Herpes during pregnancy: what you need to know about this disease?

Herpes simplex virus (HSV) - by virtue of its features - is present in the human body, and its carriers are practically all of humanity. Experts argue that, in itself, the carrier of the herpes virus does not represent a danger, and it is impossible to "cure" of it ...

In some people, herpes sores are repeated often, others - very rarely or never in life. Herpes virus during pregnancy manifests its presence in the body much more actively, which can negatively affect the process of bearing a child and even disrupt the normal development of the fetus.

Why is our immune system unable to completely get rid of the herpes virus? Because it is not just a parasitic nucleoprotein organism, capable of living only in the cells of the human body. It is a neurotropic parasite that "hides" not somewhere, but in cells of the body of neurons (neuronal ganglia), integrating its DNA into their protein structure.

Herpes virus during pregnancy (however, and not during the "interesting situation", too) at any immunity stress during hypothermia, cold, flu or stress is activated and through the processes of the nerve cell (axons) it makes its way to the skin and mucous membranes, where the rashes appear .

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Causes of cold sores during pregnancy

As is known, the immune system reduces its ability to protect a person for many reasons, for example, due to lack of vitamins, poor ecology, chronic infection.

But in pregnant women, immunity is reduced at the cellular level for a special physiological reason: hormonal changes in the body occur with an increase in the production of those hormones that suppress rejection reactions, creating favorable conditions for the development of a new life in the womb of a future mother.

And it is this period that "uses" the herpes virus. If the disease appears for the first time (primary herpes caused by the type of HSV-1 virus), then the cause of herpes during pregnancy is infection upon contact with a sick person. But if a woman had a "cold" before her pregnancy on the lips (or "fever"), then there is a high probability of recurrence of herpes during pregnancy.

Typically, HSV-1 herpes manifests on the lips and in the nasolabial triangle, and the type of HSV-2 virus affects the genitals (genitals). When infection and clinical manifestation of the disease occur in the first trimester of pregnancy (from 1 to 13 weeks), that is, during the period of greatest sensitivity of the embryo and fetus to negative effects, doctors can recommend stopping the pregnancy. But if herpes lips during pregnancy or genital herpes occurred in the third trimester (from 28th to 40th week), then the woman continues to carry the baby.

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Symptoms of herpes during pregnancy

Symptoms of herpes of the lips during pregnancy are manifested as usual: the sensation of tingling and burning on the lip becomes itchy, then this place swells and turns red, and literally the next day on the place of itching and hyperemia, as well as the lip of the lip appears vesicular rash - filled with serous liquid painful vesicles (vesicles) of different sizes.

To these symptoms of herpes during pregnancy, weakness and headache join, the temperature may rise. In some cases, an increase in the surrounding lymph nodes is observed.

Having reached the maximum swelling, the bubbles are opened with a spill of contents, in their place are formed sinking sores. As the sores dry out, a brownish crust appears on the affected area - a scab, under which a painful wound remains. Recovery comes in about ten days, when the redness and swelling subsiding, and the dried up corpse itself disappears. Doctors warn that it is impossible to peel the crust in any case: it is possible to relapse herpes during pregnancy.

Genital herpes during pregnancy

The HSV-2 virus penetrates the human body in the same way as HSV-1, and during unprotected sex. But it is localized in the nerve nodes located in the region of the spine.

Genital herpes during pregnancy has such symptoms: the appearance of painful eruptions (with redness and bubbles filled with fluid) in the genital area and buttocks; itching and burning, especially with urination; vaginal discharge; swollen lymph nodes in the groin. In addition, there are signs of general malaise in the form of chills, fever to + 38 ° C, headache and muscle pain.

As in the case of herpes on the lips, the bubbles burst, crusts form which, after a week, disappear, leaving spots behind them. All these signs of genital herpes during pregnancy, changing in this order, can last 15-20 days - if the infection occurred for the first time. In case of repeated infections, the symptoms can not be clearly observed, and the duration of the disease can be limited to several days.

Herpes zoster during pregnancy

Herpes zoster (herpes zoster or herpes zoster) refers to secondary infections. The cause of this disease is a virus of the same family as the herpes simplex virus, a virus of zoster (virus zoster, WZ).

