Reply To: HSV1 – Transmission Risk to Child

[sprocket7475]

Hi Terri,
Thanks so much for your reply and the valuable service you are providing here!

Thanks for confirming that my doctor is following the ‘usual’ pattern with regard to the use of Valtrex during pregnancy. I haven’t gotten to actually meet with him during this pregnancy yet (I am 5 weeks along and won’t have my first ultrasound until 8 weeks), so I have only been able to talk with his nurse about this. She then consulted with my dr and relayed his recommendation to me. She kept telling me – we’ve never had anyone take the medication for prophylactic reasons throughout pregnancy (and the impression I got was that they had never run across this question, which I find highly unlikely, as my dr is an experienced OB). Nevertheless, she did tell me to contact them if I have a cold sore outbreak after going off the meds. And I will be able to talk to my dr in more detail when I have my appointment next month.

Thanks also for the info regarding transmission risk to my (13 month old) son. I realized when rereading my original post that I said I only kiss him on the cheek or forehead – I should note that I also kiss him on other parts of his head (top, back, side, etc.). I assume those would be considered the same as the forehead (thick skin, not vulnerable to HSV infection), but please let me know if that’s not the case.

Regarding asymptomatic shedding – when not on the Valtrex, as I mentioned, I often get tingles, itching, irritation around the outer edge of my mouth, sometimes redness and swelling. I usually apply rubbing alcohol with a piece of tissue or Q-tip when those symptoms appear. And, in the vast majority of cases (as again, this happens very frequently), a cold sore doesn’t actually manifest. I always felt that those symptoms were related to my HSV, and now that I have learned more about ‘asymptomatic’ shedding (and also had the experience of those symptoms being GREATLY reduced when being on the Valtrex), I feel confident that they are indicative of shedding. These symptoms come and go – sometimes the irritation/swelling/redness will appear and be gone within an hour or two.

My follow-up questions are:

1) Even with the symptoms mentioned above (likely indicative of shedding), but no actual cold sore, do you still advise that it should be fine (basically zero transmission risk) to kiss my 13 month old on the cheek or head? I will not do so if I have actual swelling/redness/notable irritation, but as I mentioned, sometimes I can feel these symptoms and then an hour later they are gone, and then later in the day they may show up again, so given that they can sometimes be so frequent, I am worried that I may kiss him at one point and then a few hours later feel the tingles or notice irritation, or have felt tingles/noticed irritation a few hours prior to kissing him, and wonder if I was shedding the entire time. I understand that you said the cheek and (fore)head are not vulnerable to infection, but if there is enough of a viral load, might there be a concern? Again, I will never kiss my child with an active cold sore (or if I can feel an actual sore coming on – this is a different level of feeling, ickiness than that associated with the above).

2) Also given the above, should I be concerned (that is, constantly wash my child’s hands) if my son grabs my face, his hands touch my lips? Just tonight, for instance, when I was putting him to sleep, his hand grazed my lips, and then he rubbed his eye. He often puts his hands in his mouth, as well. Is there any concern of transmission here, just with asymptomatic shedding?

3) Regarding your comments about the body not developing a dependence on Valtrex – I guess I am trying to understand how robust the immune response will be once going off the meds. Granted, I am not very knowledgeable regarding antibody production, but if Valtrex has been disrupting the viral replication process for so long, and thus the immune system hasn’t had to work ‘as hard’ to respond to and fight the virus, could the Valtrex have effectively disrupted the production of antibodies? And/or could the level of HSV antibody in my blood have dropped (compared to pre-meds)?

I really appreciate your patience and help. I dealt with cold sores for years without being worried about the inconvenience and discomfort they caused me, personally – but now that a child is in the picture (and soon to be children!), I want to be super careful.