Herpes Pregnancy And Newborn Infants
Herpes can pose serious risks for a pregnant woman and her baby. The risk is greatest for mothers with a first-time infection because the virus can be transmitted to the infant during childbirth. Guidelines from the American Academy of Pediatrics recommend using specific diagnostic tests for women in labor to determine the risk of transmission. Babies born to mothers infected with genital herpes are often treated with the antiviral drug acyclovir, which can help suppress the virus.
Why Have False Positive Tests Been Used As An Argument Against Routine Testing For Genital Herpes But Not For Other Stds Which Can Also Have False Positives
False positive test results are test results that say a person has a disease or condition when they do not actually have it. False positive results can occur with many diagnostic tests, including STD tests. The chances of false positive results increase as the likelihood of the infection decreases in the person being tested. False positive HSV-2 results can happen, especially in people who are at low risk for a herpes infection. Also, we do not know if people who test positive for herpes will change their sexual behavior as a result of a positive test. This tells us that the harm of a possible false positive test may be a greater concern than the benefits of an actual diagnosis. Unlike curable STDs, such as chlamydia, herpes infections are life-long, so it is especially important to avoid a false positive test.
Valacyclovir Tablets Are Used In Adults:
- to treat cold sores
- to treat shingles
- to treat or control genital herpes outbreaks in adults with normal immune systems
- to control genital herpes outbreaks in adults infected with the human immunodeficiency virus with CD4 + cell count greater than 100 cells/mm3
- with safer sex practices to lower the chances of spreading genital herpes to uninfected partners. Even with safer sex practices, it is still possible to spread genital herpes. Valacyclovir tablets used daily with the following safer sex practices can lower the chances of passing genital herpes to your partner.
- Do not have sexual contact with your partner when you have any symptom or outbreak of genital herpes.
- Use a condom made of latex or polyurethane whenever you have sexual contact.
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Can It Lie Dormant
The herpes virus can lie dormant in the body for years before people experience any symptoms.
After people have the first outbreak of herpes, the virus then lies dormant in the nervous system. Any further outbreaks are due to the virus reactivating, which causes symptoms to appear.
Symptoms are usually less severe during repeat outbreaks. Sores also clear up more quickly, often within 37 days. This is due to the antibodies the body produces to fight the first outbreak of herpes. The body can then use these antibodies to respond more quickly to future outbreaks.
There is currently no cure for herpes. Even if a person stops experiencing symptoms, the virus will remain inside their body.
It is also important to point out that herpes is transmissible even when no sores or other symptoms are present. For this reason, early prevention is advisable.
To help reduce the chance of this happening, people can use condoms or dental dams during sex.
Condoms and dental dams do not offer complete protection against the herpes virus, as herpes can live on areas around the genitals. However, these methods do reduce the likelihood of contracting the infection or passing it on.
A person who has herpes can also take other steps to reduce the chance of passing it on to a sexual partner. Such steps include telling their sexual partner that they have herpes before having sex.
Both people can then take additional steps to reduce the likelihood of transmission. These steps may include:
Symptoms Of Oral Herpes
Oral herpes is most often caused by HSV-1, but can also be caused by HSV-2. It usually affects the lips and, in some primary attacks, the mucous membranes in the mouth. A herpes infection may occur on the cheeks or in the nose, but facial herpes is very uncommon.
Primary Oral Herpes Infection
If the primary oral infection causes symptoms, they can be very painful, particularly in children. Symptoms include:
- Tingling, burning, or itching around the mouth are the first signs.
- Red, fluid-filled blisters that may form on the lips, gums, mouth, and throat.
- Blisters that break open and leak. As they heal, they turn yellow and crusty, eventually turning into pink skin. The sores last 10 to 14 days and can be very uncomfortable.
- Blisters that may be preceded or accompanied by sore throat, fever, swollen glands, and painful swallowing.
Recurrent Oral Herpes Infection
A recurrent oral herpes infection is much milder than the primary outbreak. It usually manifests as a single sore, commonly called a cold sore or fever blister . The sore usually shows up on the outer edge of the lips and rarely affects the gums or throat.
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If A Pregnant Woman Gets Genital Herpes Is There A Chance Her Baby Can Get Infected
Yes. Even though adults with genital herpes may not have any symptoms, herpes infections in babies can be life-threatening. Women who get genital herpes during late pregnancy have a very high risk for having a baby with herpes infection, and these women may not even know they are infected. Women who get herpes during early pregnancy, or who are infected before they get pregnant can also spread herpes to their babies. Most babies with herpes get infected as they come into contact with the herpes virus while passing through the birth canal, but infection can also occur before birth or in the weeks after birth.
