The Truth About Neonatal Herpes according to Stephen L Sacks MD...

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M.L.S. - 18 Dec 2003 02:49 GMT

Greetings all you who wish to be greeted!

I wish to announce that I've done and gone the extra mile, and just
for you, too. Yes, you.

What, you may be wondering, is he up to now? And well you might. But
it's only something I shoulda oughta done before, long ago, even,
maybe.

After (or maybe during) the fun and excitement of the posting clash
last week I scurried to Amazon.com (no affiliation here, boy) and
ordered me up a copy of "The Truth About Herpes" by the late great
Stephen L. Sacks, MD. It arrived today. 4th edition. Soules. 1997.
Paperback.

The hilarious thing is the specific reason that I ordered the thing,
and what I found pertaining to said reason within five minutes of
cracking the spine.

When someone (I can't remember who) said that the book claimed that
the herpes virus was so small that it could fit through a coffee
filter, my "Well, Duh!" alarm went off. Certainly, I thought, such an
esteemed book would have found a better, more apt, more convincing
example to help convey the very, very, very, teensy, tiny nature of
the average herpes simplex virus. That surety and curiousity is what
made me go click, yep, silly me.

So here it is... page 31: "A virus is a very small living thing."
[Ouch, right there, too, now that I think about it.] "It is so small
that it can pass through something as fine as a coffee filter." I
guess that answers my skepticism, though I still think it does a
disservice to describing how small viruses really are, though,
naturally I know, that Dr Sacks wasn't writing a technical book, so, I
guess I'll skip it, for now. But coffee filters really aren't very
fine. They're not.

So, after I was done assimilating all that, it occurred to me to look
and see what Sacks had to say about neonatal herpes. Here's some
quotes:

"Before birth, the membranes surrounding the baby are a natural
barrier that helps to prevent the virus from travelling from the
mother's skin to the baby's skin." -- page 23.

"A fetus can also get a herpes infection *inside* the womb." [...]
"Nothing specific can be done to prevent congenital herpes, but the
risk is very low. In fact, even women with a proven herpes infection
inside the womb often have completely normal and unaffected babies."
-- page 24.

"Most people with herpes make plenty of herpes antibodies -- proteins
that neutralize the virus on contact (see chapter 2). The antibodies
probably get into the amniotic fluid in which the baby floats, coating
the baby in a layer of protection. Antibodies may knock out the virus
before (or after) it gets onto the baby's skin." -- pages 24 & 25.

"Another way to look at this is that if a pregnant woman knows she has
herpes and has had it for awhile, she is protected by nature from
transmitting herpes to her newborn in most cases. Her baby acquires
immunity to herpes from her. If she sheds virus asymptomatically, her
baby will probably be exposed, if at all, to only a small amount of
virus, which will probably be readily neurtalized by her immunity." --
page 25.

"While inside the uterus, the fetus is protected from most infection
by the filtering capabilities of the placenta, which excludes almost
all infecting agents [...]" -- page 135.

"If a pregnant woman knows she has genital herpes, newborn herpes is
largely preventable and highly unlikely." -- page 136.

"Near term, it is possible (though unlikely) for little holes in the
amnion (sac of waters) to open and reseal, allowing infection in.
Fortunately, this is unlikely to lead to herpes infection." -- page
140.

There is a little more but that's the bulk of the pertinent stuff.

I don't know how anyone could claim to have read Sacks and not been
reassured. I really don't.

Yours truly,

Mike

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r. - 18 Dec 2003 04:07 GMT

While the catalyst for you to do the research sucked, IE a troll, the
information you provide here is good stuff to help any and all who
research in the archives.

Is the virus passed via skin to skin contact or it is also passed via
blood? I am not stirring up....just asking....because the quote
indicates that the amniotic sack 'prevents skin to skin' transfer.
(pg. 23)

r.

>Greetings all you who wish to be greeted!
>
[quoted text clipped - 80 lines]
>
>Mike

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M.L.S. - 18 Dec 2003 05:42 GMT

>While the catalyst for you to do the research sucked, IE a troll, the
>information you provide here is good stuff to help any and all who
>research in the archives.

Thanks very much. I remember how important this place was for me back
in '99. There was a lot of information here then, but quite a bit
new, too, since then. Always lots of new questions, or different
takes on things. I'm glad to be here, glad to help a little, and
always glad to try to learn something new.

>Is the virus passed via skin to skin contact or it is also passed via
>blood? I am not stirring up....just asking....because the quote
>indicates that the amniotic sack 'prevents skin to skin' transfer.
>(pg. 23)

I'm going to have to sit down with the book for a few hours to see
what it says, if anything, but off the top of my head:

Herpes is not generally blood borne. The two exceptions might be
during particularly severe Primary outbreaks, and in persons with
severely compromised immune systems (ie., with AIDS.) The latter
condition speaks for itself, but I believe there are a couple things
that reduce the number of viruses in the blood stream in a healthy
body, even during a Primary outbreak.

