Discordant Couple

[MD000]

Hi, I'm an HSV negative female in the healthcare profession and I've decided to take a leap of faith and be with a man who is HSV 2 positive.  He has not been symptomatic for a couple of years and is on prophylaxis and we're being cautious.  

My question is that assuming I don't get infected with these precautions, if I decide to have a child with this man in the future, would it be better to be a mad scientist and inoculate myself prior to conception, so that I develop at least some protective antibodies, or just continue precautions and hope that I don't come down with a primary infection during pregnancy?

Thanks

[Edward W Hook, MD]

Sorry, I cannot give your a figure as to the percentage of infections which lead to congenital infections that occur when the infection occurs prior to the 3rd trimester.

As for the impact of prophylactic therapy in males on sperm quality, etc - there are data and they suggest no increase in abnormalities in children born in these circumstances.  These data are not a formal study but the results of a very large case regisitry kept by Glaxo-Smiith Kline, the manufacturer of acyclovir and valacyclovir.  EWH

[MD000]

Ah!  Dr. Hook, it’s really hard enough to meet a compatible match who inspires one emotionally and mentally.  But a woman in love hopes for the best, although I’m trying to be as sensible as possible.  :)

The fact remains that even if I’d be negative prior to pregnancy, I would have to expose myself to become pregnant.  And if I get the infection with conception, that leads to increased risk of congenital infection with primary infection as you mentioned.  

Is there a figure for the percentage of congenital infections PRIOR to 3rd trimester of pregnancy?

Also any thoughts on whether prophylactic therapy affects sperm quality or cause fetal defects?

Thanks.

[Edward W Hook, MD]

Before I get to your question, let me congratulate you on your approach to your relationship with your partner.  You are working to escape the unwarranted anxiety and stigma-laden reaction which is such a great part of the burden this infection creates for many persons.  Great work.

Now on to questions about getting pregnant.  The "mad scientist" approach is probably not necessary.  Your question implies that the greatest risk for delivering a congenitally infected child is to acquire the infection during pregnancy.  This is the case.  When you decide to become pregnant, it will be time to get another test to make sure you have not unknowingly acquired infection - it happens.  Secondly your partner should continue his prophylactic therapy.  Finally, during your pregnancy, many experts would recommend abstinence during pregnancy to insure that infection does not occur. Whether to start the abstinence immediately upon pregnancy or to wait until later is controversial but all experts in the field are clear the abstinence between members of a discordant couple is to be recommended for the 3rd trimester of pregnancy.

Hope this helps.  EWH