Question on asymptomatic shedding and vaginal delivery

[Palomita]

Hi

I have had HSV-1 genitally for about 5 years. I am 31 weeks pregnant and trying to figure out if my particular case of herpes gives me any reason to more heavily consider a c-section.

I do not have visible outbreaks but know that I do shed asymptomatically because I gave it to my husband about 6 months ago. I used to have o/b's but they kind of went behind the scenes I guess. Even without passing it to hubby I know that people generally shed the virus about 6-10% of the time.

What I hear is that the way they determine whether or not to do a c-section is primarily by visual examination to check for lesions. Since I cannot rely on that (since I don't get them) but know that I shed, should I risk delivering vaginally? I do intend to go on suppressive therapy if I choose this route.

Thanks for taking the time to read this, and I appreciate any input anyone has.

[hsvmom]

If it were me, I would deliver vaginally as long as I didn't have any symptoms.

Your baby already has your hsv antibodies, so s/he is already well-protected and the antivirals will make asymptomatic shedding very unlikely. In the absence of symtpoms, visible or prodromal, in a mother with recurrent herpes, the risk of transmission is just under 1% even without antivirals. So with suppressive therapy lowering the risk even further, you can see how low your risk truely is. A c-section is major abdominal surgery and poses a much higher rate of serious risks to both mom and baby than herpes does in your situation.

How did your husband's doctor determine that his herpes infection was recent? I ask because unless your doctor determined it was a primary infection, it's quite possible that he had it for a long time as well and didn't have outbreaks. I have hsv-1 and I don't have outbreaks, but the docs said my bloodwork shows that my primary infection happened within weeks of my delivery and that is why my boys were infected.

If you don't have any symptoms, are on meds, and your doctor suggests a vaginal delivery then I would encourage you to go with the vaginal delivery.

Good luck!

[Delilah]

I'm curious about you giving it to your husband. Just because I've had hsv1 genitally for going on 5 years and haven't givin it to my husband. I was told since I contracted it from a coldsore on his lip the chances of him getting it genitally is slim to nowt because he's already got the antibodies for it from having it orally all his life. How long had your husband been exposed to your hsv before he contracted it..etc. I am just trying to guess as best I can what the chances of my husband not contracting it are...despite what I've been told I still wonder.

Don't they swab you before delivery to make sure you arent shedding?

I've had 2 c-sections and they aren't that big of a deal. Best thing to do is talk to your doctor and see what they recommend.

Your baby already has your hsv antibodies, so s/he is already well-protected

I personally wouldn't trust that. If it were 100% true babies being born with hsv wouldn't be an issue because it would never happen. Babies get antibodies from the mother, clearly, but if they got hsv antibodies how is it that so many people, every day, contract herpes? Also if that were true most of the population would already be born with antibodies for one or both types of herpes, do to the parents having them, and NOT be contracting it later on in life. Either that OR having antibodies for hsv makes no difference when it comes to contracting or not contracting herpes. I'm not trying to argue with you I'm just questioning how much of a place antibodies really have when it comes to contracting especially when it comes to something as fragile as a newborn.

Just a thought.

Good luck

[hsvmom]

Don't they swab you before delivery to make sure you arent shedding?

No, cultures aren't routinely done before delivery. Studies show that culture results do not correlate with shedding at delivery, meaning it doesn't predict the risk of shedding or transmission. Some docs might still do it I guess, but you should know that the results are not very useful.

As for antibodies...yes, this plays a HUGE role in the risk of transmission of herpes, which is the predominant reason that the risk is so low for mothers with recurrent infection and the reason that 80% of infected babies are born to mothers exposed within weeks of delivery. I do understand what you are saying, but it works a bit differently.

Babies get antibodies from the mother, clearly, but if they got hsv antibodies how is it that so many people, every day, contract herpes? Also if that were true most of the population would already be born with antibodies for one or both types of herpes, do to the parents having them, and NOT be contracting it later on in life.

Newborn antibodies are not permanent. They are designed to temporarily protect the baby until its immune system is mature enough to take over. Breastfeeding increases this protection significantly. So, babies born with hsv antibodies will not be permanently protected, which is why so many people still contract herpes later.

You might understand it better if you consider it in terms of vaccinations: vaccines provide protection by exposing the body to weakened or dead pathogens. The body responds by creating the protective antibodies. So if you were vaccinated as a child, and it's likely you were, then you are protected from diseases such as polio, measles, mumps, rubella, etc and now children are even vaccinated for hepatits B and chicken pox. When you have a child, your baby will be protected from those same diseases by the antibodies your body shares with him/her, temporarily or for as long as you breastfeed. After that, your child needs his/her own vaccinations to have continued immunity. If we could keep the antibodies we're born with, then we would have no need for childhood vaccinations. Does that help explain it any?

