Herpes
Herpes
Not So Simplex
Herpes simplex used to be just a plain old “cold sore.” In the 1980s it became the dread virus that threw a wet blanket on the fires of the sexual revolution. The herpes hysteria grew because medicine had neither prevention nor cure. Even the admonition “Hey, let’s be careful out there!” didn’t help. The herpes hysteria has diminished because of the more serious threat of AIDS.
The herpes virus is the Greta Garbo of sexually transmitted diseases elusive and mysterious. The true incidence of herpes isn’t known since it’s not reported to public health agencies. Even trying to confirm whether or not you have herpes can be maddening. Let me count the ways.
Blood Test
A blood test only proves exposure to the virus, not whether you’ve had herpes. Most adults will have a positive test that only shows a universal exposure to the virus.
Cultures
The only way to prove the diagnosis of herpes is to use a swab and dab the suspected area and have the specimen tested to see what grows (culture). Problems arise with false positives (the test says you have it but you don’t) because of other viral infections. False negative culture (virus present but doesn’t grow) occurs even if you have lesions but they aren’t “shedding” at the time. It’s also possible to contract the virus and not have it show up as an infection for years. No one knows for sure what triggers the infection. Some marriages have met an untimely and unnecessary end over who gave what to whom. Remember, a clinical diagnosis, where the doctor just looks at the lesion and says “Yep, you’ve got it,” is subject to error. Cultures must be done to be certain.
Contracting herpes creates havoc with both your body and psyche. Common feelings are shame and guilt. You may feel like a sexual leper. Your pregnancy will probably dredge up those old feelings you thought you had worked through, especially the guilt. Now you have your baby and the possible consequences to consider. The facts should reassure you and allow you to enjoy your pregnancy without the gloom and doom.
Just the Facts
One percent of pregnancies are complicated by herpes. The risks to pregnancy differ between the primary infection (your first) and any recurrence. In early pregnancy with a primary infection, there’s a greater risk for miscarriage but not birth deformities. Herpes generally isn’t an indication for terminating pregnancy. In the last 6 weeks of pregnancy, there’s an increased risk for preterm labor and infecting the baby after birth. Recurrences of herpes during pregnancy don’t offer any risk to the baby; very rarely does the virus cross the placenta to the baby. The number of babies who actually become infected with herpes after birth is very small, 1 in 4000 or 5000. Unfortunately, those babies who acquire herpes have a mortality rate of 40 percent. Two-thirds of those who survive have serious neurological problems or eye damage. To help ensure your peace of mind, here are a few simple guidelines to follow:
- If you’ve already been proven as having herpes, no cultures are needed during pregnancy.
- If you haven’t previously had herpes and you discover lesions (sores), you need to be cultured while the virus is still “shedding.” The best time to do a culture is when you feel the tingling or burning right before the outbreak and the first or second day after the outbreak. Make an appointment with your doctor and show him exactly where your suspected lesion is.
- During outbreaks, be sure not to spread the lesions to other parts of your body. Soap and water are good disinfectants. Corn starch on the sores and drying them with your hair dryer work as well as anything.
- There’s but one cardinal rule: The baby and the virus shouldn’t meet. If lesions are present when you go into labor, you’ll most likely have a cesarean.
- If no lesions are detected at the time of labor, you’ll have a vaginal birth.
Delivery Management
When lesions are present at delivery, a cesarean birth is done to try to prevent transmission of the virus to the baby, but there are no guarantees. When there are active lesions and the membranes are ruptured, the role of cesarean is unclear. Some doctors won’t do a cesarean if the water has been broken for more than 4 hours because they feel that the infection has had ample time to travel upward into the uterus. Other doctors prefer to do a cesarean regardless of the length of time the membranes have been ruptured. It’s a tough decision because no one knows for sure which is the best approach.
The Good News
Even if you deliver with active lesions, remember that more than 90 percent of babies don’t become infected. Most babies appear to be protected from infection by the mother’s antibodies.
After delivery, even if you have lesions, the only precaution you need to observe is good hand-washing. Isolation procedures or a private room aren’t necessary. The nursery may insist you room with your baby, depending on their policy. You can breast-feed if you wish.