Speaker 1: The information in this podcast is provided for education and
Speaker 1: research information only. It is not a substitute for professional
Speaker 1: health advice.
Speaker 2: Welcome to the Kick your Expert led podcast, helping you
Speaker 2: explore and learn everything about getting pregnant, pregnancy, birth, and
Speaker 2: becoming a parent.
Speaker 1: On the podcast and our online pregnancy program grow My Baby,
Speaker 1: we share my experience of helping more than four thousand
Speaker 1: babies to be born and.
Speaker 2: Our experience of running a women's health clinic and parenting
Speaker 2: for boys.
Speaker 1: We're here to help everyone to feel empowered in pregnancy
Speaker 1: and birth with real life, practical information.
Speaker 2: Welcome everyone. I'm Bridgid Maloney.
Speaker 1: And I'm obstetrician doctor Patrick Maloney.
Speaker 2: And today we've got a topic that I think is common.
Speaker 1: Yep.
Speaker 2: Yeah, people know about herpes, but do they really know
Speaker 2: about herpes in pregnancy.
Speaker 1: Yeah. I think it's really relevant because you know, herpies
Speaker 1: infections can be recurrent and the same person who's struggle
Speaker 1: with a few recurrences of the virus over there teens
Speaker 1: and twenties, one of they might want to be pregnant.
Speaker 1: It does have important manifestations in pregnancy that we need
Speaker 1: to discuss.
Speaker 2: I want to start by asking what is the difference
Speaker 2: between a cold saw and genital herpes.
Speaker 1: We normally use the word cold saw to describe the
Speaker 1: lesions on your lips, right on your face, and they
Speaker 1: are typically caused by subset one of the virus, Herpy's
Speaker 1: simplex virus one, but not always. And then there's the
Speaker 1: genital sorts, which are usually herpy simplest virus two, but
Speaker 1: there's some there's some interactions. Sometimes the facial ones are
Speaker 1: two and the gentle ones are.
Speaker 2: One, and you wouldn't really know the difference unless you've
Speaker 2: got it tested. There's no difference in the legions, No,
Speaker 2: not really no.
Speaker 1: So anyone who's had the herbies cold saw virus on
Speaker 1: their lips knows that it can be recurrent, that they're
Speaker 1: irritating and painful, that they can pop out when you
Speaker 1: run down or overexposed to sun or to me late
Speaker 1: nights or when I was a hospital doctor treating a
Speaker 1: patient in the emergency department who had a really bad
Speaker 1: case of Col's horse and she was telling me about
Speaker 1: how she'd been not looking after herself, to me late
Speaker 1: night's drinking too much, And I said, oh, well, you know,
Speaker 1: should stop that.
Speaker 2: How old were you when you said.
Speaker 1: There, yeah, and I was like an intern and one
Speaker 1: of my mates was listening from the next cubicle in
Speaker 1: Wench went so, you know, they're kind of part of
Speaker 1: life for young people. But for today's purposes, we're really
Speaker 1: talking about the genital lesions and there and their importance
Speaker 1: in pregnancy.
Speaker 2: I want to just tell people about my UNI days.
Speaker 2: And I was just probably like an eighteen year old,
Speaker 2: straight out of home and going to the doctor by
Speaker 2: myself for the first time. Abo's something totally unrelated to
Speaker 2: the cold salt on my lip, and all of a sudden,
Speaker 2: I had this GP talking to me about you do
Speaker 2: realize that you can't be giving oral sex because of
Speaker 2: the colds are on my lip, and I just was
Speaker 2: so embarrassed. I think I just picked up all my
Speaker 2: pieces of paper or whatever and just left.
Speaker 1: If I know that that was going to be mentioned,
Speaker 1: I would not have known. Look, the relevance of the
Speaker 1: facial lesions to pregnancy is really just that if you've
Speaker 1: got one of those when you're at full term and
Speaker 1: the baby coming, the baby's susceptible to the to the
Speaker 1: virus within the first month and can become seriously unwell.