I know you aren't trying to argue with me, but antibodies actually play the biggest role in protecting an infant against infection. It's the reason that mothers with recurrent herpes only have a 5% risk of transmission even WITH an active lesion at the time of delivery, which is determined by studying the outcomes of babies born to mothers with overlooked symptoms at the time of delivery. In mothers who contracted the virus late in pregnancy and have not seroconverted yet (their blood test will still be negative), the risk of transmission with symptoms is 50% and in mothers who are seropositive but contracted herpes during the last trimester, the risk is around 30% in a delivery with symptoms.

I apologize if this all sounds Know-It-All-ish, but since I already have two boys infected during delivery, it is something I have learned a LOT about. One of the doctors who helped treat my boys is a leader in this area of medicine and him and his team were gracious enough to answer all these questions for us while treating my guys and even several since then.

oh...and the reason I said the baby already has antibodies is because it is generally accepted that sufficient antibodies are passed by the 28th week.

HTH

[Delilah]

Yeah that clears alot of my questions up. I wasnt aware that babies lose the antibodies after time, which explains alot. I was 6 mos preg with our second son when I contracted hsv from my husbands lip lesion. I was very scared that I would somehow pass it onto the baby, even though I was having a c-section. You know how your mind worries. First month everytime he cried and wouldn't stop, like babies do sometimes, I inspected his little body terrified I was gonna find a lesion.

And no, you don't sound knowitallish, it's good that there are people here that know enough to help explain things to others that need the support and the knowledge, because we all know alot of the doctors out there are very little help when it comes to this subject.

[SpecialGuest1234]

Hi

I have had HSV-1 genitally for about 5 years.

Just to be clear ~ how were you tested and were you type tested at the time?

I am 31 weeks pregnant and trying to figure out if my particular case of herpes gives me any reason to more heavily consider a c-section.

An excellent resource to have handy online is the free herpes handbook over on www.westoverheights.com ~ There is a pregnancy section that you will not want to miss.

I do not have visible outbreaks but know that I do shed asymptomatically because I gave it to my husband about 6 months ago.

Share the story on that with a little more detail. How was your hubby tested and was it type specific?

I used to have o/b's but they kind of went behind the scenes I guess. Even without passing it to hubby I know that people generally shed the virus about 6-10% of the time.

What I hear is that the way they determine whether or not to do a c-section is primarily by visual examination to check for lesions. Since I cannot rely on that (since I don't get them) but know that I shed, should I risk delivering vaginally? I do intend to go on suppressive therapy if I choose this route.

People with genital herpes type-1 tend to shed the virus less than those with genital herpes type-2. Also, it's pretty difficult to pass genital herpes type-1 to a partner's genitals although not impossible which is why I ask about the specifics surrounding you and hubby's herpes testing.

For the record ~ a woman that has had herpes prior to conceiving doesn't have to have a c-section and I'm not sure why many assume that you do.

I'm currently 26 weeks pregnant (due at the end of November) and planning on starting supressive therapy with Valtrex in the middle of October.

Keep in mind that I have a 1 1/2 year old and did the same thing with her.. suppressive therapy 6 weeks before the due date, a vaginal delivery, and she is healthy as a horse!

Thanks for taking the time to read this, and I appreciate any input anyone has.

Glad I can help ~

Angela

[SpecialGuest1234]

I personally wouldn't trust that. If it were 100% true babies being born with hsv wouldn't be an issue because it would never happen.

Actually ~ Mom's that have herpes prior to getting pregnant do share all of their antibodies with their unborn babies. It's the Mom's that contract herpes during the last trimester for the 1st time that need to be careful. Also, it's the Mom's that contract herpes for the 1st time during the last trimester and the doctors have no idea OR the Mom that wind up having problems. Then there wouldn't be enough antibodies to share with the unborn baby.

What HSV Mom said was correct. I am 26 weeks pregnant and am confident that I am sharing my antibodies with my unborn baby and will continue to share those antibodies if I should choose to breast feed.

Babies get antibodies from the mother, clearly, but if they got hsv antibodies how is it that so many people, every day, contract herpes?

After a time ~ those antibodies are lost depending on if Mom decides to breast feed or not. Antibodies are no longer shared once the baby is born OR if breast feeding is stopped.

Also if that were true most of the population would already be born with antibodies for one or both types of herpes, do to the parents having them, and NOT be contracting it later on in life. Either that OR having antibodies for hsv makes no difference when it comes to contracting or not contracting herpes.

