genital herpes outbreak at 38w and freaking out WEIRD UPDATE #20 HAPPY UPDATE # 24

[Tigerle]

I have had sore spots on my perineum for a few days now which I realize only tonight are probably a (secondary) herpes outbreak. I can't believe I've been in such denial. I think I had some vague notion that secondary herpes isn't a big deal in pregnancy but now that I've been googling it it appears that an active outbreak at delivery is one of the few cast-iron reasons for a CS and if my water breaks, I need to go in right away to have one, as the risk for infection then goes up.
I phoned L&D and the doc on call told me to see my ob/gyn in the morning for oral suppressive therapy, hope for a late delivery and to come right in if my waters should break. She thought that if I'd been on oral suppressives for a while, I might be having a vaginal delivery even with lesions not perfectly healed, but wasn't sure, so would have to ask her boss in the morning. No one ever told me that there is good reason to start suppressive therapy at 36weeks to prevent this. Whatever you don't research for yourself...
It's 11.10 pm here (I live in Europe) and I'm freaking. Help!

[Jane]

It's okay. Just get on some valtrex, and wait for it to heal. The stress of the wait will help hold labor off.

36 week supressive therapy is not recommened for everyone with a herpes history (by blood work, that would be 40% of women!). Only those that have 3-4 outbreaks a year or have had outbreaks in pregnancy.

It is possible to swab the vagina and do DNA analysis for herpes DNA. It will tell you if it's around. I'd recommend starting the therapy ASAP, but also doing the swab to confirm it's herpes. I'd hate to see you get a c-section over some ingrown hairs.

If for some reason, you do expose your baby
(water breaking on way to section) , she will be better protected because you've got some great antibodies going on. Just the fact that it's been a few days means that you've got more antibodies now than yesterday.

You will need to decide how you feel about a birth with lesions that aren't quite healed. With crusted over, healing lesions, some women do birth. They can be covered with tegaderm for more protection, but it's not a fail safe.

[BunnySlippers]

I think zinc is supposed to help. There is also some amino acid supplement you can get for herpes to keep from breaking out. I do not remember what it is, I only saw it when browsing the herb shelf at a store.

[Tigerle]

Thanks for your fast replies! Anything to calm me down!
I am VERY sure it's herpes - it is a long time ago that I have had an outbreak with lesions, but I know the exact places I get them. That's why I am so mad at myself for not realizing this (and mad at my obgyn, who might have noticed on Monday, but of course it did not occur to anyone to check for lesions). So it's a GOOD thing this has been goin on for a few days? Good to know that - and good to know that I might not have been recommended suppressive therapy anyway. If I had known what I've found out the last 45 minutes through Dr Google, I would probably have insisted any way though, I am that kind of person.
I tried finding out whether I could get my hands on oral suppressives tonight without a prescription, but it seems there is no way. Hope I can get some sleep anyway. Ugh.
sending Dh to the kitchen to look for vit C and zinc supplements...

[angelpie545]

Not to be a debbie downer, but I would seriously consider a c-section in this case, because neonatal herpes is very, very serious and there is little medical science can do to treat it. Don't get me wrong, I'm 100% pro natural birth and all that, but I know of a very sad case that could have easily been prevented if mom had a c-section. I would hate to see that happen to anyone else. Wishing health and peace your way.l

[Jane]

I agree that neonatal herpes is evil.
It's not necessarily good you've had it a few days, in a repression sense, bc it's easier to supress the faster you get on it. But it's good in an antibody sense - you will have more antibodies to share with your daughter.

I have had one client in your exact situation - 38 weeks, secondary outbreak. She did her valtrex, they were gone visually in 7 days, we gave it 7 more for safety, mother nature decided to wait 8 more, and then she went into labor. If she'd gone into any sort of labor in that 14 day window, tho, shed have gladly marched in and demanded a section.
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[Mamato3wild ponnie]

I would double up on the Valtrex....2- 500mg in the morning and 2 600mg in the evening. Also the Vit C in 1000mg doses several times a day. And a baking soda and epsom salt bath 3-4 times a day will help heal the lessions. You will be fine.

[Tigerle]

Thank you for your replies! I really appreciate the support!

I saw my obgyn this morning, who tried to calm me down telling me he'd probably find hemorrhoids, but on checking admitted it looked like herpes lesions. He did the swab, but sas the lab result won't come in before Monday, by which time he thinks it might have cleared up anyway. So now I'm on 200 mg aciclovir 5 times a day (swallowed 400 mg right there in the pharmacy and on reading the instructions thinking I might consider doubling up, as recommended for patients with a compromised immune system like after surgery - but that's pregnancy too, right? - and suggested by mamato3wildponnie. After all, if the worst comes to the worst they'd have to give it to a neonate as well in high doses, so who cares if she gets some of it now through the placenta, if this is the kind of medication that should cross?) Also am overdosing on vitC and zinc and put some of DS' old diaper rash cream with zinc on it. Anyone have on opinion on that? And
mamato3wildponnie, could you tell me how much baking soda to how much water would be right?

thanks you so much apricot for the information about the timeline - make sure the lesions are gone and give it 7 days for safety, that is exactly the kind of info I was looking for but couldn't find on the net and the L&D doc (might have been a resident, she sounded young) couldn't give me. I feel a lot better now that I am "on it" and doing what I can. So now I am trying to relax to give my immune system a boost, but not too much so stress will keep inhibiting my labour, right wink:? The obgyn thinks labour won't start for a while, there are no indications things will happen anytime soon. I'll just keep my legs crossed for the next two weeks. And get myself reconciled to the CS if it came to that. After all, safety for my baby matters most, right? it's just been a shock.
What a headache. Who needed that?

