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Taking any kind of medication during pregnancy causes one to pause with apprehension. Weighing the risks of the untreated herpes infection versus the potential effects of the treatment, which is the safest option for your child?

You hear the diagnosis; it’s official, you have genital herpes. You are heartbroken. Your pregnancy has been uncomplicated thus far and you have done your best to make sure that you and your child are healthy, but then you noticed that it started burning when you urinated and small blisters began appearing around your vulva. The doctor continues to talk about treatment options for genital herpes during pregnancy and offers what seems to be a straightforward solution: Valacyclovir. So many questions rush through your mind at this point and the doctor invites you to air them.

Will this cure your herpes?

Unfortunately there is no cure for genital herpes but there is no need to worry. Herpes simplex virus, which is the root cause behind genital herpes, is one of the most common causes of sexually transmitted infections worldwide, with studies demonstrating prevalence in pregnant populations. The HSV-2 subtype is the organism mainly associated with genital herpes and causes outbreaks which result in pain on urination and the formation of painful, red sores in the genital area. Following an outbreak, the virus continues to live in nerves near the spinal cord where it lives for the duration of the host's life. Whenever the host's immune system is weakened, such as during stress or undergoing an illness, the virus can reactivate, replicating rapidly and causing a recurrence, resulting in a new outbreak. [1] These recurrences tend to be shorter than the first outbreak and are less severe in their symptoms. People are able to lead normal lives as long as they take precautions to help limit the spread of the virus and the occurrence of outbreaks.

If it wont cure the genital herpes, then why take it?

The aim behind the treatment is to limit the number of recurrences and diminish the severity of outbreaks of symptoms such as the genital lesions. These sores would increase the risk of spreading the disease to the child during a natural vaginal delivery as herpes spread via skin contact with infected surfaces, which are typically the lesions or even the vaginal secretions. [2] Taking the antiviral treatment late in pregnancy reduces need for a cesarean section among women by reducing the amount of flareups of genital herpes near the delivery date by suppressing the replicative ability of the virus, reducing its numbers. This can permit the mother to undergo a vaginal birth if there are no herpetic lesions present and a lack of early symptoms of genital herpes (itchiness, vulvar discomfort). It is worth nothing that antiviral therapy will not prevent the transmission of HSV to the child in all cases.[3]

What are the risks of herpes to my child?

Infection in a newborn typically affects the eyes and skin, resulting in redness of the eyes and blisters appearing around the mouth. This infection can spread to the tissues surrounding the brain of the child, eventually affecting the brain itself, causing severe neurological damage. More serious infections can involve major organs of the child, including the lungs, liver and kidneys. This can progress to failure of the organs which will lead to the eventual death. [4]

Will this harm my child?

Valacyclovir is a medication that is broken down in the body into a structurally related form of another drug called acyclovir. [5] Acyclovir has been found to be safe to use to treat women in all stages of pregnancy, including those who breastfeed. [6] Data on the exposure of Valacyclovir in pregnant populations is limited, however data from animal trials suggests that it poses a low risk in pregnant women. Acyclovir has been used to treat newborns who are suffering from an HSV infection, and has been shown to be safe and effective in these populations. [7] It is worth noting that antiviral treatment is unable to reverse any damage caused by the HSV infection so delayed treatment can have result in severe disability, such as visual and auditory impairment, learning disabilities, seizures or cerebral palsy, a condition where there is a failure in coordination between the brain and muscles.

Are there other options?

If you test positive for HSV but have never experienced any symptoms, evidence suggests that there is no need to take antiviral therapy. [8] If you are suffering an outbreak of genital herpes during pregnancy, you may be offered to deliver via a cesarean section. While cesarean section does not totally eliminate the risk of transmission, it is recommended for all women to undergo a cesarean section with clear symptoms of genital herpes such the red sores or early signs like itching or pain in the crotch. [9]

Valacyclovir is a safe and useful tool to help suppress outbreaks of genital herpes in the later stages of pregnancy due to the fact that fewer pills have to be taken per day and the quicker availability of the drug throughout the body. [10] Be sure to contact your primary healthcare professional to determine which treatment is best for you.

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