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Hi Terri
For women who are asymptomatic for 10+ years with hsv2 do you recommend suppressive therapy towards the end of pregnancy?
Also, if a person has been asymptomatic for many years ( even with stress, illness, surgeries) would you expect pregnancy would trigger an out break?
If a person with asymptomatic hsv had there first outbreak say 2-3 days after vaginal birth would the baby be at risk for contracting hsv?
Lastly, I’ve read that 75% of women with hsv2 can expect one outbreak during pregnancy is this true and if so from your experience in treating many people over the years how many can they expect during pregnancy ?Thank you!
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Yes, even without outbreaks, the recommendation would be suppression in the last month. And yes, because pregnancy suppresses the immune response, it is possible that being pregnant could trigger an outbreak. Women with established herpes infections are far less likely to infect their babies than those with new herpes during the pregnancy. But the question you ask is complicated – it is the first recognized outbreak or the first infection – very different questions.
I’ve not read that statistic about pregnant women with herpes. And since 80% of women with herpes don’t know they have it, I’m not sure how someone could come up with that statistic, honestly.Terri
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There is about a 1% chance that someone with a well established herpes infection would infect their child at birth. An outbreak at delivery would not be good and a c-section would likely be done. Suppression would help prevent that.
I don’t know the average number of outbreaks in a pregnancy, I suspect it varies widely
Terri
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Viral shedding IS active virus.
I seriously doubt that anyone would do a vaginal delivery on a woman having a herpes outbreak at the time of delivery. Never.
Infants who acquire HSV 2 are not defined as oral or genital, specifically. but an interesting question for their future.Terri
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1. can you describe what prodrome symptoms are? A lot of the websites says burning which worries me because I have had episodes of 5-7 days of burning ( more like the area is red and hot) maybe twice in the last year or so, both times I went to my Gyn and they prescribed me a triamcinoline nystatin cream saying it was a little red no blisters, sores and it was more outside of the urethra not around or in the vagina
Prodrome can involving burning, yes, but more often, a crawling under the skin feeling is common.
2. How long does a prodrome last? Some websites say a few hours some say a few days
Yes, a few hours to a few days is accurate.3. Can you have burning as a prodrome and no outbreak?
Yes, but so many things can cause burning so I wouldn’t rely upon that as the only indication of viral activity.4. If you have prodrome during labor without lesions is the risk still 1% of spreading to the infant
Yes, I suppose there is some risk, but antiviral therapy should be very helpful. I’ll tell you that in labor, you aren’t going to be able to sort out prodromal burning from anything else. If you are very concerned about the burning, you could have a swab test done prior to labor and see if virus is identified. So that later, closer to labor you might have a more accurate idea about if prodrome is happening.Terri
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