[Theia]

Essential oil of Melissa (Lemon Balm) is effective in viral infections. I get oral herpes and use it topically for those purposes. But do check to see if there are any warnings for use in pregnancy cuz I'm not read up on it in that way.

Another thing to consider, cut out certain foods in your diet (I know, hard in the 3rd Tri when you can only eat 2 bites at a time). Find foods that are high in Lysine and avoid foods that are high in Arginine. These two amino acids have strong effects on HV. Lysine is an HV inhibitor, and Arginine is an HV promoter.

Best wishes for you to have a safe and healthy birth.

[HappyMommy2]

For my cold sores, Valtrex FAR surpasses acyclovir. Push your docs hard for valtrex. And not for the small "suppressive" dose. You have an outbreak, so you need the big kill-it-now dose! Good luck mama!!

[BunnySlippers]

Originally Posted by Theia

Find foods that are high in Lysine and avoid foods that are high in Arginine. These two amino acids have strong effects on HV. Lysine is an HV inhibitor, and Arginine is an HV promoter.

Best wishes for you to have a safe and healthy birth.

Lysine- that is the one I could not think of!

[Tigerle]

Originally Posted by HappyMommy2

For my cold sores, Valtrex FAR surpasses acyclovir. Push your docs hard for valtrex. And not for the small "suppressive" dose. You have an outbreak, so you need the big kill-it-now dose! Good luck mama!!

I'll try to get a prescription for valtrex but it might be hard - I read it's not approved for pregnancy here. I am already taking the dose for immunosuppressed patients, without asking the doc.

I phoned L&D again to ask whether I should come in for CS prep just in case, get a physical exam, get the paperwork done etc, figuring that if I have to come in within the next two weeks, it's an automatic CS anyway and it will save us time. The nurse-midwife answering the phone thought it was a good idea but called me back after speaking to some Senior and Knowledgeable physician.
His opinion (this is a university hospital and thus maximum care facility, but with a reputation on being extremely conservative on the CS front due to having a midwifery school attached):
no need to come in, no need to rush me into CS prep. With a secondary infection, CS isn't a given for him, they will evaluate on the day, depending on what the lesions look like if any are still visible, whether they are already scabbing, where they are, how long ago the outbreak was, how long I've been on suppressive therapy etc. No need for any prep beforehand, there will be time enough on the day if the CS seems advisable, as long as I and the pregnancy are otherwise healthy, which we are. I know from friends that when they do emergency CS, prep takes them all of five minutes, so I guess my time-saving concern seemed unnecessary to them, probably even insulting...

I don't know why that made me feel better, but it did. It took some of the inevitability away I guess. We can TALK about it on the day, and I am sure if I demand a CS, they will do it.

Still aiming for 7 symptom-free days. Off to eat some more dairy (lysine rich) and vitamin C and have another sitz bath!

Edited to add I WISH the food highest on the list of argenine rich foods wasn't chocolate, of all things! In times of high stress, i feel I need chocolate for my sanity. Ice cream is NOT the same...

[Jane]

Valtrex and acyclovir are the sane thing once you take them. One turns into the other. It should bs just fine that you're on acyclovir.
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[HappyMommy2]

Originally Posted by Apricot

Valtrex and acyclovir are the sane thing once you take them. One turns into the other. It should bs just fine that you're on acyclovir.
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That is what the doctors keep telling me, too. However, my body's reaction to them is FAR different.

Valtrex makes my cold sores go away immediately. The acyclovir just makes them smaller, but they still last 7-10 days.

---

OP - Obviously you have to follow your own doc's advice. However, when i called mine about taking valtrex while pregnant ... she said - "it is fine, it is what we give mamas who have genital outbreaks prior to giving birth."

Sending you some healing vibes (and sticky baby vibes too) to avoid that c-section!!

[Tigerle]

Thanks all!

Sticky vibes are VERY welcome - for more reasons than one now! After having to take DS to the ER this weekend for suspected meningitis (it wasn't, thank God, but hardly sleeping at night monitoring a very sick child is probably what made me comletely ignore my symptoms, I realize now), now FIL is in the ER with suspected heart attack (it probably isn't, but he and MIL are still waiting for some test results and it's not yet clear whether he needs to be admitted - helping out with DS is probably what made him ignore his symptoms). I've just been to the neighbours to ask whether they are willing to serve as a backup just in case we need to rush me to the hospital during the night....we're like "just how many shoes are still left for dropping...?".

