1. Is the pain while urinating associated with the healing process of a primary herpes outbreak?
Normally, pain with urination due to a first episode herpes infection Will be gone in a few weeks at the most. She probably should be worked up to be certain she does not have a urinary tract infection.
2. Is the itching normal, or part of the healing process, and if so are there expectations of how long it could possibly last?
Again, normally itching associated with the first episode of herpes infection would result in a few weeks. She may wish to be evaluated for a possible yeast infection if the itching continues.
3. My wife is on a suppressive dosage of 500mg, 1 time daily, for the remainder of her pregnancy, would it make more sense for her to come off of the Valacyclovir until 36 weeks?
Doctors vary in the way they manage herpes during pregnancy. Most will begin antiviral therapy at the end of pregnancy, between 34 and 36 weeks. If it looks like labor could be starting early, for any reason, the suppression is usually started earlier. Most providers do not have patients on suppression the entire pregnancy though there are no recommendations against that practice.
4. I’ve read some people experience itching with Valacyclovir and switch to Acyclovir and notice a reduction in itching, would this be a good idea or would it be better to not experiment especially since she’s pregnant?
I have not Heard of this. Valacyclovir is metabolized into acyclovir very quickly in the body so I’m not sure how that would happen anyway.
5. Is there anything you can recommend for the itching?
I recommend that she be evaluated for a possible yeast infection by her OB provider.
6. If her water breaks, how soon would the baby have to be delivered?
Again, this is something that the OB provider Will discuss with her. Since she is having that question now, I think she should ask the question of her provider soon so she can stop wondering.