Genital Herpes During Pregnancy
Prevention of neonatal herpes depends both on preventing acquisition of genital herpes during late pregnancy and avoiding exposure of the neonate to herpetic lesions and viral shedding during delivery. Mothers of newborns who acquire neonatal herpes often lack histories of clinically evident genital herpes . The risk for transmission to the neonate from an infected mother is high among women who acquire genital herpes near the time of delivery and low among women with prenatal histories of recurrent herpes or who acquire genital herpes during the first half of pregnancy . Women who acquire HSV in the second half of pregnancy should be managed in consultation with maternal-fetal medicine and infectious disease specialists.
All pregnant women should be asked whether they have a history of genital herpes or genital symptoms concerning for HSV infection. At the onset of labor, all women should be questioned thoroughly about symptoms of genital herpes, including prodromal symptoms , and all women should be examined thoroughly for herpetic lesions. Women without symptoms or signs of genital herpes or its prodrome can deliver vaginally. Although cesarean delivery does not eliminate the risk for HSV transmission to the neonate , women with recurrent genital herpetic lesions at the onset of labor should have a cesarean delivery to reduce the risk for neonatal HSV infection.
Acyclovir 400 mg orally 3 times/dayORValacyclovir 500 mg orally 2 times/day
A Pharmacist Can Help With Cold Sores
A pharmacist can recommend:
- creams to ease pain and irritation
- antiviral creams to speed up healing time
- cold sore patches to protect the skin while it heals
You can buy electronic devices from pharmacies that treat cold sores with light or lasers.
Some people find these helpful, but there have not been many studies to confirm if they work.
If you regularly get cold sores, use antiviral creams as soon as you recognise the early tingling feeling. They do not always work after blisters appear.
Treatment If The Blisters Come Back
Go to a GP or sexual health clinic if you have been diagnosed with genital herpes and need treatment for an outbreak.
Antiviral medicine may help shorten an outbreak by 1 or 2 days if you start taking it as soon as symptoms appear.
But outbreaks usually settle by themselves, so you may not need treatment.
Recurrent outbreaks are usually milder than the first episode of genital herpes.
Over time, outbreaks tend to happen less often and be less severe. Some people never have outbreaks.
Some people who have more than 6 outbreaks in a year may benefit from taking antiviral medicine for 6 to 12 months.
If you still have outbreaks of genital herpes during this time, you may be referred to a specialist.
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When To Get Tested
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How Do You Prevent Genital Herpes
People with genital herpes outbreaks are highly contagious. Anyone with active disease should avoid any sexual contact when sores are present. Even the use of a condom does not prevent the spread of disease because not all sores are covered by the condom.
Although the chance of spreading disease is greatest when sores are present, people who have had genital herpes may always be contagious to some degree, even if they have received medical treatment. The virus can become active and be transmitted to a sexual partner even when the skin appears completely normal. For this reason, safe sex practices should be used between disease outbreaks to lessen the chance of spreading the disease to a sexual partner. There is no vaccine available to prevent genital herpes infection.
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Can Genital Herpes Be Prevented
Practising safe sex is the best way to help prevent genital herpes infection.
It is safest to:
- always use condoms and dental dams, even when there are no sores or blisters present
- avoid sex when there are sores or blisters present you are most infectious at this time
- avoid sex with someone who has any blisters, sores or other symptoms of genital herpes
- avoid oral sex when there is any sign of a cold sore
Genital Herpes Is Spread By Skin
The virus can be spread when someone with HSV has an episode or an outbreak characterised by having a sore, blister, ulcer or skin split . It can also be spread between episodes, when there is no sore, blister, ulcer or skin split present called asymptomatic viral shedding.
During viral shedding the virus is on the skin surface and can be spread through genital skin-to-skin contact, or from the mouth or face to genital skin during contact.
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Warnings For Certain Groups
For people with kidney problems: If you have kidney problems or a history of kidney disease, you may not be able to clear this drug from your body well. This may increase the levels of this drug in your body and cause more side effects.
This medication may also decrease your kidney function. This means your kidney disease may get worse. Your doctor will adjust your dose depending on how well your kidneys are working.
For pregnant women: Acyclovir is a category B pregnancy drug. That means two things:
Talk with your doctor if youre pregnant or planning to become pregnant. This drug should be used only if the potential benefit justifies the potential risk to the fetus.
For women who are breastfeeding: Acyclovir may pass into breast milk and may cause side effects in a child who is breastfed. Talk with your doctor if you breastfeed your baby. You may need to decide whether to stop breastfeeding or stop taking this medication.
For seniors: The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects.
For children: This drug hasnt been studied in children younger than 2 years.
