USPSTF:
Do Not Screen for Genital Herpes [8/5/16] by Veronica
Hackethal, MD - The US Preventive Services Task Force (USPSTF) has
released new recommendations advising against screening for
genital herpes simplex virus (HSV) in asymptomatic adolescents and
adults, including pregnant women.
The report was released August 2 and updates the 2005 USPSTF
recommendations, drawing on "substantial" new evidence about the
accuracy of screening tests for HSV-2 infection and "limited" new
evidence about its harms and benefits.
New
Guidelines for Neonates Exposed to HSV During Delivery
[1/28/13] -
Guidance on
Management of Asymptomatic Neonates Born to Women With Active
Genital Herpes Lesions. [full
text]
Kimberlin DW, Baley J; COMMITTEE ON INFECTIOUS DISEASES; COMMITTEE
ON FETUS AND NEWBORN.
Pediatrics. 2013 Jan 28. [Epub ahead of print]
Herpes simplex virus (HSV) infection of the neonate is uncommon,
but genital herpes infections in adults are very common. Thus,
although treating an infant with neonatal herpes is a relatively
rare occurrence, managing infants potentially exposed to HSV at
the time of delivery occurs more frequently. The risk of
transmitting HSV to an infant during delivery is determined in
part by the mother's previous immunity to HSV. Women with primary
genital HSV infections who are shedding HSV at delivery are 10 to
30 times more likely to transmit the virus to their newborn
infants than are women with recurrent HSV infection who are
shedding virus at delivery. With the availability of commercial
serological tests that reliably can distinguish type-specific HSV
antibodies, it is now possible to determine the type of maternal
infection and, thus, further refine management of infants
delivered to women who have active genital HSV lesions. The
management algorithm presented herein uses both serological and
virological studies to determine the risk of HSV transmission to
the neonate who is delivered to a mother with active herpetic
genital lesions and tailors management accordingly. The algorithm
does not address the approach to asymptomatic neonates delivered
to women with a history of genital herpes but no active lesions at
delivery.
Genital Herpes
and Pregnancy: Preventing Neonatal Transmission (Archived Web
Conference) CME/CE [Medscape registration is free]
Release Date: February 16, 2005; Valid for credit through February
16, 2006
Cesarean Section Appropriate in Women With Active Genital HSV [Medscape registration is free]
"Other risk factors for neonatal HSV were first-episode infection, isolation of HSV from the cervix, HSV-1 vs. HSV-2 isolation, invasive monitoring, delivery before 38 weeks, and maternal age younger than 21 years."
This means that women with a long-standing HSV infection not
cultured from the cervix who carry to term are at lowest risk for
passing on neonatal herpes to their baby, even with an active
lesion. However, it seems clear that suppression therapy is
a big win for women with a history of herpes.
Suspected
cases
of neonatal herpes require prompt treatment
Antiviral treatment curtails virus and enhances normalcy at 1
year.
The
acquisition
of herpes simplex virus during pregnancy.
Brown ZA, Selke S, Zeh J, Kopelman J, Maslow A, Ashley RL, Watts
DH, Berry S, Herd M, Corey L
N Engl J Med 1997 Aug 21;337(8):509-15
The chance of asymptomatic shedding at any one time is about 2%, half of which occurs within 7 days of an outbreak. Young age and recent acquisition of genital herpes were identified as risk factors for asymptomatic shedding of HSV during pregnancy.
Neonates delivered vaginally during a recurrent episode have an
infection risk of only 1% to 4%. So the risk of infection
for an asymptomatic woman is less than 0.02% to 0.08% on average,
and even less than that for older women who did not acquire herpes
recently.
HERPES AND PREGNANCY from herpes.com
A
double-blind, randomized, placebo-controlled trial of acyclovir
in late pregnancy for the reduction of herpes simplex virus
shedding and cesarean delivery.
Watts DH, Brown ZA, Money D, Selke S, Huang ML, Sacks SL, Corey L.
Am J Obstet Gynecol. 2003 Mar;188(3):836-43.
CONCLUSION: Acyclovir significantly reduced, but did not eliminate, herpes simplex virus lesions and detection in late pregnancy.
[See Related
Articles for most recent studies]
Hale, T. (1996) Medications and Mother's Milk, 5th ed.:
Acyclovir (Zovirax)
Approved by the AAP for use in breastfeeding
mothers.....Percutaneous absorption following topical application
indicates poor systemic absorption, with undetectable plasma
levels....Acyclovir levels in breastmilk are reported to be 0.6 to
4.1 times the maternal plasma levels, Maximum ingested dose was
calculated to be 1500 mcg/day assuming 750ml milk intake. This
level produced no overt side effects in one infant. In another
study, doses of 800 mg five times a day produced milk levels from
4.16 to 5.81 mg/L (total infant ingestion per day=0.73 mg/kg/day).
.......Toxicities associated with acyclovir are few and usually
minor.......Acyclovir therapy in neonates is common and produces
few toxicities. Calculated intake by infant would be less than 1
mg/day.