I read up some more on valtrex: apparently it's got a much better bioavailability which makes it more convenient to take but hasn't shown improved results in clinical trials, and they have found embryotoxicity in rats, though not in humans so far. But that's a statistical result of course, it makes perfect sense to me that some people might get much better results with valtrex, and others with acyclovir. What with all this stuff going on though, I haven't had the energy to go back to bully my obgyn into changing my prescription yet, and my symptoms have rapidly improved since going on acyclovir, so I might not do so after all. Thank you for the advice - it is so good to hear from btdt people, it's not a situation one can just call anyone up to ask about...

I could get used to a lysine rich diet though, except for the no chocolate thing - dairy, eggs, meat, tomatoes, fruit, yum!

[Mosaic]

You can also get l-lysine supplements from the store... can't hurt, right?

[Tigerle]

Originally Posted by Mosaic

You can also get l-lysine supplements from the store... can't hurt, right?

Oh I'm taking those too! I've really got it covered now, am doing all that I can and can even relax now because FIL is has been released and is better too.

And I've reconciled myself to the idea of a possible CS. If it's safest for the baby that's what it is. And I've realized it doesn't mean that all I am doing now is futile: I am sure being on suppressive therapy will reduce the odds of transmission even further (including when caring for my baby after birth) and will make me feel better sooner too. We'll all be fine. I just really needed a few days to process this and you've all been a tremendous help!

[Theia]

I'm sorry to hear about your DS and FIL. But it sounds like it's all working out. I just wanted to say that being aware of my diet has made a huge difference in my outbreaks (by lessening frequency), and I'm glad that my info was helpful.

I'm glad you can relax now because stress is thought to be a big factor in triggering HV outbreaks. I'll probably be stalking you over the next few weeks, (ie looking for your birth announcement) to see how it all turns out. I wish you and your new DC a beautiful introduction to life. Of course sending sticky vibes for the next week or so to get you back to a healthy state.

[Tigerle]

Originally Posted by Theia

I just wanted to say that being aware of my diet has made a huge difference in my outbreaks (by lessening frequency), and I'm glad that my info was helpful.

Which reminds me that I should share a very helpful website I found about the lysine/arginine diet, in case someone with a similar problem finds this thread:
http://www.herpes-coldsores.com/diet...LysineArginine

Originally Posted by Theia

I'm glad you can relax now because stress is thought to be a big factor in triggering HV outbreaks. I'll probably be stalking you over the next few weeks, (ie looking for your birth announcement) to see how it all turns out. I wish you and your new DC a beautiful introduction to life. Of course sending sticky vibes for the next week or so to get you back to a healthy state.

[Tigerle]

So I felt much better by Sat, my husband could only see new skin where the lesions were, and I was happily looking forward to just waiting it out now. Sun I began feeling itchy and burning again, this time feeling more like a yeast infection. Having read that secondary yeast infections are likely, I started using yeast cream too. Today it still wasn’t better so I went to see my obgyn to have him check out the new development and to ask for the result of last week’s test. They happily informed me the test had been negative, but I asked to see it, having this funny feeling about it.
Now the weird thing was that I’d heard him call out to his assistant the week before to send the test away for HPV testing, and I’d asked “but shouldn’t it be HSV testing, I thought HPV is human papilloma?”. The obgyn said “no, no, this covers herpes virus too” so I figured this was their shorthand for a full virological work up.
Well now we have a test result telling me I am free of human papilloma but NOT covering herpes, nice to know but not the question I needed answered! We argued for a bit about it and it took him a while, after first insisting that there was no other test for herpes and that there was no difference between HPV and HSV, to come around and admit that there might have been a mistake. Then he examined me and insisted he found new herpes blisters in a place I’d never had any before! While I was on the CTG monitor, he phoned someone to educate himself on HSV tests. Unsurprisingly, found out there was a specific HSV test he should have asked for, took a new sample and let me go, both of us rather quiet. He’s probably aware he’s not going to have me much longer for a patient.
I was in shock but then remembered there was no reason this man should be able to properly recognize herpes lesions if they jumped up and bit him, not ever having had occasion to obtain a positive test result for any of his patients. So I met DS and said “we’re going in to L&D, I want a second opinion NOW!”
When they could finally make time for me at L&D, I spilt the whole tale to them, still mad – heaven knows professionals don’t like it if you come in complaining about one of their brethren, but I wanted them to know why my regular obgyn had completely lost my trust and that I was relying on them for my primary care in this matter now. I mean I do not mind educating medical personnel about the more obscure things I find out on the web, but I think telling apart HPV and HSV is a bit much!
During a thorough visual exam, they could not find ANY herpes lesions, though they agreed there might be something else going on as the skin was irritated and inflamed. They took samples for HSV and yeast testing but told me that according to what they could see, I would have been good to go on the day (no signs of labour as of yet though). They want me to come in on Friday for continuous monitoring in case something was developing they couldn’t see yet, which is also when they should have the test results, and to just continue with both my herpes and my yeast regimen just in case.
I’m really weirded out by this but am not going to find someone new at this point in my pregnancy - but I will as soon as I’ve got this wrapped up. I’m still sure about having had an actual outbreak and that I have been doing all the right things.
Thanks for reading this – just needed to vent! Hoping for a chance to post a happy update sometime next week or so...