Urgent! 39 weeks pregnant with prodrome

[Cathst3]

Hi Terri,

I’m currently 39 weeks and 2 days pregnant with my second child. (I have genital hsv1.) I’ve been on Valtrex 500mg 2x a day since 36 weeks as supression but normally take nothing. I got herpes 1 year ago and have only ever had that primary outbreak.

Occasionally over the course of the last year I would have nerve pain/tingles (the same as accompanied my first outbreak) but nothing’s ever come of it. It will usually pass after a day or so and never come to sores.

Well, lo and behold, I have a terrible headcold and last night I started feeling that herpes nerve pain. I of course got anxious, as I am planning on a vaginal delivery and am scared of passing herpes to my baby.

My first child was 11 days late, so I am assuming I probably have at least another week to go in this pregnancy. (The baby is not engaged and I am barely dilated or effaced.) If this doesn’t come to sores and just passes, should I be concerned about having a vaginal delivery? What are my shedding risks and how would you go about this if you were me? I feel I’d just made peace w/ the risk of my baby getting herpes from me being low, so this is emotionally throwing me for a loop late in the game.

I do not want a C-section, but obviously a healthy baby is most important. Assuming I don’t go into labor in the next few days, do you feel the risks are elevated? What if I do but don’t have prodrome or an OB at the hospital? Should I increase my valtrex dose? Let me know what you think is best. I really value your expertise.

[Cathst3]

Hi Terri, one more thought that is just occurring to me:

I have a toddler son (almost 2) who has been attending daycare. I know I was seronegative for CMV at the start of this pregnancy, and I have been taking aggressive hand washing precautions to avoid contracting CMV, which is prevalent in his sub 2 age group. Last week my son was sick with a very high fever, and I’ve since gotten his cold (sore throat, lot of nasal congestions). If this were CMV, could that be causing some of the nerve symptoms I’m having and not HSV1?

What concerns should I have or precautions should I take if this were a primary CMV infection? This is obviously a term pregnancy.

Many thanks for your help.

[Terri Warren]

I’m sorry I have not seen this until – we’ve been camping in the woods without internet.
If you have been on suppression and your doc knows you have HSV 1, you should be just fine. Obviously, if the baby shows any signs of fever or not eating or blisters, you should be seen immediately. The good news is that babies get antibody from there mom toward the end of pregnancy and most often that is enough to protect them against infection. And if you have no outbreak, infection of the baby is highly unlikely. Just keep communicating with your doc or midwife and I think things will be fine here. I don’t think the CMV is causing the nerve issues but be certain to discuss this with you doc as well, as I am certain you are already doing.

Terri

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