[Question #688] How to have a healthy baby if I am a HSV individual?

47 months ago
Hi Dr. HHH,
A brief of my background:
- woman, 32 yo, single, never had abortion, miscarriages, menstrual cycle is normal
- diagnosed with HSV-2 since 2009
- Occasionally take valacyclovir since 2009-now 9 (not every breakouts, but if i think it's quite painful only and i always took it until the breakout over)
- still have breakouts once in a 2/3 months from 2009, usually occurs during my period or around after it
- I've lived in a tropical country where TB is common problem, I do have history of TB when I was a child and have checked about it until dec 2015, doctors said I dont have any TB
- I have a straight medical check up regularly every year, the only thing I have now is pre-diabetic (A1C is 6.1), no history of smoking, contraception, asthma, etc
- tested for HIV, Hepatitis B and C  - all negative
- not too active sexually, but I am very health concern and I have long term partner who is HSV negative
- only history of influenza a couple of times within last 7 years

my questions:
1. Why I still have 5/6 breakouts a year? It's already 7 years and I've read that it should be lesser within years, and yet i still have it although shorter period and less painful. I am aware it relates to menstrual cycle, is it normal? why is that possible?
2. I am planning to have a baby with my partner, what can I do to prevent the breakouts? what can i do if the breakouts happen during pregnancy?
3. I've read about suppresing therapy that consume antiviral everyday with lower dose. is it necessary for my case? Do I need it to prevent any miscarriages or complications during the pregnancy?
4. Is my immune low? Or am I too exhausted from my work because I do have irregular hours of working, is it related?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
47 months ago
1. Why I still have 5/6 breakouts a year? It's already 7 years and I've read that it should be lesser within years, and yet i still have it although shorter period and less painful. I am aware it relates to menstrual cycle, is it normal? why is that possible?
The average number of outbreaks per year is 4-6 so your frequency of recurrences is not unusual.  Yes, most people have fewer recurrences over time but not everyone - some people stay the same and some people even increase the frequency of recurrences.  It is a good thing that your outbreaks are shorter and less painful but it could be that you will stay in this pattern for quite a while.
2. I am planning to have a baby with my partner, what can I do to prevent the breakouts? what can i do if the breakouts happen during pregnancy?
Have you ever taken daily therapy, called suppression?  Many people with the frequency of recurrences like your will take medicine every day to reduce the frequency of outbreaks AND reduce the risk of transmission to a partner (you don't mention his status)
3. I've read about suppresing therapy that consume antiviral everyday with lower dose. is it necessary for my case? Do I need it to prevent any miscarriages or complications during the pregnancy?
oh, well, there you are!  Please see my answer above.  It isn't necessary to take daily therapy to reduce the risk of miscarriage.  I'm not aware of any link between recurrent herpes outbreaks and increased risk of miscarriage.  It is likely that your health care provider will use daily therapy at the end of your pregnancy to reduce the risk of having an outbreak at the time of delivery, requiring a c-section
4. Is my immune low? Or am I too exhausted from my work because I do have irregular hours of working, is it related?
I couldn't say if your immune system is low or you are too tired from work, but I can say that the frequency of your recurrences is not abnormal, but I can certainly see that it is annoying.

Terri
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47 months ago
Hi Terry,

Thanks for the reply. My partner is negative, I mentioned it in my background status. We have this relationship for almost 7 months and never had sexual encounter yet, because I want to make sure it is safe for him and us to try have baby.

Long before,  I did try suppression for 4/5 months with 1x500 mg  valvir (that time I dont have any partner yet, this was in 2010/2011, I think), I've read it somewhere and that is the reason why I know about the suppression therapy, aside that, i've tried to confirm the therapy to a couple of doctors (been to 3 doctors), and they didn't really familiar about daily suppression therapy like my case (I came to Obgyn).

 Aside that, from what I've read , it never mention the period of the suppression therapy, so I stop consuming that time after several months. But i didn't remember the changes of shorter period or lesser frequencies.

Do you think I should resume the suppresion therapy and how long should I take it or maybe any signs that I should aware about it?


Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
47 months ago
I was just wondering if your partner had tested negative by antibody test or just believed himself to be negative - those can be different things.  Sounds like what you are saying is that he did test negative.  So are you saying that when you took suppressive therapy there was no difference in the frequency of recurrences?  That is unusual.  Normally, suppression really reduces the frequency of recurrences.  Whether you want to resume suppression it up to you - it would reduce the risk of transmission to your partner if your are planning to try to get pregnant together.

Terri
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