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Suppressive Treatment for Genital Herpes in Pregnancy

Overview

The primary goal of genital herpes management during pregnancy is to prevent infection in the baby. Women with herpes lesions during delivery are at the highest risk of transmitting the infection to their baby. If you tend to have recurrent herpes lesions, your doctor will most likely discuss the risks and benefits of using suppressive treatment toward the end of your pregnancy. Suppressive treatment can help decrease your risk of recurrent lesions and other symptoms. This can reduce your risk of transmitting genital herpes to your baby during delivery.

Suppressive treatment drugs in pregnancy

Your doctor may recommend suppressive therapy during pregnancy to help reduce your number of herpes outbreaks, especially if you have six or more episodes per year. Long-term suppressive therapy can significantly reduce these outbreaks and is likely safe during pregnancy.

Acyclovir (Zovirax) and valacyclovir (Valtrex) are the drugs most commonly used for herpes outbreak suppression and treatment during pregnancy. These drugs help reduce how active the virus is. They also help speed up lesion healing. They may also decrease the chance of active lesions at the time of labor. In turn, this decreases the likelihood of needing a cesarean delivery to avoid virus transmission.

No evidence links acyclovir or valacyclovir to serious side effects in infants born to mothers who took these drugs during pregnancy.

Treatment with these drugs usually starts around the 36th week of pregnancy. It continues through delivery. Both the American College of Obstetricians and Gynecologists and the Centers for Disease Control and Prevention recommend the following dosages during pregnancy:

  • acyclovir: 400-mg doses three times per day
  • valacyclovir: 500-mg doses twice per day

Famciclovir (Famvir) has also been approved for treatment of recurrent genital herpes. Famciclovir is as effective as acyclovir or valacyclovir, but it’s also more expensive. However, there is no data on the use of famciclovir during pregnancy, so this drug is used less often.

Transmission prevention during sex

Genital herpes suppressive treatment can also help reduce your risk of transmitting the infection to new sexual partners. Other steps can help ensure that you don’t infect a sexual partner, as well. For example, genital herpes infection can be transmitted through mouth-to-genital contact in addition to genital-to-genital contact, so you should use a condom or dental dam. This is true even when you have no symptoms.

Most infections of genital herpes are transmitted during periods without symptoms.

When you have an outbreak of symptoms, you should avoid sexual contact altogether. This includes the period before an outbreak when you may be more sensitive to touch in your genital area. The sensitivity is a warning that an outbreak of herpes lesions is about to occur.

Herpes, treatment, and HIV
Genital herpes lesions can make it easier for you to transmit HIV infection. So, suppressive treatment in people who are infected with genital herpes and HIV may help reduce the possibility of transmitting both infections.

Talk to your doctor

You have options for suppressing your genital herpes during pregnancy. There are several benefits of this, including:

  • decreased risk of virus transmission to your baby during delivery
  • possible reduction of the need for cesarean delivery
  • decreased risk of virus transmission to sexual partners

Talk to your doctor to discuss if one of the suppressive drugs may be a good option for you.

Read more: Symptoms, treatment, and prevention of birth-acquired herpes »

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