Question:
Hi Everyone -

I've had genital HSV2 for about 6 years. I contracted it from my husband (then boyfriend). We didn't know he had it since his herpes presents in a strange way. A flat sore that looks more like a cut (no clusters). After my first outbreak (high fever and sore) I had a repeat outbreak about 6 weeks later (much less traumatic - no fever). Since then, I've only had prodomal symptoms but never a visible sore. My husband on the other hand has outbreaks very often - especially when he is run down, but sometimes for no explainable reason.

I'm 38w pregnant with twins and have been on suppresive therapy 1000mg of Valtrex for about a month. We had sex yesterday. Before doing it we inspected him closely for an outbreak .. we didn't see anything. He is also taking suppressive therapy now - 500mg/day. Anyway today he has the start of a sore. I'm going to have him inspect me later, but I suspect that he'll see nothing. Should I worry? I was planning on delivering vaginally and really hoping it was going to be soon.
I really want to avoid a c-section. I actually changed dr's around 30 weeks because my previous doctor was so pro c-section (no related at all to my herpes)

Also I was wondering if anti-herpes meds are every given to babies of moms with Herpes even if no symptoms are showing?

Thanks so much,
Stacy

Answer:
To answer the specific question, no. Antivirals are not given to babies automatically, even if the mother does have an active outbreak at delivery. That's especially true if the mom had herpes prior to pregnancy. What some doctors WILL do routinely is surface cultures. This is a totally noninvasive way of testing for exposure by using a cotton swab to culture the eyes and mouth. Results usually take 3-5 days, which sounds like a long wait, but most babies with herpes don't present until at least the 7th day, so finding out at the 3rd-5th day would be really early and good.

As for the risks... Since you had herpes prior to your pregnancy, your risk of transmitting the virus in the absence of an outbreak is less than 1%! On antivirals, the risk is even lower!!! So unless you have symptoms (visual outbreak or prodromal), herpes is not a reason to deliver surgically.

With twins...there are some things I would encourage you to consider. First, the rate of placental failure in twins is much higher after the 38th week, so most doctors want you to deliver by then. That usually means an induction or a c-section if you haven't delivered by then. Induction is always contraindicated with herpes. The longer you carry, the higher the liklihood that an induction/c-section will be necessary. Also, twins are harder to keep on external monitors during delivery. Nearly all twin labors are monitored continuously, partly b/c of the extra risks and partly b/c most twin labors are augmented with pitocin b/c the stretched out uterus doesn't always contract as efficiently as it would with a singleton. Because it can be harder to monitor fetal heart tones externally, internal scalp electrodes are used more frequently with twin deliveries. Internal scalp monitors are also contraindicated with herpes.

All of those things are very personal decisions that you will make with your husband and physician. I really don't think that you'll have any complications as a result of the herpes. I'm glad you found a doctor who would support you in your goal to deliver vaginally! I delivered mine vaginally (obviously!) and while it was a very very complicated pregnancy and delivery, I am very glad that I was able to and I loved the experience of it. Good luck!

Answer:
Thanks hsvmom!