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Valtrex for pregnant women

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Hi everyone! Has anyone heard of doctors prescribing Valtrex to pregnant women regardless of their status? A friend told me he saw Valtrex in the delivery room while his girlfriend was having the baby. The doctor said that she brings it to the delivery room regardless of the status of the patient just in case it's necessary. I asked if his girlfriend had herpes and he said no. To me this seems strange from the doctor. Is this a routine thing doctors do when delivering babies? I'm worried that she maybe didn't disclose to him and he's in denial. But if this is something doctors do on a regular basis, then I stand corrected.

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I don't know how unusual it is for a doctor to routinely carry Valtrex around. I do know that a large U.S. study indicated 30% of pregnant women have HSV2 (presumed genital infections) and 66% have HSV1 (some oral, some genital). Given 30% of neonatal herpes cases (which are rare and almost always due to an infection contracted during the final few months of pregnancy) are caused by HSV1, it may be fair to assume close to half of pregnant women have genital herpes, but that's just a guess since location of HSV1 infections can't be determined through blood tests alone. Most of these infected women don't know they have genital herpes, so it would make sense for doctors to not make assumptions one way or another, especially since HSV is not routinely tested for in pregnant women or their partners, but I can't comment on why the doctor might have Valtrex with her. I have no idea.

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Herpes testing is not part of the standard STI testing for pregnant women. At least not in the U.S. Those at greatest risk (by far) are those who contract it in late pregnancy and don't yet have the antibodies to test positive before labor. Therefore, these people can't be identified through blood testing, only swab testing, if they happen to have a noticeable primary outbreak which happens in 10-20% of cases. So in the absence of obvious symptoms of a primary outbreak in the months preceding labor, the only way to capture these people who are at greatest risk would be to blood test pregnant women *and* their partners at the beginning of pregnancy, then focus effort on the women who test *negative* and have partners who test positive and pose a risk of infection during pregnancy. You can imagine that would be difficult.


For now, doctors typically rely on women who are aware of their infection (about 1/8 of women who have genital herpes; the other 7/8 are unaware they are infected) to inform them of their existing infection so they can take the extra step of taking antivirals in late pregnancy and checking for any signs of an outbreak at the time of labor. Risk is extremely low among women with established infections (meaning infections old enough to test positive through blood testing; more than a few months old) and extremely high among those who contract it in late pregnancy and do not yet have sufficient antibodies to test positive through blood testing.

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