What Is The Treatment For Herpes Simplex
Mild, uncomplicated eruptions of herpes simplex require no treatment. Blisters may be covered if desired, for example with a hydrocolloid patch. Severe infection may require treatment with an antiviral agent.
Antiviral drugs used for herpes simplex and their usual doses are:
- Aciclovir 200 mg 5 times daily for five days
- Valaciclovir 500 mg twice daily for five days
- Famciclovir as a single dose of 3 x 500 mg
In New Zealand, famciclovir is not currently funded by PHARMAC .
Higher doses and/or longer courses of antiviral drugs may be used for immunocompromised patients, eczema herpeticum, or for disseminated herpes simplex.
Topical aciclovir or penciclovir may shorten attacks of recurrent herpes simplex, provided the cream is started early enough.
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What Is Oral Herpes
More than half of American adults have oral herpes. Some estimates say up to 80% of American adults have oral herpes.
Oral herpes is primarily caused by HSV-1, although it is also possible to have an HSV-2 infection around the mouth.
A person with an oral herpes outbreak may first feel itching, burning, or tingling around the mouth, lips, or tongue. Later, cold sores or small blisters may develop in these areas or anywhere on the skin.
Roughly four to six days after these cold sores start leaking, they start healing by forming a crust. Outbreaks of oral herpes can last for two to three weeks, which can be shorter than the two to six weeks of a genital herpes outbreak.
People who develop symptoms of herpes may first experience tingling, itching, or burning, then notice sores or blisters forming around the mouth or genitals.
Symptoms tend to develop 220 days after exposure to the virus.
What Are The Symptoms Of Herpes Simplex
Many people with the infection never experience any herpes symptoms. If you do notice symptoms, youll experience them differently depending on whether youre having your first herpes outbreak or a repeat outbreak. Recurring symptoms are usually milder than the first outbreak. Symptoms dont last as long with later outbreaks. Some people may only have one or two outbreaks during their lifetime. Others may have as many as four or five outbreaks a year.
People who do have herpes symptoms may experience:
- Cold sores around their lips, mouth or tongue. They may look crusty or like fluid-filled blisters.
- Tingling, itching or burning.
- Pain while urinating.
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Do Natural Remedies Help
There are several options that can be tried to ease the pain. A73612 and Donnor52059 suggest dabbing cornstarch directly on the sores. I cant find any scientific studies that have researched this, but I cant see that it would do any harm.
A73612 also recommends squirting water from a bottle over the sores when you pee. This is a time-honoured method that will help to ease the pain.
Yolandayw mentioned taking a simple painkiller such as paracetamol during an outbreak. Feelbroken advised putting Vaseline on the sores. Lidocaine 5%, a local anaesthetic gel that numbs the area, is another option. Some people find it helpful to put on five minutes before passing urine. You need to get it on prescription and it doesnt suit everyone. Some people develop sensitivity to it which makes the symptoms worse.
Yolandayw also advised using ice as a home remedy. Simply wrap the ice in a tea towel and apply for 5-10 minutes. Never put ice directly on the skin as this can cause ice burn. Drinking plenty of water can also be helpful as it reduces the concentration of urine, making it less painful when you have to pee.
D91907 mentioned putting aloe vera gel on the sores. There is some scientific evidence that aloe vera is useful for both genital and oral herpes.
Support Fred Hutch Research
The Jerome Labâs herpes research thus far involves only HSV-1, but the scientists are now working on ways to extend their success to HSV-2. The first step will be to repeat their experiments using HSV-2 in guinea pigs, which, unlike mice, experience natural reactivations of herpes virus infections, just as humans do.
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Can Herpes Be Prevented Or Avoided
The best way to prevent getting herpes is to not have sex with anyone who has the virus. It can be spread even when the person who has it isnt showing any symptoms. If your partner has herpes, there is no way of knowing for sure that you wont get it.
If you are infected, there is no time that is completely safe to have sex and not spread herpes. If you have herpes, you must tell your sex partner. You should avoid having sex if you have any sores. Herpes can spread from one person to another very easily when sores are present.
You should use condoms every time you have sex. They can help reduce the risk of spreading herpes. But its still possible to spread or get herpes if youre using a condom.
Types Of Antiviral Drugs
There are three oral antivirals recommended for the treatment of oral or genital herpes:
| Famvir, 250 mg | Twice daily |
Preventing genital herpes recurrence is important as it reduces the risk of HIV. According to the CDC, having an active genital herpes infection increases the risk of HIV by 200% to 300%.
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When Treatments For Genital Herpes Are Given
- Initial treatment. If you have symptoms such as sores when you’re first diagnosed with genital herpes, your doctor will usually give you a brief course of antiviral therapy to relieve them or prevent them from getting worse. Your doctor may keep you on the drugs longer if the sores don’t heal in that time.
