I don't know where you read such a thing, but it's spurious.

Such statements typically come from scaremongers, usually in
conjunction with trying to sell some miracle product; or by trolls,
usually in conjunction with trying to sell their own particular brand
of stupidity.

You're getting bad information.  Having herpes is not a barrier to
delivering happy, healthy children.  

Mike

"Charles" <master_silence@hotmail.com> wrote in message > I know but, its
also disturbing to read things like this :

I think you can replace "HSV-2 infections" with almost any medication or
medical condition and that statement would still be considered true.

Having herpes really doesn't impact having children.  You just need to be
more careful, that's all.

ar

Indeed - such things can be an issue but context is everything. Part ofthe
problem is a lot of this sort of thing is dragged out of texts that are
about 20 years old. Acyclovir made a big impact on such things. Basically
whikle such things are possibles, if we are discussing details of things
that are going to be relevant to a newly infected individual or newly
diagnosed indidvidual then these things are way down any list for us here.
They do get discussed in side threads.

THe word 'can' is a HUGE ommission here, or at least if this is lifted
from a medical text its lost enough context that it needs to be added. The
issues of rarity and consequences are also ignored which are vital for
context.

Right at a basic level primary infection in quite lot of HSV2 cases can
cause an aseptic meningitis. Thats part of the primary infection symptoms
for many people and its the headache and so on....the figure of this
occurring in 50% of primary diseases cases springs to mind but I'd have to
check....this is not raising the spectre of anyone getting infected
falling down to the menigitis most people really fear which is the fast
acting meningococcal menigitis.....for more serious episodes then it is
better compared with the encephalitis since its essentially the same set
of events leading to a slightly different area affected...there is also
mollaret's meningitis which has been linked to HSV2..thats is a) rare and
b) while unpleasant [year long headaches etc] is again not in the same
league as meningococcus. Blithely saying HSV2 infections cause menigitis
makes an overly simple statement for a very complex issue...even the stuff
Im dragging out here is probably on the simplistic view...though I hope
more reasonable a presentation.

OK this is the one that gets most people going. Yes it does happen and yes
it can be fatal...but if I may drag out some context. In the UK the
figures for deaths from HSV (which will really be the encephalitis
mainly) in the mid t late 90s (the last figures I saw) were 20-30
deaths per year in just around 570000 deaths per year. Now most of that is
HSV1...the only paper I've seen quantifying this had IIRC 64 patients of
which one was HSV2 encephalitis. So thats one death per 2-3 years from
HSV2 encephalitis.....within the same time span around 700,000 to 1million
HSV1 positive individuals and 150,000 to 200,000 HSV2 positive individuals
dying from other causes....and however many thousands simply having
outbreaks....

Before acyclovir this figure would have been higher (but still rare) and
would also have had a much higher rate of unpleasant side effects in
survivors...the drug has really really changed outcomes.

Much harder to track down - Shornick and Black write in 1992 in the
Journal of the American Academy of Dermatology
'The potential risks to the fetus in herpes gestationis have long been a
controversial subject, but because fo the rarity fo the disease, have only
occasionally been studied.'

You DO get all the above associted with much more commonly with varicella
zoster virus - but that virus is one that can normally travelin the blood
easily - and hence risks crossing the placental barrier. The association
with HSV2 becomes more common from papers in the 80s linking higher rates
fo HSV2 to recurrent abortion and even then its mainly linked to something
weird with latent virus (which then gets chicken and egg).

Management these days with antivirals would make a difference....this
would fit the problems of disseminated herpes infections in neonates being
hard to treat..but again these days all these issues are considered very
rare and these are really likely to be infections at birth rather than
during the pregancy...

So yes, HSV can end up affecting the fetus and neonate, citing Brown et
al in Janurary's edition of JAMA - this occurs most commonly in neonates
with exposure to infection genital secretions at birth - now they tested
202 women and only 5% transmitted to the child....caesarians had one
transmission out of 85 compared to 9 from 117 vagnial births...this will
be the high risk area. However they do suggest now that this is related to
maternal primary or recurrent disease..

Other papers dealng with this suggest rare vents early on in pregnancy can
do things....but all say 'rare', 'rarely seen', 'rarely documented' etc
etc. Sggestions of ACV therapy to manage this subsequently comes.

Quoting Esklid et al in BJOG: An International Journal of Obstetrics and
Gynaecology (Vol109, 2002, p1030-1035)....they looked at hsv2 antibody
status during positives in 1st trmester, appearance during preganancy,
increasing titres or loss of antibody....using 35,940 cases. They could
NOT link fetal death to HSV2 infections. SO we are talking about a high
likeihood that any case reports are going to be freak events.

THere is loads of advice and data around birth and the early part of life
for physicians to keep an eye out for these sorts of infections and hat
itself will help manage. THe literature very much seems to focus on the
time around birth as the risk period and management methods exist. The
next most common situation looked at is primary infection during pregnancy
and the whole thing there is very difficult to sort - but again rare. They
do quote some nasty mortality figures (someup to 50% of infected neonates)
for neonatal HSV - but without an incidence rate for infection thats kinda
hard to put in context as to how often we are talking about. A disease
that kills 1% of kids but affects 90% IS much more lethal than one that
kills 50% of those it affects but only affects 1 in 10,000.

There is a big paper from 2001 in the journal Pediatrics (Vol108, 2001,
pp22-229) by Kimberlin and a huge list of coauthors) which discusses the
natural history of neonatal HSV since ACV....their line is that it is
start of therapy that is absolutely vital in suspected cases and that not
enough has been done on this front....early therapy before certain events
was needed for survival.

A study in 2001 by Scott et al in Inf Dis Obs and Gyn (vol9) looked at
giving suppressive therapy to help limit this exposure and it seemed to
work...

Basically there is a lot of info out there (look in pubmed anyone with
webaccess can), it says either very very rare (so you have far more to
worry about from other directions) or where its less rare (but still quite
rare) there are a series of management issues that will make it even
rarer....

Well on that front there are I know a number of individuals here who have
been there and done that in the face of HSV2....I don't think any of them
regret it (though I hesitate to speak for them).

Essentially I can probably pull some horror story about pretty much
any disease if I wanted to, by failing to use context, and failing to
discuss the matter fully. Doing so might be based on sayign some things
that are factually correct in as far as they go but simply end up giving
totally the wrong impression....I think thats pretty much what has
happened here....it took one minute to dig out 200 odd papers on the
subject with titles and one liners that you could pull out really scare
people but look in depth and assess the data and the story settles more
into context of 'rare events' or 'manageable events'....

Tim
--
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