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Cold sore treatment/prevention

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  • Cold sore treatment/prevention

    I’ve been getting cold sores since I was a preteen. Always a hassle to be sure. They not only are super contagious (I have a breastfeeding toddler who doesn’t understand boundaries) but they wipe me out physically for several weeks (where I feel drugged and have a hard time staying awake.) I use abreva for outbreaks which works well but I tend to have outbreak after outbreak after outbreak when I’m pregnant (I just got a positive hcg result last night) and lo and behold... I woke up with a cold sore (this time, other than exhaustion for the last week and a half, I had no symptoms leading up to it.) Would an antiviral such as valacyclovir or acyclovir be safe for or even recommended during pregnancy?

  • #2

    Acyclovir or valacyclovir are probably ok to use in pregnancy. They are rated P2-benefits are likely to exceed the risk.

    Acyclovir: "Pregnancy: It is known that acyclovir crosses the placenta to the fetus. Acyclovir is an antiviral agent against the herpes viruses. The main use of acyclovir during pregnancy is to treat primary genital herpes (HSV 2) infection which can cause prematurity, intrauterine growth retardation (IUGR), and neonatal herpes in the infant. Acyclovir is also used in pregnancy for prophylaxis against recurrent genital herpes infection. It is known that the drug crosses the placenta to the fetus[1], however, no adverse effects in the fetus or newborn attributable to the use of acyclovir have been reported."(Medications and Mothers' Milk database, Dr Thomas Hale PhD).

    1.##Henderson GI, Hu ZQ, Johnson RF, Perez AB, Yang Y, Schenker S. Acyclovir transport by the human placenta. The Journal of laboratory and clinical medicine. Dec 1992;120(6):885-892.
    2.##Stone KM, Reiff-Eldridge R, White AD, et al. Pregnancy outcomes following systemic prenatal acyclovir exposure: Conclusions from the international acyclovir pregnancy registry, 1984-1999. Birth defects research. Part A, Clinical and molecular teratology. Apr 2004;70(4):201-207.
    3.##Ratanajamit C, Vinther Skriver M, et al. Adverse pregnancy outcome in women exposed to acyclovir during pregnancy: a population-based observational study. Scandinavian journal of infectious diseases. 2003;35(4):255-259.
    4.##Brocklehurst P, Kinghorn G, Carney O, et al. A randomised placebo controlled trial of suppressive acyclovir in late pregnancy in women with recurrent genital herpes infection. British journal of obstetrics and gynaecology. Mar 1998;105(3):275-280.

    Valacyclovir: "Pregnancy: Studies have not shown that a relationship exists between the use of Valtrex in pregnancy and birth defects. Quick Note: Genital Herpes is a common viral infection that is transmitted through sexual contact with an infected person. In pregnant women with the virus, transmission occurs to the infant when it comes in contact with the infected genital tract during delivery. Animal studies using a dose of 400 mg/kg of valacyclovir did not prove to cause congenital malformations (GlaxoSmithKline, Research Triangle Park, NC). It is also important to note that the current recommendation is for women who have active lesions at the time of delivery to deliver via cesarean section. Several studies have been performed on the use of antivirals, such as valacyclovir, during the third trimester. The goal of such studies is to prevent genital herpes from recurring at delivery. It has been shown that the use of valacyclovir during the third trimester does in fact reduce the number of recurrences at delivery and at the same time decreases the number of cesarean sections needed to be performed."(Medications and Mothers' Milk database, Dr Thomas Hale PhD).

    1.##Sheffield JS, Hill JB, Hollier LM, et al. Valacyclovir prophylaxis to prevent recurrent herpes at delivery: a randomized clinical trial. Obstet Gynecol. Jul 2006;108(1):141-147.
    2.##Andrews WW, Kimberlin DF, Whitley R, Cliver S, Ramsey PS, Deeter R. Valacyclovir therapy to reduce recurrent genital herpes in pregnant women. Am J Obstet Gynecol. Mar 2006;194(3):774-781.

    Sandra Lovato R.N.
    InfantRisk Center