genital herpes....acckkk! - Mothering Forums

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#1 of 13 Old 08-20-2005, 01:46 PM - Thread Starter
 
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OK, I've decided to get over my fear of being judged as slutty or unclean, and reach out to you mamas for advice. I just found out this pregnancy (our fourth) that I have genital herpes, and have had it for more than ten years but got my primary outbreak during the middle trimester of this pregnancy. OMG was that ever traumatic, not only physically but also mentally...I was like, what the hell?? We've been happily married for ten years, where the hell did this come from?? The doc said it can lie dormant for ages, and had done so in my case. DH was sweet about it, he was like, oh well, stuff happens and I just hope you feel better. He actually wanted to go out and get me a treat to help me feel better, but I was too full of self-loathing at that time to take him up on his offer!

Anyway, I just had the one outbreak and nothing since. My OB (whom I love, and who is into everything natural 100%) nevertheless recommends antiviral medication starting at week 35, and a c/s if there is an outbreak of herpes at the time of delivery. I'm nervous about taking those drugs. Nervous about having possibly a bad reaction to them, and nervous about the drug getting into the baby. Does anyone have any experience with or knowledge about this? My inclination is to NOT take the drugs, but then of course I play the what-if game....but what if I have another outbreak, god forbid I end up with a c/s. (I had an emergency c/s with our third. Lifesaving, yes, but horrible, YES!) I hate to make fear-based decisions, but I admit I am feeling a tad nervous.

I've heard Lysine can help decrease the chance of outbreaks. Does anyone know anything about that? All of your advice would be welcome! You're an awesome group of mamas.
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#2 of 13 Old 08-20-2005, 02:31 PM
 
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I'm not due until March, but I saw your post.

I have had genital herpes for almost 2 years. I very much think that Acyclovir during the last few weeks of pregnancy is much preferable to a c-section. Then you'll be full of all kinds of drugs. Acyclovir is a drug they also use to treat chicken pox in children and herpes in infants. I haven't had any outbreaks yet and if I make it to the last month with no outbreaks, then I will probably just risk it, but if I have several in the next few months I will take an antiviral during the last few weeks. I don't know how early your other children were born, but you could probably wait until 37 or 38 weeks to start taking it. It seems to me that if you had an outbreak at 35 weeks and didn't deliver for 3 or 4 more weeks then there would be little chance of having another so quickly.

I haven't had a chance to talk to my midwife yet (I haven't had a first appointment), but I also feel very comfortable about delivering with sores on my labia. I am not so sure about sores on my cervix. Either way I'd probably give the baby a bath pretty quickly. In my other two labors my water also didn't break until I was pushing and with my second I only pushed about 4 times, so if this labor is anything at all like that, I don't think there will be much time to pass on the virus.

It is my understanding that herepes is the worst if it is your first outbreak during delivery because you haven't been passing on as many antibodies to you child. It is also very common, and even though so many women have herpes and are probably even shedding during labor and delivery, very few infants get herpes. The problem is it is so terrible if they do-- blindness, brain damage, ect. It is terrible in infants. But the transmission rate is very low.

I take lysine if I feel the tingle of an outbreak coming on, and I will probably take it during the last weeks of pregnancy (maybe with acyclovir). I have heard that it isn't a good thing to take any amino acid for more then a month, I can't remember exactly why--something about then your body doesn't absorb the other amino acids as easliy. Another thing you can do is eat foods with a favorable lysine/arganine ratio (the herpes virus needs aranine to replicate, but lysine is close enough it messes it up somehow)--avoiding nuts especially can help, they have a lot of arganine.

Good Luck.
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#3 of 13 Old 08-20-2005, 02:37 PM
 
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I have no experience nor knowledge on the subject, but I wanted to say to you both for having to deal with this. I would have trouble with being relaxed about it.

Kristin -- mom of Erin (11/5/02) and Leah (9/29/05)
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#4 of 13 Old 08-20-2005, 03:17 PM - Thread Starter
 
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Thanks for your support and help, Mallory and Kerc. I sure appreciate it. A question for you Mallory: Does acyclovir cause any side effects or bad reactions? Have you ever taken it and not felt good/normal? And also, when you found out you had the herpes, were you freaking out? I was! I felt so dirty and awful, and my husband was out of town for a month, which I was glad about because it gave me time to settle down mentally before he returned. Now I know that tons of people have it and also, since I haven't had another outbreak, I'm much more relaxed about it. But OMG, the month of May is one I'm still trying to forget! God only knows when and where I got the virus in the first place.

Anyway, Mallory I appreciate your input. Sure is confusing, isn't it?
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#5 of 13 Old 08-20-2005, 07:56 PM
 
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Well I at least had it the expected 6 weeks after the start of sexual relations with my (now) second husband, and not in the middle of a long term relationship. I can see how that could be a real surprise, and not a good one .

I don't know that I feel so bad about getting it, but my dh felt so terrible- he had no idea he had it, and they don't usually test you for it unless you have an outbreak, so even a general round of STD tests won't catch it.

