Herpes simplex one on nipple - anyone else?

[Patrick's mummy]

Hi all
This is the first time I have posted in this forum but I am hoping someone may have some ideas/experiences to share.

I have two DS and both have been breastfed for about 18mths. With my second DS I had planned to do CLW. However, I also had ezcema on my nipples throughout my nursing experience with him and because everything was always cracked, I got a lot of infections. Mainly thrush but then DS2 got oral herpes (inside his mouth, not on his lips) from a child at daycare and before we had got this diagnosed, he did of course manage to give this to me. It was incredibly painful for both of us and not helped by conflicting diagnosis/advice from local doctors...

Anyway, long story cut short was that it took me 3 weeks to clear the lesions from my nipples by taking drugs for it and during that time I was advised not to feed him at all (by LLL). This basically resulted in weaning, which I was really sad about.

I am now about 32 wks preg with no 3 and am thinking about how to prevent a flare up. My understanding is that HSV1 reoccurs where it first occurred during times of stress etc. I am worried about that happening because I also heard that a baby under 4 weeks can die from exposure to the virus. I read up on it on LLLI website and they said that if you get it on your nipple to pump the milk but if the pump touches the lesion (how wouldn't it?) that that milk needs to be thrown away. So, I'm concerned about the worst case scenario where I have a flare up on both nipples, can't feed the baby directly - what then?

I do have friends locally who I think would pump for me but given how frequently a young baby needs feeding, how realistic is it to get all his/her milk needs from others?

I am finding there is very little info out there about herpes on the nipple as apparently (according to the dr..) it's quite uncommon. I wondered if anyone on this board had had this experience and what you did?

Thanks!

[NW6Londonmum]

The following was posted by a UK bf counsellor on a group I'm a member of. You may find something in it:

Hi Tracey

I was supporting a friend a while back who suffers from oral herpes
and was about to embark on tandem nursing. We scoured my bf books
for information, she asked her gp and her bfc and I contacted the
Herpes Association, and together we came up with the following:

"The Herpes Simplex (I) virus can cause 'cold sores' (usually on the
lips but sometimes in the mouth or on the breasts) or a genital
infection (II) in mothers. It can be extremely serious and even
fatal for very young babies under one month old. No one with a cold
sore or a sore mouth from a herpes infection should kiss a baby.

Women with herpes sores on the breast should not breastfeed and
should discard their milk until the sores have healed and therefore
aren't shedding viruses. Any sores on the breasts must be kept
covered so that the baby does not touch them.

If there are no sores on the breast, experts simply recommend strict
hygiene precautions, treating the infection and continuing to
breastfeed. It is extremely unusual for breast milk to contain
herpes viruses.

Until the sores are dried, the mother needs to follow strict
precautions:

wash her hands before holding the baby and after she touches the
sores
put clean coverings over the sores, and
avoid kissing the baby when she has a cold sore on or near her mouth
A few experts, however, advise a woman with a first herpes attack,
especially of the genital area, not to breastfeed. This is because
of the danger of a newborn baby becoming infected with viruses that
are potentially very dangerous to him, as his immune system is
vulnerable and breast milk hasn't yet had a chance to develop much
anti-herpes protective activity. These experts also say there's more
chance of developing a sore on the breast during a first attack.

In any case, if there is a sore on the nipple or areola or anywhere
the baby might come into contact with it while he nurses, the mother
will need to express her milk from that breast until the sore heals.
She can however, continue to nurse on the unaffected breast.

A woman advised not to breastfeed can keep her milk supply going by
frequent expression or pumping, but should discard the milk if there
is any risk of transferring the virus into the milk by contamination
from the sores. Once the infection has cleared and she's no longer
shedding viruses, she'll then have plenty of milk and can start to
breastfeed. The anti-viral drug acyclovir has considerably
brightened the outlook for treatment.

Diagnosis of the virus in babies and children can be difficult by
visual examination and is sometimes mistaken for hand, foot and mouth
disease. However, a culture of the sore can confirm herpes within a
few days.