Speaker 1: So the problem with having a facial lesion when the
Speaker 1: baby comes is really shouldn't be kissing the baby, and
Speaker 1: that is you know, sad, yeah, and and upsets people,
Speaker 1: And it can be worth discussion of suppressive therapy laid
Speaker 1: in pregnancy for someone who's had multiple out outbreaks of
Speaker 1: facial herpes to prevent it happening at turn, you know,
Speaker 1: avoiding kissing the baby even though it's even though it's sad,
Speaker 1: it's something we we could also do. The genital allegions
Speaker 1: are more serious because if the baby comes out through
Speaker 1: the gentle tract and picks up herpose from a lesion
Speaker 1: on the volver, it can be very very serious.
Speaker 2: All right, And I do want to get into that
Speaker 2: just to highlight how common this is. The who says
Speaker 2: that about sixty four percent under the age of fifty
Speaker 2: have the HSV virus HSV one virus, and about thirteen
Speaker 2: percent age between fifteen and forty nine have the HSV two.
Speaker 2: So that's that's really common, isn't it yea super common
Speaker 2: and people, as you said, it can have both. So
Speaker 2: tell us why are we nervous about herpes in pregnancy?
Speaker 1: Well, often the legions we're talking about are are recurrent.
Speaker 1: So just as you could be if you've been exposed
Speaker 1: to purpose in the past and had a couple of
Speaker 1: little blisters on the labia and then they went away,
Speaker 1: they tend to come back at times when you are
Speaker 1: run down, overworked, too tired, poor sleep and so forth,
Speaker 1: And a lot of those conditions apply to late pregnancy,
Speaker 1: so a recurrence in advanced pregnancy is a real possibility.
Speaker 1: The thing with herpoes is the diagnosis is often not
Speaker 1: that difficult because they hurt and painful. Genentitle lesions are
Speaker 1: unlike most of the other genitle elections. If it really hurts,
Speaker 1: that needs.
Speaker 2: To be checked for herbs, and it would make someone
Speaker 2: go to the doctor there take.
Speaker 1: A swab and get diagnosis. But you know, if you're
Speaker 1: prone to recurrences and you might get one at term,
Speaker 1: then the danger is that you could have a subtle lesion.
Speaker 1: Baby could get pick up the herbies on the way
Speaker 1: out during the birth process and become seriously unwell.
Speaker 2: And what does seriously unwell mean?
Speaker 1: You know, in a high risk situation, the pedatricians would
Speaker 1: look at things like, you know, babies that were had
Speaker 1: any sign of any serious illness like listless or abnormal
Speaker 1: observations of fevers or an actual rash with blisters.
Speaker 2: Oh wow.
Speaker 1: And you know, the pedatricians do amazing job, because sometimes
Speaker 1: that the sign of a baby becoming significantly unwell as
Speaker 1: something as subtle as poor feeding.
Speaker 2: Yeah right, yeah, and gosh, it could be so many
Speaker 2: different things.
Speaker 1: And you can't ask them. So so this mostly comes
Speaker 1: down to history. This is us saying to the pedatricians,
Speaker 1: this person is at risk.
Speaker 2: Yeah, and is it like CMV the episode that we
Speaker 2: did a few months or weeks ago where the act
Speaker 2: if it's your first time, it's.
Speaker 1: Worse, it's worse. Yeah, definitely. Yeah. Yeah, so you got
Speaker 1: a much higher viral load and much more likely to
Speaker 1: have virenemia the first time around. So that means that
Speaker 1: it's actually virus circulating your whole body in bloodstream. So
Speaker 1: the woman in a primary episode is much more likely
Speaker 1: to have sevige and allegions and be systemically unwell with
Speaker 1: fevers and dehydrated and sick, whereas recurrences are painful and
Speaker 1: irritating but typically confined to the area where the where
Speaker 1: the recurrence is located. Yeah, yep, so, and I think
Speaker 1: the viral load is much higher in a primary episode.
Speaker 1: So the pediatricians are much more concerned with someone with
Speaker 1: the first episode of herpees happening during at the end
Speaker 1: of the pregnancy than they are typically with a recurrence.
Speaker 2: And does that go for like the HSB one, the
Speaker 2: cold soil type.
Speaker 1: I guess so, although that you know, that's much easier
Speaker 1: to manage because you can cover the lesion on the
Speaker 1: on the face and you can avoid kissing the baby,
Speaker 1: and that I think those changes to baby, those interventions
Speaker 1: are typical, whether it's first or whether it's first or
Speaker 1: subsequent YEP infection.
