For a non-pregnant woman with a normal immune system, treatment of recurrent genital herpes is optional depending on the degree of symptoms. But for pregnant women, antiviral medication throughout pregnancy may decrease the risk of recurrent lesions, which will reduce the risk of transmission to the baby. Women with active herpetic lesions during delivery are at the highest risk of transmitting the infection to the baby, so those women will be encouraged to have a cesarean delivery. Hence, if you have a tendency to have recurrent herpes lesions, your doctor will most likely encourage you to have suppressive treatment for herpes throughout your pregnancy.
Treatment for Recurrent Genital Herpes in Pregnancy
Acyclovir (Zovirax) and valacyclovir (Valtrex) are drugs used for genital herpes. These medications help reduce viral activity and accelerate the healing of lesions. However, treatment does not shorten the duration of pain and other symptoms, nor does it delay your next occurrence.
Remember that drug doses vary. Your doctor will determine the correct dosage for you.
In addition to acyclovir and valacyclovir, famciclovir (Famvir) has been approved for treatment of recurrent genital herpes. Just as valacyclovir is converted to acyclovir, famciclovir is converted to penciclovir, which works similarly against the virus. Famciclovir is given in doses of 125 milligrams (mg) or 250 mg, twice daily. It should be taken at the first sign of recurrence and continued for five days. (Famciclovir is as effective as acyclovir or valacyclovir and is more expensive, so is not as frequently used.)
Because medication cannot delay a future infection and because pregnancy often causes additional episodes, your doctor may recommend suppressive therapy during pregnancy, especially if you experience frequent recurrences. Frequent recurrence is usually defined as six or more episodes per year. Long-term suppressive therapy can significantly reduce these recurrences and is safe to use indefinitely. Through the use of long-term suppressive therapy, most patients actually become recurrence-free.
Acyclovir, valacyclovir, and famciclovir are all used for long-term suppressive therapy. However, only valacyclovir shows a dosing schedule advantage (once rather than twice daily) over acyclovir. The table below presents suggested dosing regimens for suppression of recurrent genital herpes.
|Acyclovir||400 mg, twice daily|
|Valacyclovir||500 mg, once daily|
|Famciclovir||250 mg, twice daily|
*Adapted from Edwards RK, Duff P. Herpes simplex virus infections in women. In: Stovall TG, Ling FW (eds.). Gynecology for the Primary Care Physician, 1999. Used with permission from Current Medicine, Inc. Prices given are wholesale (AWP) from the 1998 Drug Topics Red Book.
Preventive Medication for Childbirth
Suppressive therapy with acyclovir (Zovirax) or valacyclovir (Valtrex) may decrease the chance of active lesions at the time of labor and the likelihood of cesarean delivery. For women with recurrent genital herpes, the suggested dose of acyclovir is 400 mg, three times daily, starting around the 36th week of pregnancy.
Is There Any Danger to the Baby?
There is no evidence linking acyclovir, valacyclovir, or famciclovir (Famvir) to serious side effects in infants born to mothers who take this drug during pregnancy.
For those with HSV and HIV, the presence of herpes genital lesions facilitates the transmission of HIV. Additionally, concurrent infection with HIV and HSV causes both viruses to multiply rapidly. For this reason, routine suppressive therapy for HSV infection in all HIV-infected patients may be helpful to prevent the more frequent recurrences.
Vaccines hold promise for the future-for preventing initial infections, and for improving immune system response in those already infected. To date, however, no vaccines have been developed that are effective for either situation. Although experimental vaccines can boost immune response, they cannot prevent primary infections or suppress recurrent infections.
Preventive Treatment to Reduce Sexual Transmission of HSV
In addition to decreasing your susceptibility to recurrent episodes, suppressive therapy will also help reduce your risk of transmitting the infection to new sexual partners. About 70% of HSV-2 infections are transmitted during periods of asymptomatic viral shedding (the virus is active even though you have no symptoms).
To prevent transmitting the infection, you should use a condom even when you are not experiencing herpetic lesions or other symptoms. You should also take into account that infection can be transmitted through oral-genital contact. Sexual contact without protection should be avoided altogether during periods of recurrence, including the prodromal period-when you may be more sensitive to touch in the genital area, a warning of an imminent outbreak of blisters.