HSV and pregnancy

Len Moaven profpuk at werple.mira.net.au.
Thu Feb 15 21:53:39 EST 1996


In article <mcoon-1502960953010001 at pesto.microbiol.washington.edu>
mcoon at u.washington.edu (upyers) writes:

> 
> > Sorry Halan but you are very very wrong. There is nothing that is
> > absolutely certain in life, but there is no risk to the baby. This
> > lesion is above the mother's eye. Even a recurrent lesion in the
> > genital region in the first trimester is 'relatively' safe. I urge
> > Janice (the mother) not to take oral acyclovir and there is no
> > indication to do anything but the usual stuff like not touching the
> > lesion and autoinoculating yourself (esp the eye). Nucleoside analogues
> > are DNA chain terminators although not yet proven to be teratogenic in
> > humans you have got to remember that this drug has only been used
> > extensively for 10 years.
> > Please folks if you don't know then don't post
> > Len Moaven
> > Senior registrar in virology
> > VIDRL Fairfield Hospital, Australia  
> 
> 
> Len
> It is YOU who are wrong. See Giovanni Maga's post. I include a snip for
> your edification.
> 
> >HSV 1 and HSV 2 neonatal infections are quite rare. These viruses seem not
> >to be able to cause transplacental infections. The reported cases of HSV
> >neonatal infections are mainly due to infection of the newborn during
> >delivery.
> 
> Ms Maga goes on to suggest some reasonable considerations and Janice
> whould be wise to consult with her doctor.
> 
> Frankly, I find it frightening that someone in your position would tell a
> women with an active HSV infection that the risk of transmission to her
> child is zero.
> 
> I stand by my advice to Janice. She should see her doctor to allay her fears.
> 
> -- 
> "The two most common things in the universe are hydrogen and stupidity" Harlan Ellison

Dear Harlan
I am afraid to say that I still stand by unequivically about what I
said. There is no current risk to the fetus fro a herpes lesion above
Janice's eye. I find it terrifying that you can advise this lady that
the baby is at risk. How much angst do you think you can cause by doing
this? There is nothing further this lady can do apart from the normal
common sense things like making sure that she does not autoinoculate
herself (especially her eye) with the virus.

Certainly when the baby is born there is a very very small risk that
the baby could acquire HSV from the mother during the neonatal period.
However (and as I advised Janice by email) she should try and avoid the
baby coming into contact with this area by covering it and washing
hands etc. Evenso the baby will probably be protected by the mothers
passively acquired immunoglobulin. Studies have shown that it is
primary (first time) attacks that affect the mother and then neonates
without any passively acquired antibody. For example, if a mother is
seronegative for HSV and she delivers a baby that comes into contact
with HSV from another member of the family or health care worker within
the first 4 weeks of birth then this can be potentially most dangerous.
Or if the mother has a primary attack of genital herpes at parturition.

The bottom line is that either way Janice's baby is currently at no
risk from HSV and when it is born it is at very very little risk of
acquiring disease. I was most concerned that your (Harlan's) post would
encourage the mother (Janice) to take oral acyclovir (which is
contraindicated in pregnancy except for very severe HSV and VZV
infections since it is potentially teratogenic) and that it would cause
undue anxiety. And also when her baby is born that she will be
terrified of giving HSV to her baby - which would be an awful thing to
happen.

I think it is worthwhile putting this scenario into context and
remembering that over 50% of the adult population is seropositive for
HSV (type 1) and that includes pregnant women. So even if you do not
suffer from cold sores then you are intermittantly excreting HSV at any
given time (if you are seropositive).

Again I whole heartedly stand behind my previous advice and again if
you don't know then don't post

Dr Len Moaven  



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