First, I don't think the herpes virus has much interest in floating
around in the blood. It's made to climb up and down nerve cells, and
inject itself into skin cells to hijack the cellular machinery, and
just doesn't have much business in the blood. If there are sufficient
numbers of viruses being manufactured out of ruptured skin cells, then
some of them may get inadvertently dumped into the blood stream, but I
doubt that it happens often. It's probably is possible that the virus
could hitch a ride in the blood stream to another part of the body,
and that's what I assume happens in the very rare cases where herpes
causes a meningitis but that other factors mitigate against such most
of the time.

Second, of course, and most important with people who have had long
enough to have antibodies to herpes, the antibodies *are* blood-borne,
and if any stray viruses should make their way into the bloodstream,
they'll very quickly be pounced on.

Third, and here I'm really speculating, the blood just may not be very
hospitable to the herpes virus. Just as herpes doesn't survive very
long in the air outside our skins, so may it not like the environment
within the blood. Again, I emphasize I'm just guessing, but herpes
doesn't like oxygen, and the blood stream is a fairly oxygen rich
environment. Also, there may be physical barriers to herpes getting
*into* the blood, ie., it may need a cut or other injury, in which
case it might not be able to break *out* of the bloodstream at any
particular point without some other damaged spot to do so, should it
manage to get itself in there and survive the trip.

As far as the quote from Sacks, it really isn't very clear, is it, but
while I'm in a guessing mood, I'll say that within the big unit of a
fetus within an amniotic sac within a mother there isn't a whole lot
of space between the outer skin of the fetus and the inner womb walls
of the mother, and not far to go to get to the birth canal. In the
larger passage surrounding the line I quoted, Sacks was jumping back
and forth from the baby being in the womb to the baby travelling the
birth canal, where the first real skin to skin contact between mother
and child can take place, so I think the sense is that the amniotic
sac does a big job in protecting the fetus but that when the mother's
water breaks, it's time to watch out. In all the other passages that
I read the real risk to a newborn doesn't begin until that journey
down the birth canal begins, and then is only a major risk if the
mother is experiencing a first HSV infection and shedding viruses.

Hope that helps.

Mike

Reply to this Message

r. - 19 Dec 2003 04:19 GMT

>As far as the quote from Sacks, it really isn't very clear, is it, but
>while I'm in a guessing mood, I'll say that within the big unit of a
[quoted text clipped - 14 lines]
>
>Mike

Everything I have read on the issue of neonatal herpes focuses on
delivery concerns and concerns of the first outbreak during pregnancy.
Everything else I have read so far indicates that a mother with herpes
runs a high chance of having a healthy baby sans herpes, as we all
know.

I would think that if there was a large pool of concern or a large
pattern of neonatal herpes, it would have been studied more and
commented on more....which is just simply not the case.

We know clearly what diseases DO affect a fetus -- such as chicken pox
and some strains of the flu for example. With the lack of anecdotal
information on herpes and the neonate, that would seem to indicate the
limited concern in the obstetric community.

Just my guesswork and two cents worth....

r.

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M.L.S. - 19 Dec 2003 06:06 GMT

>Everything I have read on the issue of neonatal herpes focuses on
>delivery concerns and concerns of the first outbreak during pregnancy.
>Everything else I have read so far indicates that a mother with herpes
>runs a high chance of having a healthy baby sans herpes, as we all
>know.

Right. What Sacks keeps pointing out is that the expectant mother who
*knows* she has herpes has an overwhelming chance of delivering and
keeping a healthy baby. It's the mothers who don't know they have the
disease (with doctors who don't take the care to find out) or who
acquire it late in term, are the ones who wind up having the (still
fairly rare) problems.

>I would think that if there was a large pool of concern or a large
>pattern of neonatal herpes, it would have been studied more and
>commented on more....which is just simply not the case.

Well, I did do some more reading in Sacks's book this evening. It
wasn't until the late sixties or so, just forty years ago, that anyone
made the connection between the mother having this thing called
genital herpes and the disease that babies were being born with.
Since then we've learned all kinds of things, and now it's the people
who don't know they have herpes that are primarily at risk of hurting
their babies. The people who know they have herpes, have had it for a
while, are all pretty safe, as long as the doctor is competent, of
course.

There are the very rare cases where the virus does breach the amniotic
sac. I think it is such a rarity, and so dependent on outside
factors, that there's been no way to look at it and say, "OK, if we do
this we'll never have that problem again." There's probably no single
cause for it, and probably nothing anyone could do anyway.
Fortunately, it is very rare. Herpes just never evolved in that
direction, for the simple reason that it does nothing to create more
generations of herpes viruses.

>We know clearly what diseases DO affect a fetus -- such as chicken pox
>and some strains of the flu for example. With the lack of anecdotal
>information on herpes and the neonate, that would seem to indicate the
>limited concern in the obstetric community.

I don't know if I'd say there is limited concern, but I think that
obstetricians deal with herpes so much (at least 20% of mothers) that
it's become fairly routine. Since the sixties they've pretty much
figured it out. There's still some things that are being worked on,
like how safe it is to take Acyclovir at different stages of
pregnancy, and how better to test the mother for asymptomatic shedding
at time of delivery, but most of what is needed to prevent the
transfer to newborns has been learned and is being implemented. At
least in first world countries.

>Just my guesswork and two cents worth....

We're all learning here, and you're getting your money's worth.

Take care,

Mike

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