最近我就大家关心的三个问题，请教了国际疱疹协会的Catherine Cook女士，先将她的回信要点发给大家。原文附后：
１、长期服用ａｘｌｗ一类的药物，对怀孕期的女性有无影响？没有药物对于怀孕女性是百分之百安全的。我们建议怀孕的女性最好不要服用抗生素，或者在开始服药之前咨询大夫。尽管如此，有的妇女还是在怀孕期间服用药物的。目前的数据并没有表明这种药物会造成严重的异常后果。目前国际上对于女性疱疹病毒感染者的建议是怀孕期间不要服用药物，除非在怀孕的后期。这个阶段服用药物的目的是控制阴道内的症状以便能够安全的进行阴道生产而不是剖腹产。如果分娩时没有破损，阴道生产是可以接受的。但是要避免新生儿在分娩过程中受到损伤。如果有破损，则最好不要阴道生产。
２、已经感染了疱疹病毒的女性怀孕后是否能产下健康地宝宝？复发性疱疹对发育中的胎儿的主要威胁时母亲在怀孕过程中首次感染病毒。对于已经感染了疱疹病毒然后怀孕的女性，除过孩子出生时的风险外，不会对胎儿有影响。
３、男性感染者的精液中是否带有疱疹病毒？没有。
原文：Catherine Cook Reply: Dear Ｓｉｒ, It sounds like you are doing
wonderful work. I have several questions for you too! Is aciclovir
widely available in the different provinces of China? Are there
reliable blood tests available for typing HSV; types one and two?
Now, on to your questions:
There are almost no medications that are actively promoted as
being 'safe' in pregnancy. The recommendation with regard to all
medications in pregnancy is for women to only be on essential
medications and to consult her doctor prior to becoming pregnant with
regard to ceasing or altering medication regimes. Having said this,
many women, both inadvertently and knowingly, have taken antiviral
medication in pregnancy. Data which has been collected from these
situations has not shown that this medication is associated with any
fetal abnormalities. The current international guidelines recommend
that women with recurrent genital herpes do not take antiviral
medication in pregnancy except for treating recurrences in the latter
part of the pregnancy to enable a vaginal birth rather than a
caesarean section.
Here is some more pregnancy information in case you may find this
useful:
Our website www.herpesalliance.org has a section on pregnancy
issues under the 'Information downloads' section. In case you want to
do some in-depth reading, I will give you the website addresses that
have the latest medical guidelines for the management of genital
herpes in pregnancy and you may have time to download this
information and discuss it with your doctor. These guidelines are
found at www.herpes.org.nz (New Zealand Herpes Management Foundation)
(go to 'health professionals' and download a copy of the 2002 medical
guidelines) and www.ihmf.org (International Herpes Management Forum).
You will see in these guidelines that for recurrent genital herpes
contracted prior to the pregnancy, the recommendation is that, if
there are no lesions present at the time of delivery, vaginal birth
is an acceptable decision, along with the avoidance of the routine
use of instruments such as a scalp clip on the baby's head. If
lesions are present, then the recommendation is either C section or
giving the mother anti-viral medication during the labour. Either
way, it is recommended that the baby has follow-up swabs to check for
infection.
Recurrent genital herpes is considered to be of low risk to the
baby and the risks to the mother of caesarean section are considered
generally to be greater than proceeding with a vaginal delivery in
the absence of symptoms at the commencement of labour. If there is a
recurrence late in the pregnancy, treatment of the mother with
antiviral medication is considered a reasonable course of action.
You will see from the reading material that the idea that you put
forward about recurrences and effects on the baby is not correct. The
key risk to a developing fetus is when the mother contracts genital
herpes for the first time in pregnancy. For women with recurrences
during pregnancy, these will not affect the baby except at the time
of the birth.
Herpes is not carried in the semen. Usually people ask this
question when they are concerned that the fetus will become infected
at the time of conception. This is not the way the fetus becomes
infected with the virus.
Please do write again if you wish to discuss any issues further.
Kind regards, Catherine Cook Nurse Counsellor IHA