That first outbreak just left me feeling so terrible, achy, vaginal bleeding (most of my sores were on cervix), headaches, tired that I was glad to take any medicine. I think the only side effect I really have is an upset stomach if I don't eat with it.

But I just looked up the side effects online-Drug Digest ,The side effects you may notice from acyclovir depend upon the dose you are taking and the infection being treated; not all side effects occur in every patient.
Side effects that you should report to your prescriber or health care professional as soon as possible:
•confusion or hallucinations (i.e., seeing things that are not there)
•increased thirst
•redness, blistering, peeling or loosening of the skin, including inside the mouth
•reduced amount of urine passed
•seizures
•skin rash or hives
•stomach pain
•tremor
•unusual weakness or tiredness

Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome):
•diarrhea
•dizziness
•headache
•increased sensitivity to the sun
•loss of appetite
•nausea, vomiting

Drugs.com
Acyclovir is in the FDA pregnancy category B. This means that acyclovir is not likely to harm an unborn baby.
Stop taking acyclovir and seek emergency medical attention or contact your doctor immediately if you experience any of the following serious side effects:
· an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);
· little or no urine production; or
· unusual bleeding or bruising.
• Other, less serious side effects may be more likely to occur. Continue to take acyclovir and talk to your doctor if you experience
· nausea, vomiting, diarrhea, decreased appetite, or abdominal pain;
· a headache or lightheadedness; or
· joint pain.

AskDocWeb
It's also used for treatment of severe first episodes of genital herpes infections, for herpes encephalitis; for neonatal herpes infections and for treatment of varicella-zoster infections.

Side effects, that may go away during treatment, include nausea, vomiting, diarrhea, or headache. If they continue or are bothersome, check with your doctor. Some people have reported hair loss from prolonged use. Others have reported dizziness, fatigue, skin rash, anorexia, leg pain, medication taste and sore throat.

The digestive side effects are reduced if taken with meals. Some nausea can be avoided with eating strategies like eating dry salted crackers and not lying down after you eat.


I hate taking any drugs in pregnancy. I don't drink caffeine, I wouldn't dye my hair, ect. But I also think if I had a provider who would do a c-section at any sign of an out break that the risks of Acyclovir aren't any worse then all the drugs they would pump into my body for a c-section. And my risk of death is much less.

Here are some more sites about herpes
Herpes Viruses Association This one is very reassuring!

Herpes.com
On the one hand, such concern is understandable, because herpes can have devastating consequences for a newborn. But on the other hand, the risk is extremely low, experts agree especially for women with known, long-standing infections.

Neonatal herpes is not a reportable disease in most states, so there are no hard statistics on the number of cases nationwide. However, most researchers estimate between 1,000 and 3,000 cases a year in the United States, out of a total of 4 million births. To put this in greater perspective, an estimated 20-25% of pregnant women have genital herpes, while less than 0.1% of babies contract an infection. "Neonatal herpes is a remarkably rare event", says Zane Brown, MD, an expert on neonatal herpes and a member of the Department of Obstetrics and Gynecology at the University of Washington. "Compared to all the other possible risks in a pregnancy, the risk of neonatal herpes is extremely small."

"I think it's perceived to be more of a problem than it is", says Scott Roberts, MD a researcher in the Department of Maternal Fetal Medicine at the University of Kansas. "The rate of neonatal herpes is very low, even though the prevalence of genital herpes in our country is quite common."

Transmission rates are lowest for women who acquire herpes before pregnancy -- one study (Randolph, JAMA, 1993) placing the risk at about 0.04% for such women who have no signs or symptoms of an outbreak at delivery. The chances of transmission are highest when a woman acquires genital herpes late in pregnancy.

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."

Experimental approaches

Acyclovir is occasionally prescribed for pregnant women who suffer from extremely frequent outbreaks, or those who acquire genital herpes during pregnancy. The use of acyclovir, valacyclovir, or famciclovir during pregnancy is not recommended by ACOG or approved for use during pregnancy by the Food and Drug Administration. Ongoing studies may clarify the role of antiviral medications.



I'll stop rambling on now, I hope some of this is useful!
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#6 of 13 Old 08-20-2005, 09:46 PM
 
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I think I'd be inclined to take the acyclovir if it would help avoid a c/s, but I also looked up homeopathic remedies for you. Homeopathic petroleum is recommended for genital herpes. Something else to add to your arsenal! Hugs, mama.
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#7 of 13 Old 08-20-2005, 10:35 PM
 
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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.
This sounds really promising. Scheduling a cesarean section because of a .25%-5% infection rate sounds a little alarmist. But, it's a risk that I suppose you'd need to be comfortable with, if you went that direction.

Anyway, I applaud you for trying for the best care possible with this birth, and I'm sorry that you had such a hard time with this during your pregnancy.

Amanda
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#8 of 13 Old 08-21-2005, 12:05 AM
 
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While the rates of transmission are very low, neonatal herpes has terrible consequenses. That is why any sign of sores means an automatic c-section for most OB and midwifes. And why even many natural mamas who have lots of outbreaks during pregnancy just go for a c-section. It is a hard decision to make.