After the first treatment, work with your doctor to come up with the best way to take antiviral therapies. There are two options:
- Intermittent treatment. Your doctor may prescribe an antiviral drug for you to keep on hand in case you have another flare-up this is called intermittent therapy. You can take the pills for two to five days as soon as you notice sores or when you feel an outbreak coming on. Sores will heal and disappear on their own, but taking the drugs can make the symptoms less severe and make them go away faster.
- Suppressive treatment. If you have outbreaks often, you may want to consider taking an antiviral drug every day. Doctors call this suppressive therapy. For someone who has more than six outbreaks a year, suppressive therapy can reduce the number of outbreaks by 70% to 80%. Many people who take the antiviral drugs daily have no outbreaks at all.
There is no set number of outbreaks per year that doctors use to decide when someone should start suppressive therapy. Rather, more important factors are how often the outbreaks happen and if they are severe enough to interfere with your life.
Continued
Management Of Sex Partners
The sex partners of persons who have symptomatic genital herpes can benefit from evaluation and counseling. Symptomatic sex partners should be evaluated and treated in the same manner as patients who have symptomatic genital herpes. Asymptomatic sex partners of patients who have symptomatic genital herpes should be asked about a history of genital symptoms and offered type-specific serologic testing for HSV-2. For partners without genital herpes, no data are available on which to base a recommendation for PEP or PrEP with antiviral medications or that they would prevent acquisition, and this should not be offered to patients as a prevention strategy.
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How Are Genital Herpes Diagnosed
Other STIs, like syphilis, cause similar symptoms. In addition to a physical exam, your healthcare provider will take a fluid sample from the blisters to test for the herpes virus. If your blisters are healed or you dont have blisters, a blood test can check for HSV-2 antibody, a marker that shows you have been exposed to the virus.
Print this Supplement Protocol page and post it somewhere you can easily reference it.
Begin on day one taking all the supplements as noted in the Supplement Protocol.
Also on day one, begin the Hydrogen Peroxide Protocol as follows:
You will need 35% Certified Food Grade Hydrogen Peroxide and pure water.
Use the purest water you can obtain. Make sure the water you use does not contain fluoride.
1. Measure 8 ounces of pure water. Pour approximately 1/2 the water into your 8 oz. spray bottle. Add the recommended number of drops of 35% Food Grade Hydrogen Peroxide . Fill your bottle with the rest of the pure water so it has a total 8 ounces of water. Give the bottle a little shake to mix well.
2. Take a shower and wash the area well with a high quality natural and organic soap. You want to use a high quality soap as you will be applying DMSO cream to the area and it will penetrate the skin taking everything that is on the skin with it.
3. After you have finished showering and washing the area, dry yourself off.
Where to spray the hydrogen peroxide mixture:
5. Blot the area dry with a clean towel.
Transmission Of Genital Herpes
Genital herpes is a sexually transmitted disease spread by skin-to-skin contact. The risk of infection is highest during outbreak periods when there are visible sores and lesions. However, genital herpes can also be transmitted when there are no visible symptoms. Most new cases of genital herpes infection do not cause symptoms, and many people infected with HSV-2 are unaware that they have genital herpes.
To help prevent genital herpes transmission:
- Use a condom for sexual intercourse.
- Use a dental dam for oral sex.
- Limit your number of sexual partners.
- Be aware that nonoxynol-9, the chemical spermicide used in gel and foam contraceptive products and some lubricated condoms, does not protect against STDs.
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Treatment Of An Initial Outbreak
The first outbreak of genital herpes is usually much worse than recurrent outbreaks. Symptoms tend to be more severe and to last longer. Your provider will prescribe one of the three antiviral medications, which you will take for 7 to 10 days. If your symptoms persist, treatment may be extended. An acyclovir ointment may also be prescribed for topical treatment of initial genital herpes.
How Does Herpes Simplex Spread
Herpes spreads through close contact with a person who has the infection. The virus can be found in skin and saliva. If you have herpes simplex, you are most likely to pass the virus to another person when you have sores. But you can infect someone else even if you have no symptoms. Healthcare providers call this asymptomatic viral shedding.
People may get HSV-1 through
- Touching a persons skin near the mouth.
- Sharing food utensils, lip balm or razors.
- If you receive oral sex from someone who has a cold sore, it may spread a herpes infection to your genitals.
People may get HSV-2 through
- Oral sex with someone whos infected.
- Skin-to-skin contact without ejaculation.
- Touching open sores, including while breastfeeding.
- Childbirth by a mother or gestational parent who has an active infection.
You cant get genital herpes from objects like toilet seats. But you could pass genital herpes through shared sex toys.
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