Herpes can easily be passed among family members, father to mother,
sibling to sibling, mother to baby. In one recorded case, a nursing
toddler with a cold sore in his mouth passed herpes to his mother via
nursing (Sealander and Kerr 1989).

If a mother wished to tandem feed her new baby and her toddler, and
the older child has the virus, there may be some concern about the
infection being passed to the baby through the virus being left on
the nipple in traces of saliva. However, the virus is quite fragile
and a quick wipe with a mild soap would burst it's skin and destroy
it. Further to this, the baby of a woman with herpes simplex has
herpes simplex antibodies (transplacental protection) and the
exclusively breastfed baby would be very unlikely to catch the virus
before about 6 months.

A baby who was not breastfeeding would have a much lesser degree of
protection from the virus and would be more at risk of contracting
herpes simplex after 3 months.

If the baby were to contract herpes simplex, the initial outbreak
would be the most uncomfortable but even so, it would be localised to
one area and sores would not break out in places other than the
initial site. Vaseline and teething gel or powders may ease the
discomfort whilst nursing and cool drinks, ice pops or plain ice
cubes to suck may be helpful at other times.

A herpes infection is serious or life-threatening only if it is
acquired in utero, at birth, or during the first few weeks of life
(Sullivan-Bolyai 1983; Quinn and Lofberg 1978). Following the
previously listed precautions can help avoid this possibility."

References:

Breast is Best by Dr. Penny Stanway, 2005 ed.
The Breastfeeding Answer Book by La Leche League International, Third
revised ed. 2003

Marian Nicholson
Director
Herpes Viruses Association
41 North Road, London N7 9DP
Tel [phone]
www.herpes.org.uk

Don't hesitate to contact Marian Nicholson direct at the Herpes Virus
Association for more information - she is very helpful.

Advice seems pretty contradictory. It says discard pumped milk but then says it's extremely unusual for the virus to be in the milk and the virus is fragile. I suggest - even if you aren't in the UK - you contact Marian for further advice.

[Vanishing Word]

Thank you for sharing this information.

[Patrick's mummy]

Thank you

Thank you for that information, that is the most I have ever seen written about this subject. Like you said, it does seem somewhat contradictory but it also confirms that it wouldn't be appropriate to feed a less than 4 week old baby with milk pumped/fed from a mother with active herpes lesions on nipples. I wonder whether I should immediately start pumping once my milk is in, so as to have a supply just in case this should happen. On the other hand, I have two other young kids (aged 4 and 2) so the feasibility of that is in question!!
would there be any reasons why pumping from early on would not be a good idea?
Thanks

[NW6Londonmum]

The main downside might be that it would cause oversupply issues which might lead to a foremilk imbalance and an overactive letdown. Ideally your baby would regulate your supply to meet their own needs.
However you sound worried about it and I think the upside (that potentially your baby could be exclusively fed bm if you have lesions) would outweigh the downside. If you get a foremilk overload you may need to pump before your baby feeds for a while.
You could consider a 'hands free' pumping top/bra for convenience (if you have an electric pump).

[Patrick's mummy]

Thanks, that makes sense. I am fairly sure I won't get a reoccurence of the lesions because my midwife told me that if I was going to, it would be more likely to happen in pregnancy but I would hate to give artificial milk to a baby that young, so I like to have a contingency plan in place! I suppose if I did pump and there was an oversupply problem, once we were past 4 weeks, I could stop pumping and things would very quickly settle down to a regular supply-demand situation.
I have seen those bra things but my pump is an Avent Isis. I can't imagine pumping with active lesions as it was incredibly painful last time but, if needs must, I will and investing in one of those bra things may make it a little more feasible.
These things are sent to try us!!

[NW6Londonmum]

Yes, once you get past the 4-5 week mark you could relax I would say. So the pumping is only a short term thing. Might it also be worth investigating whether you have any donor milk available in your local area?
Regular pumping with an avent isis - watch out for RSI. It might be worth considering renting/ borrowing a double electric pump just for that one month. It'll make life a lot easier.
Good news that you are unlikely to see lesions. Fingers crossed - but as you say no harm in being prepared.