Neonatal herpes Cutaneous lesions are usually noted at day 4 to 7 of life. The initial lesions are often noticed at sites of trauma, such as at the sites of scalp electrodes. In addition to cutaneous lesions, diffuse encephalitis may result. This carries a prognosis of 15% mortality even with appropriate antiviral therapy with intravenous acyclovir dosed at 250 mg/m2 every 8 hours. Disseminated infection involves multiple organ systems, with disseminated intravascular coagulation, hemorrhagic pneumonitis, and encephalitis. This clinical picture carries a 60% mortality, again, even in the setting of appropriate antiviral therapy.

empahsis mine


I hope I haven't taken over too much, I just feel like this is a hard thing to decide about and since I was diagnosed I have been reading as much as I can. I personally am of the feeling that even if I have sores I would like to vaginally deliver, I hope that my midwife is open to that. I will also probably take the Acyclovir as a kind of back up, because I really feel the risks of it are less then a c-section.

Please don't take my advice for it though do your own studing and soul searching and figure out what will work for you.

Good luck.
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#9 of 13 Old 08-21-2005, 04:21 PM
 
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Quote:
Originally Posted by Mallory
While the rates of transmission are very low, neonatal herpes has terrible consequenses. That is why any sign of sores means an automatic c-section for most OB and midwifes. And why even many natural mamas who have lots of outbreaks during pregnancy just go for a c-section. It is a hard decision to make.

Neonatal herpes Cutaneous lesions are usually noted at day 4 to 7 of life. The initial lesions are often noticed at sites of trauma, such as at the sites of scalp electrodes. In addition to cutaneous lesions, diffuse encephalitis may result. This carries a prognosis of 15% mortality even with appropriate antiviral therapy with intravenous acyclovir dosed at 250 mg/m2 every 8 hours. Disseminated infection involves multiple organ systems, with disseminated intravascular coagulation, hemorrhagic pneumonitis, and encephalitis. This clinical picture carries a 60% mortality, again, even in the setting of appropriate antiviral therapy.

empahsis mine


I hope I haven't taken over too much, I just feel like this is a hard thing to decide about and since I was diagnosed I have been reading as much as I can. I personally am of the feeling that even if I have sores I would like to vaginally deliver, I hope that my midwife is open to that. I will also probably take the Acyclovir as a kind of back up, because I really feel the risks of it are less then a c-section.

Please don't take my advice for it though do your own studing and soul searching and figure out what will work for you.

Good luck.
Good info! Thanks for sharing the risks of it all!
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#10 of 13 Old 08-21-2005, 09:03 PM
 
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I don't have any wisdom to give you, but I do have a giant hug of support!

My sister has herpes, and delivered her son vaginally after the doc was very careful to make sure there were no signs of an outbreak. But remember no matter what happens, the most important outcome is a healthy mom and a healthy baby, no matter how he/she gets here. And that includes an emotionally healthy mom, so please don't continue to beat yourself up!

A happy woman
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#11 of 13 Old 08-22-2005, 12:20 AM - Thread Starter
 
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I sure do love being able to chat with all you mommies!! I love all your answers, and your help finding good information, and all your support. It all really helps, believe me. Won't it be cool after we've had our babies, and we can continue to share stories and ask each other questions, and find out how it all "turned out"! (Sorry, I'm delirious with sleepiness, hope I'm not babbling too badly.)
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#12 of 13 Old 08-22-2005, 01:20 AM
 
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I don't want to alarm you, but considering you're having your primary outbreak during pregnancy, I'd be very careful. It's a tough decision, because you don't want pregnancy to be your first experience with acyclovir in case you have a bad reaction. OTOH, it's a fairly benign drug, despite the warning list of side effects. And I agree with other posters that it's almost certainly preferable to be on acyclovir than have a c/s.

What does your midwife/OB/doctor say? Some of them consider it pretty much a non-issue and would be very comfortable with you attempting a vaginal birth. Also, when you know to look for it, someone can have a good look down there when labour begins. If you don't have any more outbreaks before then, your chances may be good of avoiding it. But this is where it's tough in your case b/c it's new and you really have no idea how often you'll have outbreaks, and you aren't experienced enough to "feel them coming".

I don't mean to be insensitive, but how does your doctor know that it's been sitting there for 10 years? AFAIK, there is no way to determine that.

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#13 of 13 Old 08-22-2005, 01:04 PM - Thread Starter
 
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They could tell if it was a new infection or an old one by measuring levels of some antibodies in the blood. Anyway, they measured a bunch of levels of something (it's all a blur) and of course, it is an old infection. But it was asymtomatic for some reason until now. God it's all confusing. I wonder why it never showed up before now. DH and I are pretty confused by the whole thing.

Anyway, I do of course have concerns about acyclovir. I'm leaning towards not taking it, because there hasn't been even a hint of recurrence after the first outbreak in May. I'm praying for smooth sailing until delivery.
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