Hi,

Thank you for the query. It is a good question you have asked. Following are my comments:

Around 2% of women acquire herpes in pregnancy. It is more common in women with decreased immunity.

Studies recommend elective c.section to prevent transmission of HSV to child if the lesions are in genital area and administration of antiviral drugs to newborn baby.
VALTREX (valacyclovir hydrochloride) is pregnancy category B drug. Meaning there are no well contolled studies in pregnancy. From available literature in prospective trial from 749 women taking VALTREX, it is seen that the congenital malformations are same as in population not taking antiviral medications. there are no additional risks involved. Valtrex is associated with renal failure & nervous system problems in some women.

Hence right now there may not be necessity to take the VALTREX since you have non genital herpes and planning to go for C.Section. Since potential complications of HSV outweigh risks of benefit with treatment it is not necessary to take medication now.

Antiviral medications can be started to newborn baby prophylactically after the child birth. Hence dont worry about neonatal herpes & respiratory papillomatosis.Your baby is unlikely to catch these infections by placental route.

Please accept m answer if no further queries.

Regards,

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Hi,
I understand your concerns about transmission through placenta. You should be happy that it is "ANTIBODIES" that cross placenta and protect your baby. Antibodies are the ones which fight against herpes infection to baby.

An estimated 20-25% of pregnant women in U.S are likely to have genital herpes (Many of them go unreported), while less than 0.1% of babies contract an infection. "Neonatal herpes is a remarkably rare event"

Fortunately, babies of mothers with long-standing herpes infections have a natural protection against the virus. Herpes antibodies in the mother's blood cross the placenta to the fetus. These antibodies help protect the baby from acquiring infection during birth, even if there is some virus in the birth canal. That's the major reason that mothers with recurrent genital herpes rarely transmit herpes to their babies during delivery. Even women who acquire genital herpes during the first two trimesters of pregnancy are usually able to supply sufficient antibody to help protect the fetus.

Transmission rates are lowest for women who acquire herpes before pregnancy -- one study (Randolph, JAMA, 1993) placing the risk at about 0.04% for such women who have no signs or symptoms of an outbreak at delivery. The chances of transmission are highest when a woman acquires genital herpes late in pregnancy.

Babies born prematurely may be at a slightly increased risk, however, even if the mother has a long-standing infection. This is because the transfer of maternal antibodies to the fetus begins at about 28 weeks of pregnancy and continues until birth. "Babies delivered at term should be protected by antibodies.

At the same time, babies delivered vaginally, even in the presence of active lesions have an infection rate of only 0.25%-5%. About 5%-8% of babies who contract neonatal herpes are infected after birth, often when they are kissed - by an adult who has an active infection of oral herpes (cold sores).

I hope I answered your query with substantial scientific evidence. I don’t think you need to take VALTREX. Since you already have the infection from some time back, you would have sufficient antibodies to protect your child. All you need is a close monitoring from a fetal medicine specialist.

If you have no more queries please accept my answer.

Regards,
Dr.Mahesh

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