[BusyBeeMom]

Originally Posted by NW6Londonmum

Advice seems pretty contradictory. It says discard pumped milk but then says it's extremely unusual for the virus to be in the milk and the virus is fragile.

I'm pretty sure they're saying that if the mother has an active lesion on the breast, she should not nurse, and should dump the milk b/c the lesion itself is shedding virus and the milk would be contaminated. The virus in the milk is coming from the lesion that is on the breast. It would be impossible to pump, with an open sore, and somehow prevent the virus from contaminating the milk.

If there are no active lesions on the breast, nursing should be safe, as the milk itself is very unlikely to carry virus, and just normal hygiene precautions should be followed (if mom has a sore elsewhere)

I'm wondering if I've got herpes on my nipples...I thought candida, but now I'm not sure. What does it look like?

[Patrick's mummy]

Originally Posted by BusyBeeMom

I'm wondering if I've got herpes on my nipples...I thought candida, but now I'm not sure. What does it look like?

When it becomes lesions, it looks like round craters with pale brown "gunk" in them and eventually they scab over. Before that it was just deep sores, similar to what some moms get when they start nursing and nipples get cracked.

What makes you think you might have herpes - have you been exposed to it? It's nasty so I hope you haven't.......

[BusyBeeMom]

Originally Posted by Patrick's mummy

When it becomes lesions, it looks like round craters with pale brown "gunk" in them and eventually they scab over. Before that it was just deep sores, similar to what some moms get when they start nursing and nipples get cracked.

What makes you think you might have herpes - have you been exposed to it? It's nasty so I hope you haven't.......

Ok, it's probably just candida gone totally haywire then. I thought they would look as described above, but just wanted to check. I've got long, narrow "gashes" that sound more like what candida can do when it gets really bad. DS had a cold sore, but I would have been surprised if I had contracted it on my breast b/c I've got antibodies to it, but was just thinking...

Anyway, I've got a call into a physician who specializes in breastfeeding medicine, so I'm really hoping she can help. None of these remedies/meds are doing diddly so far.

[Patrick's mummy]

Originally Posted by BusyBeeMom

Ok, it's probably just candida gone totally haywire then. I thought they would look as described above, but just wanted to check. I've got long, narrow "gashes" that sound more like what candida can do when it gets really bad. DS had a cold sore, but I would have been surprised if I had contracted it on my breast b/c I've got antibodies to it, but was just thinking...

Anyway, I've got a call into a physician who specializes in breastfeeding medicine, so I'm really hoping she can help. None of these remedies/meds are doing diddly so far.

Aww, it's horrible. I have had persistent thrush with both my nurslings and I do sympathise. Have you tried eliminating sugar and wheat?

[Toolip]

Originally Posted by NW6Londonmum

…should discard the milk if there is any risk of transferring the virus into the milk by contamination from the sores…


…If there are no sores on the breast, experts simply recommend strict hygiene precautions, treating the infection and continuing to
breastfeed. It is extremely unusual for breast milk to contain
herpes viruses.

I don't think that this is contradictory. I think that they are just saying that herpes is not in breast milk just because you have a sore somehwere on your body but that the sores are highly contagious and will contaminate pumped milk if it's on or near the nipple.

This also goes along with what I understand about herpes.

Have you ever thought about getting some kind of topical herpes cream? I use Denavir (Abrevia is the OTC version, not quite as good but still works) for my cold sores and it is amazing stuff! I put it on before it even breaks out because I can feel the "tingle" of a sore coming, if I catch it early, it never becomes a sore. I would think that it might be a good option since it is safe to put on your mouth and if you only had a sore on one side, you could treat it without taking something systemically.

I would just be extremely careful about not getting it in the baby's (or anyone's) eyes. That's what I've been told is the major risk to young babies. I change my pillow case every day when I have a sore and wash my hands constantly.