The medication recommended here (zovirax) I need to tell all of
you about. It works ok when taken orally in pill form but not in
the cream form that you rub on a herpes outbreak. I was pretty
shocked about this myself but my son works at a drug co. and this
is the information they got. It was hush, hush like don't tell to
many people ( hah like no one will be looking) but it truly
doesn't work in that form and they keep making lots of money off
of it. So for what it is worth don't use the cream!
I beg to differ. The study that I was in was with the cream only.
I have used the cream and find it works really well. I don't know
what source the pharmacists had but I have been using it for 15
years and think the cream is great.
A
Complete Holistic Treatment Protocol for Herpes Viruses
Our local chiropractor/nutritionist says she's had great results
in her practice using an herb from the Amazon called tayuya.
It will shorten outbreaks from a week to 2-3 days. Many
patients say if they take it at the first tingle it prevents the
outbreak completely. She carries it under the name DermH3.
Our local naturopath recommends:
* acupuncture to increase immunity (working to support remission
with the liver divergent meridian; can also use carrot oil on
Liver DM points)
* tinctures of echinacea, siberian ginseng and reishi mushroom
combined 1-2 droppersful every 2 hours; vitamin C and zinc to
body's tolerance; lots of fluids to flush the system
* frequent topical application of melissa essential oil (it is not
cheap and not so easy to find, but very effective); diluted manuka
or tea tree oil as a less ideal substitute.
* lemon balm (melissa) tea, also chamomile tea, hops,
passionflower, st. john's wort...tension tamer. teas that calm the
nerves. I've heard some people using chamomile tea bags topically
too.
* taking a warm bath in any of the above herbs; also baking soda.
essential oils are good in the bath for calmative and therapeutic
effects.
* abstaining entirely from sugar, chocolate, caffeine, dairy,
alcohol, hot/spicy food, anything processed
* avoiding sex, biking, and other topical irritants and avoiding
all forms of stress which further antagonizes the nervous system
* lots of sleep and rest
take per day:
1-2 tsp camu-camu powder (excellent in smoothies)
2 droppersful cats claw tincture
Topically on area that has breakouts: rub on everyday for 30 or
more seconds:
doTerra Melissa essential oil (diluted: 4 drops in 5 ml
fractionated coconut oil)
Also be sure to use sunscreen on area that has breakouts if the
area is exposed to the sun
Can also add L-Lycine orally.
I would recommend L-lysine 1500mg per day until symptoms are gone
and then maintain 500mg per day.
The CNM who was my preceptor has shared the following guidelines
re herpes with me: 1000 mg lysine every 2 hours plus 1000 mg vit C
on day one of the outbreak, then 1000 mg twice a day till the
sores are gone.
What about weaning from the acyclovir onto a maintenance dose of
Lysine though? I have a friend that gets severe oral herpes that
was pretty chronic with worsening during any stress. She now takes
about 500 mg a day regularly and has had no further outbreaks in
the past two years.
There is an excellent write up in Christine Northrup's book
"Womens Bodies, Womens Wisdom". Lots of alternatives to acyclovir:
1) Garlic - 12 tabs @ outbreak onset then 4 tabs q 4-6 hours; 4
tabs a day for prophylaxis 2) Vitamin C (1000mg) &
Bioflavinoids QD 3) L Lysine 500mg TID.
Antiherpes
virus
activity of extracts from the medicinal plant Geranium
sanguineum L.
Serkedjieva J, Ivancheva S.
J Ethnopharmacol. 1999 Jan;64(1):59-68.
It can therefore be concluded that quantitative proof exists in vivo that H-Away effectively and safely inhibits HSV2 (genital herpes).
Enhancement
of
anti-herpetic activity of antisense phosphorothioate
oligonucleotides 5' end modified with geraniol.
Shoji Y, Ishige H, Tamura N, Iwatani W, Norimatsu M, Shimada J,
Mizushima Y.
J Drug Target. 1998;5(4):261-73.
Conclusion: the anti-viral constituent geraniol in H-Away is able
to penetrate into cell membranes to safely inactivate HSV1 (cold
sores, fever blisters).
Cold
Sore
Relief™ (Formerly Herpilyn®) from Enzymatic Therapy contains lemon
balm leaf extract.
These products contain glycyrrhizinic acid, which has
anti-ulcerous, anti-viral and anti-inflammatory induction,
stopping viral growth (barrier effect).
What happened to the research a few years ago that showed that
infants of women with long term herpes were immune to herpes and
that vaginal birth was safe, period?
Article in the Summer '95 Birth Gazette about the active herpes
mode of delivery debate? It's in Medical Media Watch, on page 35
(Vol 11 No 3).
The US docs vetoed vag births. Here is an article from the Family
Practitioner's Journal:
Physicians Continue to Disagree About
Vaginal Delivery and Herpes
I've met midwives who've done stuff with spray-on bandage
coverings for the lesions. Worked fine.
In addition to the spray-on bandage, I've heard of nail polish
used successfully to cover lesions.
The problem with nail polish/spray on bandage to cover herpes lesion is that there is frequently cervical shed of the virus in addition to the local lesion.