Cold Sores (HSV1) And Genital Herpes (HSV2)
Herpes virus HSV1 and HSV2 are the cause of cold sores and genital Herpes respectively. Symptoms of a Herpes Simplex infection usually presents as tiny blisters or sores on the skin which could include the breasts, areola or nipples. Herpes is spread by skin to skin contact from the mother to the breastfeeding infant. It is most contagious when sores are open because fluid from the blisters easily spreads the virus to your baby.
A COMPARITIVE STUDY OF HERPES SIMPLEX 1 AND HERPES SIMPLEX 2
|Cause of 95% of orofacial Herpes.|
The remainder of Herpes by HSV2
Causes 10-30% of Primary Genital Herpes
Lesions rarely recur on genitals
Oral lesions are found to recur
Latency in Trigeminal ganglion
Transmitted by Saliva
Usually single lesions
Duration 2-3 weeks
|Causes Primary & Recurrent Genital Herpes.|
Rarely causes primary oral Herpes
Oral lesions caused by HSV2 rarely recur.
Genital lesions caused by HSV2 can recur
Latency in the Sacral Ganglion.
Usually Multiple lesions
Duration 2-6 weeks
Can I breastfeed With A Cold Sore (HSV-1)?
The herpes simplex virus type 1 is the medical term for a cold sore or also known as ‘fever blisters’. Cold sores are blisters that appear on the lips and/or mouth. They persist for 2-3 weeks and subsequently form crusts.
As this virus is spread by merely touching the cold sore it is possible to pass the virus on to your baby. However, with the correct procedures, you can successfully breastfeed your baby whilst having a cold sore. It is vital that your baby doesn’t come into skin-to-skin contact with any herpes lesions or sores.
Thankfully newborns rarely get cold sores, as they receive maternal antibodies to protect them. According to the NHS UK, a baby is most at risk of getting a herpes infection in the first 4 weeks after birth. Cold sores are at their most contagious when they burst and will continue to be contagious until completely healed. To prevent your baby from contracting a cold sore the following guidelines should be followed.
Protecting baby from the cold sores
- Maintain strict hygiene practices by washing your hands thoroughly with soap and water prior to breastfeeding your baby. Hand washing can help prevent the spread of herpes to your baby through skin contact.
- Cover your cold sore while breastfeeding or holding your baby to prevent it from touching off your baby’s skin.
- Avoid kissing your baby if you have a cold sore.
- Avoid touching the sore yourself if possible.
- Consult with your doctor regarding the appropriate treatment for your cold sore.
Can I Kiss My Baby If I Have A Cold Sore
A baby is most at risk of getting a herpes infection in the first 4 weeks after birth. A baby should never be kissed if you have a cold sore to reduce the risk of spreading infection. All lesions caused by Herpes simplex are most infectious when they blister and leak virus-rich fluid.
Can A Mother Breastfeed With Genital Herpes (HSV-2) Safely?
According to the Centers for Disease Control and Prevention (CDC), HSV-2 can cause herpes disease in newborns and infants and can appear anywhere on the body. Contraction of this disease in a young baby is serious potentially resulting in skin or other mucous membrane herpes, disseminated herpes infection or less commonly herpes encephalitis.
So this makes us ask the question – Can we breastfeed with the presence of genital herpes?. Breastfeeding can continue if no lesions are present on the breasts and if active lesions elsewhere on the body are carefully and thoroughly covered. The CDC advises that where a mother has active herpetic lesions on her breast, she needs to temporarily stop breastfeeding her infant from the affected breast. She may continue to nurse her baby or express from the unaffected breast. However, she needs to take the necessary precautions to ensure the affected side is safely covered with no risk of transmission to her baby.
It is not considered safe to nurse your baby with the presence of active herpes lesions on the breast, nipple, or areola. Breastfeeding can only resume once the lesions have completely dried and healed. Breast milk from a mother with active herpes lesions will need to be expressed to maintain her milk supply and prevent engorgement.
Varicella-Zoster Virus (Chickenpox/Shingles) While Breastfeeding
The varicella-zoster virus is another member of the herpesvirus family. It is the cause of two main illnesses called chickenpox (varicella) and shingles (varicella-zoster). Once you have acquired chickenpox, the virus lies inactive in ganglia in the sensory nervous system, near your spinal cord. After a period of time usually in later adulthood, the virus may reactivate as shingles. This usually happens when the immune system is weakened in some way either due to infection, physical or emotional stress.
DIFFERENTIATNG VARICELLA AND SHINGLES
|CLINICAL FEATURE||CHICKEN POX||SHINGLES|
|1.CAUSATIVE AGENT||VARICELLA VIRUS||VARICELLA ZOSTER VIRUS|
|2.COMMUNICABILITY||1 day before to 5 days after |
appearance of rash
|Same as chickenpox|
|3.TYPE of RASH||Macule, Papule, Vesicle, Pustule||Vesicles|
|DISTRIBUTION||Generalized, first on |
unexposed body surface areas.
|Clusters, Unilateral, does not|
cross mid-line usually
along torso and breast
What If A Mother Contracts Chickenpox While Breastfeeding?
