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Natural birth and genital herpes/HSV2, not on genitals

post #1 of 7
Thread Starter 

I have kind of an odd case of HSV2, in that I've never had a genital outbreak.  I have had several outbreaks, and had the outbreak cultured as well as a blood antibody test which confirmed HSV2.  However, every outbreak I've ever had has been in the same spot, on the back of the upper part of my right arm.  I had my first outbreak about 2.5 years ago, and had several recurrent outbreaks over about a six month period after that before they finally checked for and diagnosed the HSV.  Since then, I've only had two outbreaks start, but for both of them I had valtrex on hand and took it immediately, and neither of them developed into a full outbreak.  Since that, nothing, until this weekend when I was 36w6d, and now I have a full on outbreak going--on the arm again.

 

I asked my OB at my 36w appt last week if I should go on valtrex as a preventative, and he said there was no concern whatsoever since the outbreaks are not in my genital region at all.  I wasn't that concerned either because it's been so long since any hint of an outbreak, and I have come this far in this pregnancy (and through some very high stress situations during) and no sign of an outbreak.  Now this.  My concern is that if I'm having an outbreak anywhere on my body, isn't it more likely that I am shedding?  Also, how do I know if I'm having cervical outbreaks and just unaware?  I'm upset now that he didn't put me on the antiviral just in case, considering the seriousness should my baby contract it during birth.

 

I loved giving birth naturally with DS and had my heart set on it again.  Would an active HSV2 outbreak on a body part besides the genitals at or near time of birth make me need a c-section for baby's safety?  My first child, DS, was born at 38w4d (no meds, no induction, no interventions of any kind), and I'm now 37w1d.  I'm afraid I might not even have time for this to heal now.  I plan to call the OB when they open and ask for antivirals again, but now I'm worried it's too late anyway. 

 

 

post #2 of 7
Thread Starter 

No one has any experience with this??  I called my OB's office six hours ago when they opened, and no one has even called me back.  Sooo, I'm guessing maybe it's nothing to worry about if they're not even concerned enough to call me back.

post #3 of 7

The antibodies your body produces cross the placenta, so your baby has already received the antibodies which makes the risk of infection even from a genital outbreak very low.  Unless it is your first outbreak, there isn't a huge cause for concern and the risks of c-section are probably higher.  I can't imagine how a c-section could prevent transmission from your arm.  I would just keep any open lesions covered.

post #4 of 7
Thread Starter 

Thank you very much.  That makes sense to me too.  I'm overly worried about a lot of things right now.  smile.gif  The office called in a five day course of valtrex late in the day, so just hoping I can at least get this one healed soon.

post #5 of 7
Quote:
Originally Posted by puddle View Post

The antibodies your body produces cross the placenta, so your baby has already received the antibodies which makes the risk of infection even from a genital outbreak very low.  Unless it is your first outbreak, there isn't a huge cause for concern and the risks of c-section are probably higher.  I can't imagine how a c-section could prevent transmission from your arm.  I would just keep any open lesions covered.



I was about to say the same thing.  I have looked into this quite extensively and most things I read were scary but then on the midwife archives they linked to so many case studies that showed even with an active leasion on the genitals, unless its your first outbreak, because baby has those antibodies, transfer is rare. 

 

Found this:

 

The primary difference between the two viral types is in where they typically establish latency in the body- their "site of preference." HSV-1 usually establishes latency in the trigeminal ganglion, a collection of nerve cells near the ear. From there, it tends to recur on the lower lip or face. HSV-2 usually sets up residence in the sacral ganglion at the base of the spine. From there, it recurs in the genital area .

Even this difference is not absolute either type can reside in either or both parts of the body and infect oral and/or genital areas. Unfortunately, many people aren't aware of this, which contributes both to the spread of type 1 and to the misperception that the two types are fundamentally different.

"People don't understand that you can have type 1 genitally or orally, that the two types are essentially the same virus,' says Marshall Clover, manager of the National Herpes Hotline." One type is associated with stigma, the other is "'just a cold sore"- our society has a euphemism for it so we don't even have to acknowledge that it's herpes.'' 

 

A third factor influencing the frequency of HSV -1 and 2 outbreaks is whether the virus is established in its site of preference. While HSV can infect both genital and oral areas, both types cause milder infections when they are away from "home" territory. Outside their site of preference, both type 1 and 2 lose most of their punch. 

 

A friend of mine who is also looking into having a homebirth and going as natural as possible has had me helping her do research since she has HSV1 genitally.  She never had that first initial outbreak that is supposed to be so severe with genital herpes and only gets one sore on the outter labia with each pregnancy (she has had 4).  But usually its mid pregnancy and all clear by the time of delivery.  She hasnt had one yet this time and she is nearing the 36 weeks mark and is scared of it popping up when she is at term and having to have a c-section.  So, I have just recently looked all this up.

 

If your onloy outbreak site is the arm (well above the waist) it would sound like you have it out of its "site of preference" as well and will have a much milder time like my friend.  With that location, its unlikely you have it genitally as well without knowing so transmission to baby would be unlikely just through birth.  Just keep any active lesions on the arm covered at all times until the crusting and drying phase is complete so that you are no longer contagious.  It should in no way affect your ability to have a natural childbirth.  Good luck!

post #6 of 7
Thread Starter 

Thank you soooo much.  That's very helpful, and your friend is also lucky to have such a helpful friend.  :)

post #7 of 7

I get cold sores around my mouth and have since I was a kid.  I have outbreaks relatively frequently during pregnancy and infrequently otherwise.  I don't know which type of HSV virus it is since it's never been cultured. tI've had them when giving birth.  Other than being careful to ask if I get them anywhere other than around my mouth, the only other precaution I've been advised of is to not kiss the baby if I even think I'm getting one and until well after it has healed.  (Tough, but worth it!)  I was also very careful about not touching my mouth and then the baby, and even now I'm careful not to share glasses or towels with anyone if I have one.

 

You'll want to keep yours covered since you can.

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