Women with herpes experience life-long, intermittently recurring outbreaks. While herpes is not typically life-threatening, pregnant women who have active lesions do run the risk of transmitting the virus to their unborn baby. Women who acquire herpes while pregnant run a 30 to 50 percent risk of transmitting the virus to the baby. This can have devastating consequences to the newborn child. Medical management in pregnancy is aimed at preventing outbreaks and viral shedding to the fetus.
Acyclovir
Acyclovir is a class-C medication, which means that animal studies of this drug have shown adverse effects, but that no studies in pregnant women have been done. Acyclovir requires multiple daily dosing--five times a day--but has been shown to be effective in reducing viral shedding, pain and healing of lesions. This drug has been used safely in pregnant women.
Valacyclovir
Valacyclovir, or Valtrex, is a class-B medication; animal studies have revealed no evidence of harm to the fetus, but no well-controlled studies in pregnant women have been done. This newer medication has been shown to be better absorbed in the system than acylcovir. Because of its better bioavailability, valacyclovir only needs to be taken twice daily. This drug is approved by the FDA for the treatment of initial outbreaks, recurrent disease and suppression of outbreaks.
Famciclovir
Famiciclovir, or Famvir, is another medication that is similar to valacyclovir. It does not require frequent dosing because of its increased bioavailablity, and it's effective in the treatment of primary and recurrent outbreaks, as well as the suppression of the herpes virus.
Cesarean Section
Cesarean section or operative delivery is not a treatment for herpes, but it is indicated in women with active genital lesions because of the potentially severe nature of the disease in the newborn. It is unclear whether maternal antibodies will protect the newborn from acquiring the virus. Pregnant women who experience active herpetic lesions should consult their health care provider immediately.
References
- "Precis: an update in obstetrics and gynecology"; American College of Obstetrics and Gynecology; 2005
- FDA: Use-in-Pregnancy Ratings
- "2006 Compendium of Selected Publications"; American College of Obstetricians and Gynecologists; 2006