According to Wombach and Riordan (2016), Breastfeeding and Human Lactation a woman should continue to breastfeed if she has acquired chickenpox. They state that because of the window of contagiousness for chickenpox, the infant will already be exposed to the infection before the mother is recognized to have chickenpox skin lesions.
Most mothers have immunity to chickenpox either due to them having it as a child or having received the vaccine. This immunity travels through the placenta and gives the baby immunity while in the womb. Therefore, the chance of acquiring chickenpox while breastfeeding is rare.
Contracting Chickenpox During The Postpartum Period
Special precautions need to be made for mothers who have developed chickenpox in the peripartum period (five days before giving birth and two days postpartum). The Medical Journal of Australia states that breastfeeding of babies infected with or exposed to VZV is encouraged. They advise that there is no requirement for the mother and baby to be separated. Newborn babies will need to receive the appropriate medical care during this time.
Can I Breastfeed If I have Shingles?
Breastfeeding is not considered to be a significant route of transmission for the varicella-zoster virus (VZV). The baby of a mother with Shingles will have immunity to chicken pox if mom has had chicken pox in the past. This is because antibodies are passed during pregnancy and remain in the baby’s blood for approximately 6 months. Provided that the shingles rash is not on any part of the breast including the areola and nipple, a breastfeeding mother who has acquired this virus can continue to breastfeed.
A mother with shingles can spread the virus when the rash is in the blister-phase. You will not be allowed to breastfeed if you have lesions on the nipple areola and surrounding breast tissue. Wait until the lesions dry up into scabs and you are no longer contagious to breastfeed.
An exception to breastfeeding is exposure to shingles lesions on the breast. This can result in chickenpox (varicella zoster) in preterm or non-immune infants. A case of shingles should be treated similarly to a Herpes simplex infection. Mothers should refrain from breastfeeding or use expressed breast milk from an affected breast until the lesions have healed. Infants may be given Varicella Zoster immunoglobulin if appropriate.
Many breastfeeding mothers with shingles will be prescribed a course of antiviral tablets lasting seven days, usually acyclovir. Antiviral medicines such as aciclovir, famciclovir, and valaciclovir are most commonly prescribed. These antivirals are most effective when taken within 72 hours of symptoms so it is important to consult a healthcare professional without delay.
Can Herpes and Varicella Zoster pass through Breast Milk?
The herpes simplex virus cannot be transmitted through breast milk. This means that neither herpes, chickenpox or shingles can pass to your baby by feeding your baby with the necessary precautions. However, it is possible that your baby could get infected by touching or coming into direct contact with a blister or sore on your breast, mouth, or another area of your body.
Acyclovir While Breastfeeding And Other Treatments
Acyclovir (Zovirax) can be taken orally, applied topically as a cream or given intravenously. Along with valacyclovir, it is compatible with breastfeeding and can be used to induce rapid healing of lesions and shorten the duration of the illness. t is used to treat cold sores and genital herpes caused by the herpes virus. It is also prescribed to treat chickenpox and shingles. Since very small quantities of the drug are excreted in breast milk, they are safe for baby.
Valtrex while breastfeeding
Valacyclovir is a prodrug of Acyclovir. This means it is biologically inactive until it is metabolized in the body. The amount of acyclovir in milk after valacyclovir is almost negligible if we compare it with a typical infant dosage and would not be expected to cause any adverse effects in breastfed infants. Research confirms that Valtrex is not found in breast milk. They conclude that Valtrex is safe during breastfeeding.
Lesions On The Breasts While Breastfeeding – What To Do
The common causes of breast lesions are:
- Friction Blisters-irritation from rubbing against your skin
- Milk blisters-A blockage at the end of a milk duct
- Herpes Virus
- Chickenpox and Shingles
Herpes Virus lesions
Herpes lesions can look like small red fluid-filled blisters. They may feel itchy or can be painful. This virus can pass to your baby through contact with the blisters or sores containing the virus. Observe careful hygiene to protect your baby. There is a possibility that lesions can appear anywhere on the body including the breast. Genital herpes sores can also be spread by touching the sores. If the sores (blisters) appear on your breast, nipple or areola you will have to refrain from breastfeeding from that breast until they heal.
Chickenpox (Varicella) and Shingles (Zoster) Lesions
The chickenpox rash begins on the breast as many small red bumps that look like pimples. Over a few days, they develop into thin-walled blisters filled with fluid. Shingles, on the other hand, may start as red patches but changes over time and develops into fluid-filled blisters. These blisters may ooze. There is associated, itching, burning and tingling
When a mother contracts one of the conditions from the Herpes Virus Family (HSV1, HSV2, Chicken Pox, and Varicella Zoster) breastfeeding does not have to be discontinued. These viruses are excreted in negligible amounts into your breast milk. Exposure to active lesions, however, can pass the condition to your baby. This can be prevented by avoiding nursing your baby from the affected breast. You will need to express your milk and discard from the affected breast. Baby can be protected from active lesions by maintaining hygiene methods enlisted above. This will ensure safe breastfeeding if you are have developed any of these viruses.
DR RADHA RAJPAL, M.D. CONSULTANT PEDIATRICIAN