Genital Herpes and C-Sections...

[ella79]

i had my first outbreak of Genital Herpes about 2 years ago, and since then have got fairly regular outbreaks (every few months). i've already had 2 outbreaks since i fell pregnant (currently 22 wks PG).
I asked my OB what would happen if i had an outbreak prior to going into labour (the blisters hang around for about a week - sometimes longer). he said that he would defintiely want to do a c/section (due to the risk to the baby. it is very unlikely that they would contract the virus, but if they did, it is VERY nasty).
i asked if there was any medication that i could take to prevent an outbreak in the last few weeks leading up to my EDD (i know that when i was first diagnosed the GP gave me some really expensive tablets that cleared up the blisters instantly!). he said that there weren't, and i just had to take my chances and hope that i didn't get an outbreak...
does anyone have any light to shed on this issue? i really don't want a c/s if at all avoidable...

[shazd]

Ella, there is actually a pill that you can take. I can't remember the exact name of it, but there is. It only offers a sort of protection against an outbreak, I don't know the full details. If I remember the name I'll get back to you but ask your Doc to check again. Because I know there is.

[BellyBelly]

Yes there is a medication you can take and its safely used by pregnant women. Worth doing your research on this though because you will find stories of babies being born by c/s with lesions on their body, so worth a thought.

[BellyBelly]

Here's an article about the drug: http://www.news-medical.net/?id=18805 and this on birthrites: http://www.birthrites.org/herpes.html

In women found to have active lesions at the time of delivery, Caesarean section might be considered an option. However, this has not been shown to reduce the incidence of neonatal herpes and may pose a risk to the mother.In women without active lesions, normal vaginal delivery is recommended.

From the herpes (US) website:

No lesion at delivery

If a woman doesn't have herpes lesions at the time of delivery, the standard of care recommended by the American College of Obstetrics and Gynecology (ACOG) is vaginal delivery. This does expose the baby to a very small risk of infection from possible asymptomatic shedding. The case for vaginal delivery is built on a number of strong arguments.

First, the percentage of babies who acquire neonatal herpes from mothers who have no active lesions at delivery is exceedingly small. In a study of 15,923 pregnant women in Seattle, only one baby contracted neonatal herpes from a mother with recurrent HSV who was shedding asymptomatically at delivery (Brown, New England Journal of Medicine, 1991). Other studies have found an even lower rate of transmission.

"The risk is not zero, but it's extremely low," says Stanberry. By comparison, studies have found that many more women shed virus at delivery -- approximately 1.4% of women tested by viral culture, and some 20% of women tested by ultra-sensitive PCR (polymerase chain reaction) technology. The dramatic difference between the numbers of babies infected and mothers shedding virus have led researchers to conclude that even babies who are exposed to viral shedding rarely become infected, probably because of maternal antibodies passed through the placenta.

The second argument for vaginal delivery is that there is no practical way to detect viral shedding quickly enough to affect a delivery decision. Prior to 1988, ACOG recommended that doctors culture women for HSV-2 in the last few weeks before delivery, in an effort to identify women who are shedding. However, several studies demonstrated that these culture tests are useless for predicting which women will be shedding at delivery, as shedding tends to last only a few days at most.

While some doctors still continue the practice of weekly cultures to determine the need for a C-section, experts now believe this simply causes unnecessary cesareans - without providing any protection to babies.

For example, a 1995 study at University of Texas Southwestern Medical Center in Dallas showed that since the hospital adopted ACOG's 1988 recommendation of delivering women with genital herpes vaginally, in the absence of visible lesions, the rate of cesarean delivery dropped by 37%, and no babies had contracted neonatal herpes (Roberts et al., Obstetrics &' Gynecology, 1995).

Some mothers do request a C-section because they want to do everything possible to avoid infecting their babies. "Many mothers may be willing to put themselves at risk for their babies," says Laurie Scott, M.D., of the Department of Obstetrics and Gynecology at the University of Texas. "But the reality is that a C-section is a potentially dangerous situation."

Maternal illness following a cesarean is approximately 28%, compared with 1.6% following a vaginal delivery. Cesareans require long recovery times, and in some instances can even be fatal. "If we were doing C-sections on every mother with genital herpes, we'd end up losing almost as many women as we were saving babies," says Zane Brown.

Furthermore, the protection offered by C-sections is not absolute. In various studies, between 16% and 30% of infants infected with neonatal herpes were born by cesarean (in most of these cases the cesarean was performed after the membranes had ruptured).

At the same time, babies delivered vaginally, even in the presence of active lesions have an infection rate of only 0.25%-5%."Every center that does research has cases where a lesion is identified after delivery," explains Brown. "The obstetrician will notice it while stitching the mother after an episiotomy, for example. In most cases, those babies don't get infected". This again shows the protective power of maternal antibodies.

In short, for mothers with recurrent genital herpes, even the practice of delivering by cesarean in the case of visible lesions is conservative in light of the very few actual cases of neonatal herpes.

"We're not operating on mathematical assumptions," says Scott. "We're operating on real-world observations of how few babies get neonatal herpes."

[AnyDream]

Ella, I reckon it would be a really good idea to find a good herbalist/nutritionist type person to really work with building up your immune system over the next few months, since if you're feeling healthy and well it decreases the chance of any outbreak at that end of your PG.

[Keira]

Hi Ella,

In the past i have had a thing that's called eczema herpeticum and it looks like shingles and i usually get it on my arms or stomach, its part of the herpes simplex family and to prevent any outbreaks i take L-Lysine capsules, which most vitamin companies make (like blackmores etc)... even if you do get an outbreak it isn't as severe and doesn't last as long as normal, and because its an amino acid its pretty safe to take during pregnancy instead of taking drugs for it.

Although, if i do get an outbreak, i still take my prescribed drug if/when i get an episode as well as taking L-Lysine, but i haven't had one for ages and i used to get it coming up every month!

Hope that helps! Good luck!

Keira

[Ambah]

Valtrex is the medication used to treat genital herpes. You can take one tablet a day for prohylactic treatment, or you can take 2 a day if you feel the signs of a outbreak occurring.
Valtrex is not contraindicated to take in pregnancy, however there have not been enough studies done which entirely confirm its safety either (according to its classification on MIMs).

I faced this issue with my first pregnany, and got next to no information from my midwives, except them telling me I should not take Valtrex during pregnancy (which isnt exactly true).

Apparently if you are undergoing your very first outbreak of genital herpes during pregnancy, then that is where the danger lies.
If it is a recurrent outbreak then there is far far less risk to your baby.

I weighed up the risk and took one Valtrex per day 2 weeks prior to giving birth to Aidyn. I would rather have taken the small amount of medication than risk him being exposed to the virus during birth - as there was always the possibility that I was shedding the virus without an outbreak.

I will also do the same for my next pregnancy...

I think c/s is too drastic, and wouldn't go down that path unless there was an active outbreak at the time of labour/birth.

ETA: Valtrex is in category B3, Quoted from MIMs -

Category B3
Drugs that have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. Studies in animals[1] have shown evidence of an increased occurrence of fetal damage, the significance of which is considered uncertain in humans.

ETA2 - I personally would not take Valtrex for the any of the previous 8 months of my pregnancy - only when approaching birth, as I felt the pros outweighed any risks at that stage.

[ella79]

wow - thanks for all of that info ladies!! i'll have another chat to my OB at the next visit to see what his thoughts on Valtrex are...
other than that i guess all i can do is try and eay healthy, exercise and get lots of sleep to try and prevent an outbreak...
will look into L-Lysine too Keira - thanks!!