Following are some resources for pregnant women with herpes. As with any illness during pregnancy, or when trying to become pregnant, you should speak with your doctor. Unfortunately, many doctors don't have time to be "up" on all the latest information, and when it comes to STD's, many family doctors and OB/GYN's are still a little bit judgemental.

The following resources were chosen becaue they offer some good background information on dealing with herpes during pregnancy and chilbirth, and because the way they are written will likely help you to think up questions you want to ask your doctor.

If your doctor doeas not answer questions to your satisfaction, and/or you feel s/he is not taking your concerns seriously, CALL AROUND and find another doctor that WILL answer your questions.

As always, your best safeguard is yourself: Do some reading, find out what's going on, and you'll be better able to tell whether your doctor is "up" on the latest information, or is unfortunately still stuck back in the days before anti-viral treatments bacame available.

International Herpes Management Forum

"The International Herpes Management Forum (IHMF) was established to improve the awareness, understanding, counselling and management of infections caused by herpesviruses. Steered by the IHMF Board of seven international opinion leaders, the IHMF involves international opinion leaders in all aspects of medical management of herpesvirus infections including herpes simplex virus (e.g. genital herpes), varicella zoster virus and cytomegalovirus infections."

The IHMF Board consists of:

• Dr Lawrence Corey is Professor of the Departments of Laboratory Medicine and Microbiology at the University of Washington, Seattle, USA. A well-known figure in the field of antiviral research, Dr Corey has a particular interest in HIV infection and how it influences other sexually transmitted diseases, particularly herpesvirus infections. He is currently involved in research on vaccines for HIV and herpes simplex virus and in studies of aciclovir and valaciclovir for prevention of asymptomatic shedding in genital herpes.
• Professor Paul Griffiths is Professor of Virology and Chairman of the Division of Pathology and Communicable Diseases at the Royal Free Hospital School of Medicine, London, UK. Editor of Reviews in Medical Virology and a member of several editorial boards including the Journal of Medical Virology, Infectious Agents and Disease and Herpes, the journal of the International Herpes Management Forum (IHMF), he is well known for his work on cytomegalovirus and for his co-factor theory, which hypothesizes that herpesviruses may be acting to accelerate the rate of HIV disease.
• Dr Susanne Kroon is a specialist in Dermatology and Venereology at Odense University, Denmark. Her research interests are broad and cover antiviral trials on herpes simplex virus and varicella zoster virus, including trials on pain management and prevention. Since 1982 her research interests have been HIV infection with aspects of epidemiology, prevention and clinical trials; she is now also involved in research on hepatitis B and C. Dr Kroon is involved in many national committees to educate the public about sexually transmitted diseases. She is a member of several international societies including the European Academy of Dermatology and Venereology, the International Union Against Venereal Diseases and Treponematoses and the International AIDS Society.
• Dr Antonio Volpi is a specialist in infectious diseases at the University of Rome, Italy. He has conducted considerable research into the epidemiology, diagnosis and therapy of viral infections in man, but has a particular interest in the natural history of cytomegalovirus infections in the immunocompromised. Dr Volpi is Chairman of the Italian Herpes Management Forum and is on the Editorial Board of Herpes, the journal of the International Herpes Management Forum (IHMF).
• Dr Richard Whitley, a renowned figure in the field of antiviral chemotherapy, holds several academic posts including Professor of Pediatrics, Microbiology and Medicine at the University of Alabama at Birmingham, USA and Loeb Eminent Scholar Chair in Pediatrics. Dr Whitley's broad interests are reflected by his membership of numerous editorial boards and societies. He is a lead researcher in National Institute of Allergy and Infectious Diseases (NIAID) trials of antivirals in neonatal herpes, congenital cytomegalovirus infections and varicella zoster virus infections in immunocompromised hosts, and is currently devoting much of his time to the research of perinatal herpes simplex virus infections.
• Dr Martin Wood is a consultant physician at the Department of Infection and Tropical Medicine at Birmingham Heartlands Hospital and an Honorary Senior Clinical Lecturer in the Department of Infection at the University of Birmingham in the UK. An authority on varicella zoster virus infections, he is a regular contributor on this subject at international conferences. Dr Wood is Editor-in-Chief of the Journal of Antimicrobial Chemotherapy and is a member of several societies including the European Society of Clinical Microbiology and Infectious Diseases, the International Society of Infectious Diseases and the Infectious Diseases Society of America.
• Dr Koichi Yamanishi is a Professor at the Research Institute for Microbial Diseases and at the School of Medicine, Osaka University, Japan. He has conducted research in both Japan and the USA and has been awarded several prizes by Japanese research societies. Dr Yamanishi's field of research covers all of the human herpesviruses but he has a particular interest in the newer members of the family, human herpesvirus types 6, 7 and 8.