Speaker 2: And also those type conversations that you have with people
Speaker 2: that kiss your baby.
Speaker 1: Yes, well this is one of the reasons why we
Speaker 1: don't why we shouldn't do that. Yeah.
Speaker 2: Yeah, I just can't think of kissing somebody else's baby, Like,
Speaker 2: you know, I've got to that point that I just
Speaker 2: I find it boring, Like I don't want to do
Speaker 2: it as much as my whole body's going, oh my god,
Speaker 2: what a goodout baby.
Speaker 1: Yeah. I just think COVID's done a fear of it
Speaker 1: to recalibrate our tolerance for connection with other people. Yeah,
Speaker 1: I honestly think that I think it's done a bit
Speaker 1: to calibrate it back the other way, you know, away
Speaker 1: from that super close contact with people. Whether it's not strictly.
Speaker 2: Necessary, Yeah no, it's just a boundary that my body
Speaker 2: just recoils from.
Speaker 1: Now.
Speaker 2: Yeah, So paid, let's go on to when when the
Speaker 2: baby's do and someone has an active lesion. What are
Speaker 2: the discussions that they're having with a care team at
Speaker 2: that time about delivery.
Speaker 1: I want to take you back a little bit further
Speaker 1: than that, because the name of the game is to
Speaker 1: prevent the active leasion term. So if we go back,
Speaker 1: if someone's had multiple recurrences across their early life or
Speaker 1: multiple recurrences within that pregnancy, then I would be talking
Speaker 1: to that passion about being on suppressive therapy to dramatically
Speaker 1: reduce the chances of them getting that leasion at term.
Speaker 1: And you can take a drug called a cyclovia and
Speaker 1: antiviral drug that's that's very safe for use in pregnancy.
Speaker 1: It has no known risks in pregnancy, and you have
Speaker 1: to take the pills a lot. There's like wife doses
Speaker 1: a day or something, but it's very effective at reducing
Speaker 1: the activity. And that's that's our best defense against getting
Speaker 1: an episode at term. But if you get an episode
Speaker 1: at term nonetheless, then the baby's better to come by
Speaker 1: since aaron section.
Speaker 2: So is there any way of treating So that's taking
Speaker 2: it just to prophilectically, But is there anything if you've
Speaker 2: actually got an active lesion? Are there other medications that
Speaker 2: you can take?
Speaker 1: Well, you can take pain relief and you can take
Speaker 1: a cycle of it to shorten the hon us. But
Speaker 1: if we're talking at term, yeah, it needs to be
Speaker 1: totally resolved if you're going to be back on track
Speaker 1: for a vaginal.
Speaker 2: Birth, And totally resolved means that there is no lesion presence,
Speaker 2: isn't Yes.
Speaker 1: And even then I'd be getting expert advice if it
Speaker 1: was close to the delivery, because viral shedding from things
Speaker 1: can go on longer than your pew do to have recovered. Yeah,
Speaker 1: And the problem is that an infection in a newborn
Speaker 1: from some of these viruses that they're serious.
Speaker 2: Is it only through delivery that a baby can get
Speaker 2: purpies or can the baby get herpies in utero?
Speaker 1: Yeah, there isn't a utero form. It's not very common,
Speaker 1: but in particular for one's got a primary episode during
Speaker 1: pregnancy and is particularly unwell that there is a possibility
Speaker 1: of baby catching it well during the pregnancy, and like
Speaker 1: some of those other viruses that we can get during pregnancy,
Speaker 1: like rubeller and CMV, they can cause all sorts of
Speaker 1: problems with the developing baby. So there's a thing called
Speaker 1: a torch screen, which is a blood test done during
Speaker 1: a pregnancy if there appears to be a chance that
Speaker 1: a baby might have picked up something during the pregnancy.
Speaker 1: So it looks for antibodies for toxoplasmosis, Rubellas, c MV,
Speaker 1: and herpes. So we would do that test if we
Speaker 1: were investigating a baby that had died in euter or
Speaker 1: was way too small, or had ultrasound evidence for example,
Speaker 1: of abnormal organ development or calcification within in internal organs.
