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Subject: "'Standard Procedure' for suppressive therapy while pregnant - UK"     Previous Topic | Next Topic
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VInspiration
Member since Sep-29-11
3 posts
Sep-29-11, 06:43 AM (CST)
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"'Standard Procedure' for suppressive therapy while pregnant - UK"
 
   LAST EDITED ON Sep-29-11 AT 06:39 PM (CDST)
 
I wonder if anyone can help me. I'm currently 24 weeks pregnant and have had recurrent herpes for 11 years. I have been with a very supportive partner for 5 years, and although outbreaks are on average every 6-8 weeks, it no longer bothers me. I have had courses of Acyclovir from time to time in the past, which is always effective as long as the treatment lasts, but have decided just to live with it.

I really want a natural birth, and would like to avoid a caesarian section at all costs. Despite the theory that pregnant women have a suppressed immune system, I have been lucky, and bizarrely, I have had fewer outbreaks during pregnancy than ever before (only one definite OB since I conceived). However, I would like to minimise the risk of active sores when I go into labour as I would like to have a natural birth without fear of passing herpes on to my baby (I know there is always a minimal risk, but I have read the statistics and the chances are very small).

I've read conflicting advice online. Some sources imply that if there is an active sore, a C-section will always be recommended. Others say that there is minimal risk of passing on to the child, even with an active sore and that a natural birth is still fine. I am from the UK and would like to know which is accurate? My midwife has implied that if there is an active sore at the time of labour, a C-section would be recommended, and I really want to avoid this.

Even if I am allowed to go ahead with a natural birth, regardless of symptomatic herpes, I would obviously rather avoid having an outbreak at the time of labour. Again I have read conflicting information on the recommendation of Acyclovir for the last few weeks of pregnancy.

I can find no contraindications of taking Acyclovir in the last trimester, and although no major study has been completed, according to my own research it has been found to be beneficial.

I would like to take Acyclovir as a preventative measure against outbreaks from week 36 onwards, as this course of action makes a lot of sense to me. I have an appointment with a consultant next week, and have been told that prescribing Acyclovir is not 'standard' in the UK. Can anyone point me in the direction of medical papers that will support my wishes to take suppressive therapy for the last few weeks of pregnancy? I would like to be armed with information when I meet the consultant to support my wishes. I would also like to know if anyone has any experience of whether it is possible or likely to be prescribed Acyclovir from week 36 onwards. Is there anyone from the UK with experience of this?

If I have any say in the matter, I would prefer to take the course and not worry about active lesions while giving birth, giving myself the best possible chance of a natural birth. It seems illogical that such a simple preventative measure with no known adverse effects is not recommended as standard.


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graceadmin
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13334 posts
Sep-29-11, 07:37 AM (CST)
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1. "RE: 'Standard Procedure' for suppressive therapy while pregnant - UK"
In response to message #0
 
If you have an active lesion present, you know you are actively shedding the virus and exposing your baby to it during the birthing process. That is why a c section is recommended with an obvious lesion. It's a crap shoot otherwise if you don't and trust me, you want to protect your baby from hsv2 infection. Yes indeed we have some case studies out there where women with well established hsv2 infections do deliver with obvious lesions but it's not worth taking the risk.

yes, there has been a decent study on the safety of valtrex during the last month of pregnancy specifically. Also lots of other studies on pregnancy and acyclovir/valtrex use that show that it reduces recurrences so you can have a vaginal birth. valtrex and acyclovir are about the same - valtrex is an acyclovir prodrug - you swallow valtrex and your body converts it into acyclovir.

The UK seems to be anti-suppressive therapy most of the time, pregnant or not. Hard to understand with all the research out there on shedding at this point.

http://www.ccjm.org/content/74/3/217.full.pdf

http://www.ncbi.nlm.nih.gov/pubmed/16522412

http://www.ncbi.nlm.nih.gov/pubmed/16816068

there are many more - check out the link at the top to articles too.

grace

The first step in stopping the perceived stigma about genital herpes - is to stop believing in it yourself


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VInspiration
Member since Sep-29-11
3 posts
Sep-29-11, 07:49 AM (CST)
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2. "RE: 'Standard Procedure' for suppressive therapy while pregnant - UK"
In response to message #1
 
   Many thanks for the links.
I will print them out and highlight the relevant parts before visiting the consultant.
I haven't found the UK to be anti suppressive therapy in general, although it isn't exactly easy to get your hands on and the inconvenience of having to get a repeat prescription almost outweighs the advantage of taking it.
(I mostly stopped taking it because H no longer bothers me, and my partner is very understanding. Despite being with him for 5 years now, he has either never contracted it or remained asymptomatic.)
I do agree though, that it seems ridiculous not to recommend such a simple preventative measure when pregnant and facing childbirth. I have a feeling I will have to fight my case if I want to take the medication - which of course I do, in order to protect my baby, so will definitely refer to the articles you recommended and use them to support my case if I need to!


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graceadmin
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13334 posts
Sep-29-11, 08:34 PM (CST)
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3. "RE: 'Standard Procedure' for suppressive therapy while pregnant - UK"
In response to message #2
 
Dr zane brown has done a lot of research on herpes and pregnancy. you can access the abstracts of his articles on pubmed.gov too.

suppressive therapy for the last month of pregnancy helps to reduce lesions but doesn't reduce transmission. thankfully the risk of transmission is less than 1% without any obvious lesions present in general

grace

The first step in stopping the perceived stigma about genital herpes - is to stop believing in it yourself


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VInspiration
Member since Sep-29-11
3 posts
Oct-07-11, 03:55 AM (CST)
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4. "RE: 'Standard Procedure' for suppressive therapy while pregnant - UK"
In response to message #2
 
   I just thought I would update on this for anyone in the UK who finds themself in a similar position.
I had my consultant appointment yesterday and the consultant has agreed to a course of prophylactic acyclovir from week 36 in order to reduce the chances of an active lesion and increase my chances of a natural birth.

It is true that prescribing antivirals for patients with recurrent herpes in pregnancy is not (yet) 'standard practice,' (who knows if it will become so). However, it is also not completely unheard of and a good consultant who is well informed on the subject matter and research up to date should have no problems prescribing it. It's generally agreed that it certainly won't do any harm, and will benefit mother and baby by reducing the risk of an active lesion.

The main difference in procedure between the UK and USA (from what I gather) is that C-section would only be recommended if the mother has contracted herpes while pregnant. If it is a recurrent strain for many years a C-section wouldn't be recommended 'as standard' but could be considered as an elective caesarian on the mother's request.

So if you are British and worried about passing herpes on to your baby, I would recommend speaking to your midwife, who will arrange an appointment to discuss your options. If you would like to go on suppressive thearapy, make your wishes known and this should be agreed.


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graceadmin
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13334 posts
Oct-10-11, 09:48 AM (CST)
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5. "RE: 'Standard Procedure' for suppressive therapy while pregnant - UK"
In response to message #4
 
Glad this appointment went well for you

keep us updated

grace

The first step in stopping the perceived stigma about genital herpes - is to stop believing in it yourself


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