In this case I think you are just a tad bit confused about how the antibodies work between hsv+ Mom and the unborn baby.

I'm not trying to argue with you I'm just questioning how much of a place antibodies really have when it comes to contracting especially when it comes to something as fragile as a newborn.

Shared antibodies play a huge role in keeping the unborn baby safe and healthy.

Hope this helps,

Angela

[SpecialGuest1234]

You know ~ I see that hsvmom did a GREAT job explaining this stuff to you guys.

Kudos!

Angela

[hsvmom]

You know how your mind worries. First month everytime he cried and wouldn't stop, like babies do sometimes, I inspected his little body terrified I was gonna find a lesion.

Oh boy do I know how a mommy's mind can worry! My oldest twin developed herpes encephalitis, which means it infected his brain and spinal cord. The prognosis was horrifying, but he recovered absolutely perfectly! Honestly, you would NEVER ever look at him play and think he had survived something so awful. It's amazing. BUT, until he was 6 months corrected age, he was at a high risk of the encephalitis recurring if he had an outbreak, and studies say that babies will invariably experience at least one recurrent outbreak during the first 6mo. I checked all 7 pounds of his teeny tiny body every morning and every night when we brought him home again. I knew every single spec of him! Now, though, they are almost 11 mo old and so I finally can relax and not worry about recurrence. So like I said...I KNOW how our minds can worry us sometimes!

[Palomita]

Thanks!

Wow, thanks for your great responses. hsvmom, what an ordeal you and your boys have been through! So happy that they are doing well today. Thanks for sharing the knowledge you came by in the process.

Delilah and Yoshi, here's a little more info on my husband's HSV. We had been together sexually only about 7 months when he had a terrible outbreak that I looked at and judged as primary. He tried to downplay it (he knew how horrified I'd be if I thought I'd given it to him) and say it was probably just a rash from staying in his swim trunks too long. But when he showed it to me I knew exactly what it was. I asked him if he had ever experienced anything like this and reluctantly he said "no". I cried and cried and have never felt so low.

Honestly, I was really surprised that I passed it to him because from what I read, most people by his age (50) carry antibodies to HSV-1. Even if the antibodies are from a prior oral infection, they help protect from the genital variety, I thought. Delilah, my guess is that he did not carry the antibodies at all, for either oral or genital herpes. It would have been very smart to have had him tested first so that we could know this for sure. It would be interesting to know if he had carried the antibodies and still acquired a second version genitally.

No, we did not have him tested to determine if it was HSV-1 or even a primary outbreak. I ran it by my Dr. and she too was dubious as to whether it was me who gave it to him or perhaps someone in the past. But when I described the way it manifested and that he'd never had anything like it (also that I had, I confess been feeling a little off when we'd had sex recently, but no ob)...she acquiesced that it was probably me passing it to him.

Oh, and on my having it for about 5 years and my acquisition of it, I believe I got it from oral sex. I had a horrible outbreak that was swabbed and confirmed to be herpes, though they neglected to tell me then which type. A while later I saw the guy that I had been with then and he had a big cold sore on his lip. He didn't say anything about it (that he was embarassed, that this was a new thing), so I figure he just got them from time to time and had given it to me. I know, more conjecture. I later had a type specific blood test done that detected only HSV-1, not HSV-2.

So that's how it happened. Luckily, my husband has not had an ob since that first one. He takes things in stride very easily and does not seem to be fundamentally altered by this, as I felt I was when I got it. And luckily for our relationship, I was up front about the risks in the beginning.

Thanks so much for the facts and personal experiences regarding pregnancy and transmission. hsvmom, I had read some of your prior posts and knew your boys had acquired it, and am relieved to learn that this was due to a late pregnancy acquisition of the virus. Yoshi, so nice to hear a personal story about a successful vaginal delivery w/ suppression therapy to back up the statistics I read. Congrats on your little girl and best wishes on your pregnancy!

On a side note, I got a swab culture done two weeks ago at a prenatal visit and it came back negative for HSV. I thought I might do three swabs about 2-3 weeks apart as delivery approached just to see if I was shedding, and if so how often. I know this is not conclusive and no indication of whether I'll be shedding at time of delivery, but I was determined to find out anyway. The Kaiser dr's so hate this idea that I may not in fact be able to talk them into the next 2 swabs. They say just pick a route (vaginal or c-section) and stick with it. Easy to say when you're not the anxious mommy.