If you are pregnant and think that you or your partner may have genital herpes, tell your doctor. Your doctor can order testing and can talk to you about ways to lower your babys risk for infection.
Acyclovir For Recurrent Herpes Outbreaks
There is no cure for herpes and therefore treatment with acyclovir does not mean that you will be protected from future outbreaks.
Recurrence of blisters varies from person to person. Genital herpes caused by HSV-2 usually returns multiple times a year. A study of 457 patients conducted by the University of Washington found that more than 35% of patients had at least 6 outbreaks of genital blisters in a single year whilst 20% had 10+ outbreaks in a year. Men were more prone to recurring outbreaks than women.
Genital herpes caused by HSV-1 has a much lower recurrence rate of around once per year.
Cold sores appear on average once a year, but you could get them more frequently if your immune system is weak.
Acyclovir for recurrent genital herpes usually provides faster relief. But lesions may still take some time to heal completely.
One study found that a higher dose of 800 mg taken orally 3 times per day for 2 days provided quick relief and lower viral shedding for recurrent genital herpes. This may be a more convenient option for patients than taking the standard dose 5 times a day.
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How Is It Spread
The herpes virus is spread by skin-to-skin contact with a person who has the herpes virus:
- Most often, from herpes sores or blisters
- Less often, from normal looking skin where the virusfirst entered the body
- The herpes virus enters the body through the:
- Lining of the mouth
- Regular skin that has small cracks or cuts
People with a weak immune system can get a herpesinfection more easily. A weak immune system is causedby some diseases and by somemedicines used to treat serious diseases.
People who don’t know they have herpes can still spread the virus to others.
How Is Genital Herpes Diagnosed
HSV nucleic acid amplification tests are the most sensitive and highly specific tests available for diagnosing herpes. However, in some settings viral culture is the only test available. The sensitivity of viral culture can be low, especially among people who have recurrent or healing lesions. Because viral shedding is intermittent, it is possible for someone to have a genital herpes infection even though it was not detected by NAAT or culture. 11
Type-specific virologic tests can be used for diagnosing genital herpes when a person has recurrent symptoms or lesion without a confirmatory NAAT, culture result, or has a partner with genital herpes. Both virologic tests and type-specific serologic tests should be available in clinical settings serving patients with, or at risk for, sexually transmitted infections. 11
Given performance limitations with commercially available type-specific serologic tests , a confirmatory test with a second method should be performed before test interpretation. If confirmatory tests are unavailable, patients should be counseled about the limitations of available testing before serologic testing. Healthcare providers should also be aware that false-positive results occur. In instances of suspected recent acquisition, serologic testing within 12 weeks after acquisition may be associated with false negative test results. 11
Providers are strongly encouraged to look at CDCs STI Treatment Guidelines for further diagnostic considerations.
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Why Are There State
Syphilis, gonorrhea, and chlamydia are notifiable diseases in the United States, but herpes is not. A disease is notifiable if healthcare providers in all 50 states are required by law to report the diagnosis to their state or local health departments. CDC is also notified, and publishes state-by-state data for these infections. Because herpes infections are not notifiable infections by law, CDC is not able to provide state-by-state data. Public health surveillance for herpes infections is mainly done through population-based, national surveys, such as the National Health and Nutrition Examination Survey .
Can I Be Treated To Prevent Genital Herpes Transmission To My Partner
Yes. A large study showed that if one partner has herpes and the other partner is uninfected, treating the infected partner with suppressive therapy can prevent transmission of symptomatic herpes in over 90% of cases. This is an option for couples who are interested in having unprotected sex or who are planning to become pregnant.
If you are entering into a new relationship and are aware that you have herpes simplex infection, you owe it to your partner to notify them before having sex.
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Symptoms Of Genital Herpes
Primary Genital Herpes Outbreak
For people with symptoms, the first outbreak usually occurs in or around the genital area 2 days to 2 weeks after sexual exposure to the virus. The first signs are a tingling sensation in the affected areas and groups of small red bumps that develop into blisters. Over the next 2 to 3 weeks, more blisters can appear and rupture into painful open sores. The lesions eventually dry out, develop a crust, and heal rapidly without leaving a scar. Blisters in moist areas heal more slowly than those in dry areas. The sores may sometimes itch, but itching decreases as they heal.
About 40% of men and 70% of women develop other symptoms during initial outbreaks of genital herpes, such as flu-like discomfort, headache, muscle aches, and fever. Swollen glands may occur in the groin area or neck. Some women may have difficulty urinating and may, occasionally, require a urinary catheter. Women may also experience vaginal discharge.