Like the herpes virus, the virus of chickenpox (chickenpox) - after recovering from a sick person - is not going anywhere from the body, but "hiding" in the same nerve nodes.

And in similar circumstances, that is, when the immunity of a pregnant woman is reduced, WZ comes out of its "shelter". By the way, according to medical statistics, herpes zoster occurs in every fifth person who once had chickenpox.

Symptoms of herpes zoster during pregnancy in the initial stage of the disease (1-4 days) are manifested as a general malaise with headache, a significant increase in temperature (up to 39 ° C), chills and dyspepsia. Also, pain, burning, itching and tingling at the place where the rash appears - on the back (in the waist region), on the chest (in the rib area), less often on the extremities and in the genital area.

Typical eruptions at first appear pink spots, which swell very quickly and turn into bubbles. The further picture - as with herpes simplex, while almost always there is an increase and soreness of regional lymph nodes.

After 18-20 days, the dried up crusts on the site of the rash fall away and there are spots with a changed pigmentation. But neurologic pain along the course of the affected nerves can continue - up to several months.

Most infectious disease doctors and obstetrician-gynecologists say that herpes zoster during pregnancy is not at all dangerous to the unborn child, since in this disease in the blood of a pregnant woman there are no varicella viruses and there are protective antibodies to this virus - antibodies of IgGP class.

Consequences of herpes during pregnancy

According to the potential ability to lead to fetal malformations, the herpes simplex virus is second only to such an acute infectious disease as rubella measles.

In the course of the studies it was found that the herpes virus during pregnancy can affect the embryo and fetus through the vessels of the placenta, through the fallopian tubes, and also in childbirth complicated by genital herpes.

It should be borne in mind that the shorter the gestation period at the time of infection with herpes, the higher the probability of spontaneous abortion (miscarriage), the retardation of intrauterine development or the birth of a child with pathology.

The most dangerous consequences of herpes during pregnancy is herpes genital. If this disease occurs on the terms of pregnancy to ten weeks, it leads to fetal death and miscarriage. Genital herpes in 80% of cases can lead to premature birth, in 75% - to infection of the fetus (neonatal infection), in 60% - to underdevelopment of the fetus, and in 20% - to his death.

When the manifestation of genital herpes during pregnancy occurs late in life (especially at 36-40 weeks), it is possible that a child with lesions of the nervous system (microcephaly or hydrocephalus of the brain), lungs, liver, spleen or skin can be born.

Therefore, with genital herpes during pregnancy - in particular, with a clear presence of rashes, a virus found in the birth canal, as well as with primary infection at the very end of pregnancy - a caesarean section is performed.

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Diagnosis of herpes during pregnancy

Diagnosis of herpes during pregnancy is based on anamnesis and examination of the patient. This applies to the herpes of the lips during pregnancy.

With genital herpes during pregnancy, everything is different. If the manifestations of the disease are typical, then the diagnosis is made on the data of a routine examination. However, often genital herpes accompanies such sexually transmitted infections as hepatitis, chlamydia, mycoplasmosis, ureaplasmosis, syphilis, and at the slightest doubt in the diagnosis doctors prescribe laboratory tests.

For the detection of the herpes simplex virus, the virological method is used: the contents of herpes vesicles are taken, scraping from affected areas of the skin or mucous membranes, and if necessary urine, teardrop or cerebrospinal fluid. You can detect the herpes simplex virus using the PCR (polymerase chain reaction) method, which also takes material from the affected areas.

To detect antibodies to the virus, serodiagnosis is performed, in which serum is examined. The same goal is pursued by an enzyme immunoassay (ELISA) - a complex definition of antibodies to ToRCH infections. In addition to blood, for the diagnosis of herpes during pregnancy, the study can be taken spinal fluid or amniotic fluid.

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Treatment of herpes during pregnancy

As a rule, in the treatment of herpes during pregnancy use drugs for topical external application. But, unfortunately, most of them are contraindicated to apply during pregnancy.

As a drug for the treatment of herpes during pregnancy, most doctors recommend the ointment Acyclovir, as well as a large number of their analogues with the same active substance (Zovirax, Herpevir, etc.). This drug is considered by many to be absolutely safe during pregnancy. Then why in some instructions to the drug - in the section "Contraindications" - it is written in black and white: "Admissibility of application in pregnancy and breast-feeding is not sufficiently studied". And other instructions state that the use during pregnancy "is possible if the expected effect of therapy exceeds the potential risk to the fetus." What does this mean?