Specific links within the site:

• Managing the Pregnant Woman With Genital Herpes: Diagnosis of Genital Herpes
• Acyclovir in Pregnancy Registry
• Epidemiology: HSV Infection and Transmission from Mother to Child
• Laboratory Diagnosis: Diagnosis of the Pregnant Woman and Neonate
• IHMF Recommendations: Managing the Pregnant Woman and Neonate Exposed to HSV
• Managing Neonatal Herpes
• Impact of Neonatal Herpes on the Family

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Kinghorn, GR. "Limiting the spread of genital herpes." Scandinavian Journal of Infectious Diseases - supplementum 100:20-5, 1996.

Forsgren, Marianne and Gunilla Malm. "Herpes Simplex Virus and Pregnancy." Scandinavian Journal of Infectious Diseases - supplementum 100:4-19, 1996.

(Comment: This issue is also titled: Herpes Virus Infections: Proceedings of a meeting held in Stockholm, Sweden 11-12 May 1995.) A few notes on the articles:

Kinghorn's article includes information that health professionals should give to their patients; so this is a good article for patients who have been receiving fewer answers from their medical advisor than they would like. He discusses the fact that while bacterial STD's such as syphilis and gonorrhea (both curable) have become less common, viral STD's such as herpes and genital warts (both incurable) are becoming more common. There is also much clinical information, including speculation on vaccines which may be beyond the understanding of many lay readers, but the rest of the article contains information that they will find helpful.

Forsgren & Malm, as evidenced by the title of their article, have gathered and presented information about women dealing with herpes, specifically pregnant women. Genital herpes can be especially difficult for a pregnant woman because of the possibility of transmitting the virus during vaginal childbirth. The article is both factual and reassuring.)

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Dignan, K and Turnheim, R. "Genital herpes." Professional Nurse. 11(12):801-2, 1996 Sept.

The article's conclusion: "Genital herpes can present major problems for women, mothers and babies. The herpes simplex virus is unpredictable in its recurrence and the lesions present in intimate parts of the body. Patients have to live with inaccurate and sensational media reporting and moral judgements about sexual behaviour. It is the responsibility of nurses to deal with these women sensitively and non-judgementally."

The entire article stresses the need to treat the psychological reaction, as well as the physical symptoms of the virus. The caring attitude, very respectful of women dealing with the virus, is especially refreshing; so many articles are written by doctors more interested in the sores themselves than in the people living with the virus.)

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The following information is from the Viridae website, and is excerpted from a book entitled "The Truth About Herpes" (4th Ed.) written by Dr. Stephen L. Sacks.

Genital Herpes - A Brief Summary

Herpes and Pregnancy - Important Points

• Your DOCTOR SHOULD BE TOLD that you have herpes if you become pregnant.

• There is NO REASON TO AVOID becoming pregnant because of a history of recurrent genital herpes.

• If your partner has herpes, and you think that you do not, avoid all sexual intercourse or oral genital sex during the last 12 weeks of pregnancy. Your physician should examine you during labor as if you had genital herpes, in order to make sure that a sore is not present. Some physicians will want to assess the pregnant woman's risk of acquiring primary infection by doing a Western blot on her.

