions – 1
– partner never acquires ghsv1 0% risk of neonatal herpes simplex
_________________________________________________________________________________________________
Conditions – 2
no sex with pregnant partner beyond 16 weeks conception, i.e. no primary infection beyond 26 weeks gestation i.e. seroconversion after possible infection prior to third semester (I assume 10 weeks is ample time to seroconvert).
– acquires ghsv1 well before ~13 weeks to term – maximum risk of transmission for recurrent episode in published literature – 5%
worst case scenario 2 years post infection based on shedding data from Christine Johnston (assume all shedding is infectious -I know it is a stretch) -1.3 %/ year.

I am assuming that after 2 years the 1.3% stabilizes and remains the same and I am not accounting for the effect of anti-viral.

Takes 3 years to get first child (neonatal herpes risk) ~ 0.20 %
Takes 7 years for second child (neonatal herpes risk) ~ 0.44 % (with 1.3 % transmission 7 years of relationship means more likelihood of transmission occurring)

I think these odds of risk are something I can live with, there are higher odds I will die in a car crash (0.88%).

Also, can PCR of amniotic fluid from amniocentesis at 21 weeks gestation reliably pick up an in-utero HSV invasion that could infect a fetus?

[Terri Warren]

I’m not sure about this one:
– acquires ghsv1 well before ~13 weeks to term – maximum risk of transmission for recurrent episode in published literature – 5%
The rest seems reasonable to me. But remember that about half the population has HSV 1 infection already, so the odds are excellent that you will meet someone who is already infected!
I don’t believe anyone would perform an amniocentesis for HSV – there are risks associated with that procedure as well, you know.
I think you’ve thought this out very well. Good job!

Terri

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