Speaker 1: The things that would show up on an ultrasound and
Speaker 1: the torch screen would be used to see if infection
Speaker 1: was behind that, and occasionally some of those would be
Speaker 1: would be in neutro herpes.
Speaker 2: If someone that you suspect their baby's been affected by
Speaker 2: herpes and in utero, would you send them to, say
Speaker 2: a maternal fetal medicine specialists.
Speaker 1: Yeah, So go to our episode where we discussed maternal
Speaker 1: fiedal medicine services with Professor Joan's fantastic, that's one. That's
Speaker 1: so these are services that give expert advice on these
Speaker 1: rare things.
Speaker 2: Yeah, so absolutely.
Speaker 1: If I if I saw one of my patients and
Speaker 1: baby looked too small and we did an ultrasound and
Speaker 1: that looked like they could have been in utro infection,
Speaker 1: what does this mean? You know? It is my baby
Speaker 1: going to be affected by this? Die? Is my boby
Speaker 1: going to be going to be physical or mentally affected
Speaker 1: by this infection? Where do I get this information? Rare
Speaker 1: thing like that? Be on the phone to Joanne, say,
Speaker 1: here's the situation I need. I need your expert at
Speaker 1: guidance and to be able to appropriately counsel my patient.
Speaker 2: What advice would you give to people that, perhaps in
Speaker 2: a couple, the partner has purpose, Yes, what can they
Speaker 2: be doing to prevent any sort of infection to their baby?
Speaker 1: Yeah? I think that it's different for the partner. Let's
Speaker 1: say we've got a couple with it. There's a male
Speaker 1: partner who's had some my current jentle herpes. The medications
Speaker 1: to be used by a non pregnant person to suppress
Speaker 1: outbreaks are easy to take this one stately dacing and
Speaker 1: so these are very very effective medications that you can
Speaker 1: just take one dose to day forever and have very
Speaker 1: few or no outbreaks. And that's definitely something that somebody
Speaker 1: should be considering if they've had more than about an
Speaker 1: outbreak a year, because they're painful and awkward. So some
Speaker 1: people are just on suppression they never get an attack
Speaker 1: in they fine. If they're not on suppression and they
Speaker 1: get an attack, then obviously I want to avoid intercourse
Speaker 1: until that episode has resolved, because if the partner's never
Speaker 1: been exposed, then they want to be exposed now. So
Speaker 1: that advice would be standard in or out of pregnancy
Speaker 1: to respect the safety of your partner and try and
Speaker 1: avoid the transmission.
Speaker 2: So, Patty, if the baby has unfortunately been diagnosed with
Speaker 2: having purpies at birth, what would the parents expect in
Speaker 2: terms of treatment.
Speaker 1: Yeah, so it's a serious situation and the pediatricians are
Speaker 1: going to be managing this very diligently, and there's a
Speaker 1: list of things that they would look at to work
Speaker 1: out how significant the risk to the baby really was.
Speaker 1: So they need to know whether the whether the mother
Speaker 1: was having a primary or a secondary episode. The primaries
Speaker 1: are obviously worse. Whether the mother had developed mature antibodies
Speaker 1: to the herpes virus herself, whether the baby was born
Speaker 1: snuck out vaginally, or born by a cesarean section, How
Speaker 1: long the membranes were ruptured in labor is highly relevant,
Speaker 1: and also the integrity of the skin. So if the
Speaker 1: baby came out with no damage at all to the
Speaker 1: skin on the head, that's batter because the skin provides
Speaker 1: a barrier to infection. Whereas if we've breached that membranes
Speaker 1: by that integrity, by the use of a fiddle scalpe
Speaker 1: electrode or a vacuum cup with tear on the skin,
Speaker 1: then that's worse. And whether the genital vision on the
Speaker 1: mother was type one or type two, all of those
Speaker 1: things irrelevant in the mind of the neo natologist as
Speaker 1: to how risky the situation is. And then obviously they
Speaker 1: work through protocols and treat the babies with antiviral drugs
Speaker 1: in a low risk situation for a matter of days
Speaker 1: and in a higher situation for months.
Speaker 2: Yeah, and so when you say they have to work
Speaker 2: out whether it's HSB one or two, if they've had
Speaker 2: an active lesion before the actual delivery. Would you be
Speaker 2: taking Would it be routine to take a swab to
Speaker 2: find it?