And this means that relevant safety studies of the drug in pregnant women have not been conducted. Acyclovir passes through the placenta! And this is the observation data, which in 1999 was still conducted, but on a small number of women taking acyclovir during the first three months of pregnancy. There were only a little over 700 such women. It is for this reason that "it is impossible to make reliable and definite conclusions about the safety of acyclovir during pregnancy".

In the US, the agency of the Department of Health, the CDC, recommends the use of acyclovir for pregnant women in the treatment of life-threatening herpes infections - when the benefits of its use outweigh the risks.

In addition, back in 2008, Western Internet publications reported that a common drug for the treatment of herpes Acyclovir usually has no harmful side effects. Nevertheless, about 1% of people who take the drug orally or intravenously, experience mental side effects, including a rare depressive syndrome, in which a person imagines that he does not have any part of the body.

To the ointments Alizarin and oksolinovuyu ointment allowed to many ointments for pregnant women, many Internet sources (obviously, simply copying each other's information) report that "in the use of these ointments for pregnant women there are no restrictions, since they do not adversely affect the fetus ". Regarding the oxolin ointment, this information is correct. And as for alizarin, the following instruction is written in the instruction attached to it: "Contraindications: pregnancy and individual and intolerance" ...

To treat herpes during pregnancy, you can use the drug Viferon (ointment, gel, suppositories). Its active substance is interferon alpha-2. Since with external and local application systemic absorption of interferon is low and the drug has an effect only in the lesion, it is possible to use the drug during pregnancy. In complex therapy of acute and chronic recurrent herpetic infection (at any stage of the disease), a strip of gel with a length of not 0.5 cm with a cotton swab is applied to the previously dried affected surface 3-5 times a day for 5-6 days. The course of treatment continues until the disappearance of the rash. And with genital herpes, the gel is applied with a cotton swab twice a day for a week.

Still there is a 2% tebrofen ointment from herpes (simple, relapsing, and also shingles), which is smeared affected areas 3-4 times a day for 5-7 days. Among the side effects of this ointment is a burning sensation at the site of its application, and among the contraindications the producers name only the hypersensitivity to the drug and the individual intolerance.

Gel for topical application Panavir, according to the manufacturer, contains the glycoside of the plant Solanum tuberosum (0.002 g per 100 g) as the main active ingredient. This Latin name is weathered by the tuberous, that is, our ordinary potatoes. By the way, this is not mentioned in the instructions to the drug ... This gel is recommended to be used at the earliest signs of the disease, then you can completely stop its further development, not leading up to the stage of the appearance of herpes rashes. The drug is also available in the form of a solution for intravenous administration, spray and rectal suppositories. However, injectable solution and rectal suppositories during pregnancy can be used only if the intended benefit to the mother and fetus exceeds the potential risk of developing adverse events that are associated with individual intolerance and hypersensitivity to the components of the drug.

It's not for nothing that people rubbed fresh potatoes with many skin diseases, including eczema. And in the treatment of herpes during pregnancy, popular alternative means of external use, such as Corvalolum, alcohol tinctures of marigold and St. John's wort, sea buckthorn and rosehip oil. At the first signs of herpes on the lips, use the aseptic properties of essential oils - chamomile, wormwood, eucalyptus, fir, geranium, tea tree.

Preventing herpes during pregnancy

Preventing herpes during pregnancy, in the first place, is to maintain immunity. Of course, no one - including a woman during pregnancy - can take and increase the number of antibodies and other molecules involved in immune reactions.

Here it is necessary to act indirectly - to eat rationally and in a balanced way, so that the body receives everything necessary and could resist infections. You need to eat fresh vegetables, fruits and berries (cabbage, carrots, beets, celery, apples, grapefruit, lemons, black currant, cranberries, etc.), dairy products (low-fat), cereals, lean meat and fish. And do not forget that the salted, peppery, fried and smoked benefits of the pregnant woman will not bring.

The immune system largely depends on the health of the intestines. So the main task is to release the large intestine on time, that is, to fight with constipation, which affects more than half of pregnant women. In addition, it is necessary to avoid stress, to get enough sleep and to be outdoors for at least 2-3 hours a day.