Wed, 18 Oct 2000

Active lesions prevent breast-feeding


Dear Doctor,

I read your recent article in The Jakarta Post and I'm very impressed with what you have written.

I have a question to ask.

I am seven months pregnant and a recent blood test revealed that I have an infection called herpes in my system. Where exactly, I don't know. My doctor says he cannot give me medical aid because I am expecting a baby. I want to know whether I can breast-feed my baby if another blood test taken after giving birth shows that the infection is still there. And, if according to the blood test the infection is no longer there, what precautions or medicines I should take to make sure that I no longer have the infection? I would be grateful for your reply.

Thank you and regards,



Dear Isha,

YES you can breast-feed your baby unless there are active lesions on the breast. This would be a small cluster of painful blisters, like boils, that easily break and spread the virus. About the blood test, I am sorry to tell you that once you have the herpes virus in your nervous system, you will always be a carrier of the virus.

There are two types of herpes virus. One, which is located above the waist in areas such as the mouth, lips and breast, is known as Herpes Simplex Virus Type 1(HSV-1). The other is typically located in the genitalia and is known as HSV-2.

As you are a pregnant woman, your nervous system is under a lot of strain and the risk of active lesions appearing during your pregnancy is high. Consequently I would recommend that you keep a close watch for any type of lesions and ask your doctor for assistance.

Once your baby is born take extra care in protecting him from exposure to any open lesions. If you find that you have HSV1, simply use a mask and keep your hands clean. Typically, the highest rate of infection in infants is between the ages of one to three years due to exposure to respiratory droplets or infected secretion. The medicine that is available for herpes treatment is, as your doctor said, not recommended for pregnant women and it is only good for reducing the time that the lesions are present. It does not prevent lesions from occurring. Because the virus is latent (sleeping) you can never be sure it will not become active, consequently part of your personal care routine must now be to examine yourself for any signs of active lesions.

Some of the known stimulants which activate herpes are stress, injury, ultra violet light, and immunosuppression (weak immunity). Thank you and take care.

Dr. Donya


Dear Dr. Donya,

I am French, 27, have no children but currently I am three weeks pregnant. My questions are:

1. I have cats at home and through what I read on the Web, I should be vaccinated against toxoplasmosis. However, the hospital I contacted in Denpasar does not have the vaccine. The doctor told me on the phone to get an injection of "tetanos-plasmo" because it is the same. Is the doctor right?

I now avoid touching my cat. I no longer allow her into my bedroom or onto my bed. Am I right to do so? Can I still take her into my arms and cuddle her as before?

2. What other shots should I have?

3. Can I use homeopathic medicines (when I have a sore throat or flu symptoms)?

4. Can I go to the dentist to have a crown put on one of my teeth? Is there any risk regarding the anesthetic gas?

5. I go to work by motorbike. When do you think I should stop riding a motorbike? If I have to stop riding a motorbike, can I still ride a car? I work six days a week.

6 I will go back to France to give birth. What month of pregnancy is the limit for such a trip?

7 My last question is about a good and reliable gynecologist- obstetrician in Bali. When should I consult one? I am worried a bit about the examination (can you tell me what the doctor will do?). Thank you.


Tampaksiring, Bali


Dear Sandie,

You are right to use caution with the handling of your cats. Toxoplasmosis is an infection caused by the protozoan parasite. Humans becomes infected by ingesting the parasite (cyst) that exists in meat or by ingesting the resistant stage (eggs) excreted in cat feces.

There is no vaccine to control toxoplasmosis in humans. There is a toxoplasmosis vaccine, but studies show only its effectiveness in pigs and lambs. If you have contact with cats you can check your blood by a method called "serologic tests" for toxoplasmosis. If the test is negative or unknown the best things to do are:

* Avoid activities that expose you to cat feces, such as changing litter boxes, gardening and landscaping, or wear gloves if you want to do these activities.

* The daily changing of your cat's litter box will decrease the chance of infection because the oocyst (eggs) are not infected during the first one to two days after passage and are destroyed by being placed in near-boiling water for five minutes.

* Feed your cat a commercial cat food and prevent it from eating undercooked kitchen and hunting rodents.

* Avoid food contaminated with oocyst by eating cooked or smoked meats, washing fruits and vegetables, cleaning kitchen surfaces after handling fruits, vegetables and/or raw meats.

The only vaccine recommended for pregnant woman in Asian countries is tetanus, which prevents a tetanus infection during delivery from contaminated equipment. But if you are sure that the hospital equipment is sterile you may not want the vaccine.

The tetanus vaccine involves two shots (with a one-month interval between shots), and the best time to get vaccinated is between three months and eight months of pregnancy.

As for flues and soar throats, try drinking plenty of warm water or a hot lemon drink, and rest as much as possible; you may get past it without having to take any form of chemical medication.

About homeopathic medicine, I cannot say one way or the other as I have no knowledge on this subject.

Typically, there is no problem with the dentist, but do your best to avoid systemic anesthetic gas. Regarding transportation, it is always safer in a car rather than on a motorbike. If the fetus is healthy he will be strong and your womb is the best protection.

Most airlines have a policy that you must fly before 34 weeks of pregnancy.

Once you know you are pregnant, you should start prenatal care immediately. See an obstetrician, eat nutritious foods, get plenty of rest, use precaution with medications and do not smoke any form of tobacco or drink alcohol. Normally during your initial exam you will be asked some questions about your menstruation dates, history of previous pregnancy and children, medical history and any allergies you have, then the doctor will do a complete physical examination and may administer another pregnancy test. The pelvic examination depends on the doctor; if you do not want one you can discuss this with your doctor. Take care and I am happy to help you.

Dr. Donya