I am heading for a vaginal delivery, I think, going on suppression at 36 weeks as the dr's recommend. Or is earlier better? Hmmm... another thing to worry about

Best wishes and thanks again! - Palomita

[hsvmom]

Yoshi will know better than I, but I believe 36wks is pretty standard in terms of beginning the suppressants. If I take antivirals for my next pregnancy, my doc will start me at 28wks, but that's because of my previous history with preterm labor and premature delivery. If it weren't for that, then I would be comfortable with 36wks.

I'm glad you realize that my acquisition late in pregnancy was the key in transmitting to my sons. Sometimes I am hesitant to post because I don't want moms to worry unecessarily by seeing those who have transmitted it, know what I mean? We were incredibly lucky to have Dr. Stanberry on our boys' team of physicians, and he is one of the leaders in genital and neonatal herpes, so we were able to learn everything we needed to know and then some about what we were experiencing.

I'm not surprised your docs aren't interested in the cultures. They just aren't useful. Don't worry if they refuse to do the cultures. I'm glad you are heading for a vaginal delivery and hope you get to experience that. Good luck!

[SpecialGuest1234]

Re: Thanks!

Honestly' date=' I was really surprised that I passed it to him because from what I read, most people by his age (50) carry antibodies to HSV-1. Even if the antibodies are from a prior oral infection, they help protect from the genital variety, I thought.[/quote']

Actually ~ type-1 antibodies are not likey going to give you a lot of added protection against type-2. Having type-2 will give you a lot more protection and you also have to remember that it's possible for people to have both type-1 and type-2.

It's not likely he would have type-2 and contract a different strain of type-2 either. In fact.. that's not common at all.

So was there ever a culture done on your husband to determine for sure if it was indeed a herpes outbreak?

Thanks! I'll be sure and let ya'll know how things go when I give birth to this new little one in November.

I'm due at the end of November and plan on starting my suppressive therapy around the middle of October. When does your doc say you should start suppressive therapy?

Try not to worry so much ~ this is supposed to be an exciting time in your life. Concentrate on getting things ready to bring that precious baby home!

Keep us posted,

Angela

[SpecialGuest1234]

Yoshi will know better than I' date=' but I believe 36wks is pretty standard in terms of beginning the suppressants. If I take antivirals for my next pregnancy, my doc will start me at 28wks, but that's because of my previous history with preterm labor and premature delivery. If it weren't for that, then I would be comfortable with 36wks.[/quote']

I think starting around 34 to 36 weeks is probably standard. I'd have to go back and re-read the herpes handbook over on www.westoverheights.com to see what Terri Warren recommends.

*Big~Hugs*

Angela

[hsvmom]

Re: Thanks!

I thought she has hsv1, not type 2. Am I reading something wrong?

[SpecialGuest1234]

Re: Thanks!

I thought she has hsv1' date=' not type 2. Am I reading something wrong?[/quote']

Oh I have no idea ~ I'm just speaking about herpes simplex virus in general.

Angela

[Palomita]

Yep, I have only HSV-1, as determined by type-specific blood test. (The fact that it was HSV was determined by swab of initial o/b, but they didn't tell me which kind). We have never tested my husband to even see if it was herpes. I just looked at it and said "that's herpes". I was so guilt-ridden I didn't think of ALL the possibilities, including the outside chance of this being a potential HSV-2 o/b not related to me but which could potentially endanger my pregnancy should I contract it. But he had been celebate for years before I came along and it just didn't seem likely that it was anything but me passing mine to him.

I would love to hear how your delivery goes, SpecialUser1234, and I will be sure to post my story too when I deliver in October or early November.

I can't tell you how reassuring and informative this exchange has been for me, thanks again to all of you! - Palomita

[raycar]

i just created this post that may offer you some advice

http://www.herpes-coldsores.com/messageforum/viewtopic.php?t=3458&highlight=brain

[Palomita]

...and here she is!

I just wanted to post that I had my baby girl on October 19th (just 5 days early). I had a vaginal delivery. In fact I delivered at home! Everything went really well and she is doing splendidly. I admit that the joy of her arrival was shaded with doubt and fear in the days that ensued, as I examined every inch of her body, looking for anything that looked remotely herpetic. But all is well and she is doing GREAT! Thanks again for the great information and support. The level of knowledge and attention to detail on this board is very impressive. Happy New Year!

[hsvmom]

CONGRATULATIONS!!! She's beautiful!

[ouch]

WHAT A BEAUTIFUL LITTLE GIRL! Congratulations lady! She is just a doll!

[Palomita]

Thanks! She is the light of our life and is growing SO fast! I can't believe she's already 5 months old!