• Before delivery, if no clinically-evident, active infection is present, a NORMAL DELIVERY can be performed (from the herpes point of view).

• CESAREAN SECTION is a low risk procedure these days and is advisable if one has ACTIVE, clinically-evident lesions during labor. However, careful observation for lesions by the patient and the physician, along with virus cultures, will most often allow a person with genital herpes to have a normal delivery, as long as the herpes is not active at the time.

• Newborn herpes is a very RARE disease, while genital herpes is a very common disease. This is because mothers with recurrent genital herpes, even if active at the time of labor, are protecting their newborn through transfer of ANTI-HERPES ANTIBODY (and other cellular immune factors) which occurs naturally. Generally, virus shedding in recurrences is on the external genitals and is present in fairly low amounts. The overall risk for a mother with recurrent herpes to have an asymptomatic episode of viral shedding on the genital area during the birthing process is no different from other times, ie, about 1-4%.

• Because of immunity and other factors even if viral shedding is present, most babies will not actually get a disease from the mother with recurrent herpes. Therefore, the overall risk for a mother with recurrent herpes to give birth to a baby with neonatal herpes is only about 1 in several thousands, as long as she and her physician are aware of the infection and looking out for active lesions at the time.

• Most babies who get NEONATAL HERPES are born to mothers who are having a true PRIMARY infection during late pregnancy and childbirth - not usually from mothers who are having an asymptomatic external genital recurrences. Because of this, true primary infection during any period of pregnancy can actually pose a serious risk to the fetus. Thus, the pregnancies at greatest risk are where the male partner has herpes (and usually does not know) and where the expectant mother is susceptible to acquiring herpes (has never had it before, ie, is seronegative). If this pregnant woman acquires herpes for the first time during pregnancy, the doctor should be informed, since depending upon the various factors, a treatment may be required and special follow-up may be in order to try to prevent neonatal herpes from occurring. While it is not true that recurrent genital herpes poses no risk for neonatal herpes, the risk is quite low already. Certainly, it remains important to be informed of the existence of herpes and the status of recurrences during labor and delivery, and it remains important to be carefully examined for active lesions during labor and delivery. Except for the examination during labor, however, very aggressive kinds of late pregnancy examinations without symptoms for herpes prevention do not appear to further reduce the already low risk of infection in the baby except in unusual situations or frequent recurrences.

• New studies suggest that it may be possible to use CONTINUOUS ORAL ACYCLOVIR SUPPRESSION to reduce recurrences of genital herpes near term. In this case, a woman with frequent outbreaks will have a greater likelihood of being asymptomatic in labor, thereby avoiding the Cesarean section. Since recent studies suggest that antiviral medications also reduce asymptomatic shedding of herpes, this approach makes a lot of sense. It is not, however, proven and is not yet considered standard medical practice. Acyclovir's safety in pregnancy appears to be very good, but is not yet fully proven. If you and your doctor decide to proceed on this path, you should still be examined for active herpes in labor and a Cesarean section should still be performed if lesions or symptoms are active. The chances of that happening, however, will be reduced. If you have infrequent outbreaks of herpes anyway, taking acyclovir is unlikely to make a difference. There is no set correct dose for acyclovir in this circumstance. My preference is to use 200 mg every four hours (even overnight) to ensure that there is a continuous blood level present. Others are using 400 mg two or three times daily. I would start this 2 to 4 weeks before delivery and continue until the baby is born. Acyclovir should not be used during breast feeding unless there is a very strong medical reason to do so. More studies need to be completed, however, before using any antiviral medication in pregnancy becomes routine general medical practice. While the studies are going on, you will want to weigh the pros and cons with your doctor.

Herpes DOES NOT rule out your chance to have a perfectly normal, healthy pregnancy, and give birth to a healthy baby.

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