Speaker 1: Yeah? We ideally we would know that.
Speaker 2: Yeah, to have as much information as possible for that
Speaker 2: woman as she goes in. Okay. Would it be useful
Speaker 2: if I made a little summary of what I've heard
Speaker 2: and can you tell me if I've got it right?
Speaker 1: Sounds good?
Speaker 2: Okay. So, firstly, if you've never had herpes, watch and
Speaker 2: it's your first infection, watch out for like systemic problems
Speaker 2: like body aches and fevers. Yep, to see if it's
Speaker 2: an active because the active one is more of an issue.
Speaker 1: Yes, yep. Good.
Speaker 2: If you have I've had recurrent recurrent herpes, then you
Speaker 2: might talk to your doctor about an anti viral during
Speaker 2: your pregnancy, yes, yep.
Speaker 1: To decrease the chances of you having a lesionate term.
Speaker 2: Yep. Good. If you've got an active general lesion, you
Speaker 2: might be advised to have while you will be advised
Speaker 2: to have a cesarean section. Absolutely good, And prevention is
Speaker 2: key in the first place. So I don't know how
Speaker 2: impregnancy you stop the stress and the diadness and the fatigue, but.
Speaker 1: In my experience, most of people affected by this problem
Speaker 1: I have had a primary episode when they were nineteen
Speaker 1: or something, and they've had a couple of occurrences since then. Yeah,
Speaker 1: and they know what they feel like. They're familiar with
Speaker 1: a little tingling and the pain, and they'll bring it
Speaker 1: to your attention. So take Our message is if you
Speaker 1: think you are getting a recurrence of a gentle herpe
Speaker 1: solusion in advanced pregnancy, bring that to the immediate attention
Speaker 1: of your caregivers.
Speaker 2: Yeah, don't hide herpes. No, that might be the slogan
Speaker 2: don't hide herpes are super important also, and this is
Speaker 2: difficult if you've got a cold, saw, don't kiss the baby. Yeah, yeah,
Speaker 2: be careful when you're like breastfeeding, it's sort of easy
Speaker 2: just to brush your face up against your baby.
Speaker 1: It seems. With newborns, you know, they've just come out
Speaker 1: of sterile environment inside their mother, and they have an
Speaker 1: immune system that works okay for lots of things. They're
Speaker 1: immediately exposed to dirt and god knows what, and you know,
Speaker 1: they cope very well with all of those pathogens that
Speaker 1: they're exposed to in the early days of life. But
Speaker 1: there are a couple of problems. There are things that
Speaker 1: can be that a vaccine preventable, but they don't get
Speaker 1: the vaccines untill later on. I'm thinking hooping cough, for example.
Speaker 1: And then there are things that they're just really bad
Speaker 1: at fighting off GBS in which we've discussed in the past,
Speaker 1: and this family of viruses that can cause overwhelming infections
Speaker 1: and so on.
Speaker 2: The kissing of the baby. You know, sometimes you have
Speaker 2: to have those difficult conversations with your near and dear
Speaker 2: to say, please, don't kiss my baby.
Speaker 1: Yeah, so I think that device we give family members
Speaker 1: to come visit the baby if you've got a cold
Speaker 1: one hundred percent. That also includes if you've got an
Speaker 1: rol abial herpi is lesion on your face.
Speaker 2: And if you like me, I can predict within a
Speaker 2: day if I've got a little bit of sunburn on
Speaker 2: my face, I will get a lesion on my lip.
Speaker 1: Yeah. It seemed to be particularly promoted by sunburn.
Speaker 2: Yeah, so that's another way you can prevent it. All right,
Speaker 2: how did my summary go?
Speaker 1: That's pretty good?
Speaker 2: Ah? Good, okay, all right? Everyone. Well, I hope that
Speaker 2: gives you enough information about herpes. It's such a common virus.
Speaker 2: You know, two thirds of the population has HSV one.
Speaker 2: So I hope they give you enough information that you
Speaker 2: can be the full bottle when it comes to herpes
Speaker 2: in pregnancy.
Speaker 1: Perfect.
Speaker 2: That's it for this week.
Speaker 1: Thanks for listening.
Speaker 2: Everybody, have a fabulous week. By for nour