Recurrent Genital Herpes Outbreak
In general, recurrences are much milder than the initial outbreak. The virus sheds for a much shorter period of time compared to an initial outbreak of 3 weeks. Women may have only minor itching, and the symptoms may be even milder in men.
How Long Before The First Outbreak
If someone has contracted HSV but not yet experienced a herpes outbreak, truthfully theres no 100% accurate way to determine when one will occur. An outbreak can occur within a week of exposure, or years later.
First, consider that everyones body is different, as is their immune system. If a person has a strong immune system, then it can be possible for an outbreak to occur years after contracting the virus.
Whats more, some strains of HSV are more forceful and aggravating than others.
There is what is considered typical, and that is that people often have their first outbreak two weeks after contracting it. But this just isnt reliable, because its equally accepted that people can often have outbreaks after two years.
Thats why so many people will have trouble pinpointing when they got herpes at all. There are varied statistics and possibilities:
Stress is a common trigger for an outbreak.
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Im Pregnant What Do I Need To Know
To get the best care, tell your doctor you have genital herpes, because it could make you more likely to have a miscarriage or give birth too soon.
Its possible to pass along the virus to your baby. For infants, it can be life-threatening. Your doctor can talk to you about how to lower the chances that this will happen.
If you have an outbreak while youre pregnant, your doctor can give you medicine to treat your symptoms and stop them sooner.
Your doctor may give you a drug to prevent an outbreak as your due date gets closer. This is because your baby could get herpes by passing through your birth canal if youre having an outbreak when you go into labor. If thats a possibility, your doctor will most likely want to do a C-section, which is surgery to deliver the baby.
Continued
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How Soon Can You Be Tested
The incubation period for herpes is 2 to 12 days, which means that the best time to get tested for the herpes virus if you havent had an initial outbreak is after 12 days. If youre worried that youve been exposed to herpes but have not yet been diagnosed, here are some steps you can take:
- If youre currently sexually active, stop all sexual activity until you can receive a formal diagnosis.
- Reach out to your doctor and schedule an appointment for once the incubation period is up.
- If youre having an outbreak, you dont have to wait to get tested. Its possible to receive a diagnosis based on the lesions.
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Genital Herpes And Pregnancy
Women with herpes before pregnancy can usually expect to have a healthy baby and a vaginal delivery.
If you have genital herpes during pregnancy, theres a risk your baby could develop a serious illness called neonatal herpes.
This can be fatal, but most babies recover with antiviral treatment.
The risk of your baby getting neonatal herpes is low if you have had genital herpes before.
Its higher if you get genital herpes for the first time in pregnancy.
Herpes Encephalitis And Meningitis
Herpes Encephalitis
Herpes simplex encephalitis is inflammation of the brain caused by either HSV-1 or HSV-2. It is a rare but extremely serious brain disease. Untreated, herpes encephalitis is fatal most of the time. Respiratory arrest can occur within the first 24 to 72 hours. Fortunately, rapid diagnostic tests and treatment with acyclovir have significantly improved survival rates and reduced complication rates. Nearly all who recover have some impairment, ranging from very mild neurological changes to paralysis.
Herpes Meningitis
Herpes simplex meningitis is inflammation of the membranes that line the brain and spinal cord. It is mainly caused by HSV-2. Like encephalitis, meningitis symptoms include headache, fever, stiff neck, vomiting, and sensitivity to light. Fortunately, herpes meningitis usually resolves after about a week without complications, although symptoms can recur.
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How Does Genital Herpes Affect A Pregnant Woman And Her Baby
Neonatal herpes is one of the most serious complications of genital herpes.5,16 Healthcare providers should ask all pregnant women if they have a history of genital herpes.11 Herpes infection can be passed from mother to child during pregnancy or childbirth, or babies may be infected shortly after birth, resulting in a potentially fatal neonatal herpes infection. 17 Infants born to women who acquire genital herpes close to the time of delivery and are shedding virus at delivery are at a much higher risk for developing neonatal herpes, compared with women who have recurrent genital herpes . 16,18-20 Thus, it is important that women avoid contracting herpes during pregnancy. Women should be counseled to abstain from intercourse during the third trimester with partners known to have or suspected of having genital herpes. 5,11
What Are The Signs Of Herpes In Women
Like men, women who have HSV-1 or HSV-2 may have no symptoms or signs of the infection. Some women may only have an initial outbreak and no other recurring symptoms. Others may have chronic recurring outbreaks of the herpes virus, and some women may not have an outbreak for months or even years after they have first been infected.
In the first herpes outbreak, symptoms usually start within 2 weeks of contracting the virus. The initial symptoms may include:
-Headache
-Around the buttocks or thighs
-Inside the cervix or urinary tract
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