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Anonymous wrote:

Anonymous wrote:

Anonymous wrote:
Wouldn't it be good information for a pregnant woman to be aware of? So many weird changes happen to your body when you're pregnant. If a woman knew that she tested positive for Herpes then she would know how important it was to report outbreaks to her doctor.

I've known people who have gone into labor at home and didn't make it to the hospital in time and wound up delivering at home or they were crowning by the time they got to the hospital with no time for a c-section.

Not really. You might think so, until you look at the data. These are evidence-based guidelines derived from population-based data.

When you chase information for the sake of information (without looking at whether it positively affects outcomes), you end up introducing unnecessary procedures and having a lot of unintended negative consequences. I mean, women are free to request the testing. Clinicians are free to offer the testing. But when you do it in the absence of symptoms brought up by the patients, or symptoms elicited in questions by the clinician, or physical exam findings noted at the regularly scheduled visits, you tend to have worse outcomes overall. You introduce more problems than you fix.

Of course, if a given individual has a more high-risk history than average, or if there is something else that makes them atypical, clinical judgment comes even more into play. You can't standardize that.

But when it comes to typical cases, this stuff isn't always intuitive -- sometimes it's counterintuitive. That's why professional organizations have published guidelines and why they lay out the level of evidence and track the studies for those who want to dig deeper.

That is the biggest double talk that I have had read.

Basically you are saying that arming women with information about their own bodies doesn't work because they are too stupid to do anything with information they get. OMG.

Nope. I'm saying you probably don't have medical training, an understanding of statistical analysis, or experience in working with population data. It's okay -- you just don't know what you don't know.

Look. You can ask your OB-Gyne or nurse midwife to be tested for anything you want to be tested for. Anyone can do that. And if they won't do it (they almost certainly would), you could easily find someone that would. And nobody here, including me, is saying that's a bad thing.

But ACOG is not going to recommend routine screening of all pregnant women given that many factors (of which the false positive rate is only one) add up to show -- in a demonstrable, measurable, and reproducible way when applied across a population -- in more errors and negative outcomes than they fix. Especially when the only recommendations to changing practice are when there are other factors in the situation external to this testing.

And like I said -- if you want to get tested, get tested. Anyone can get tested. It's just not routinely recommended.

---

PS: This is not intuitive stuff, I know. But unintended negative consequences are real. For example, you'd think that routine screening for cystic fibrosis would be a good thing, right? Testing all newborns for this at the mandated heel prick would "arm families with information about their children's bodies" and medical futures, and that would be unequivocally good, right?

You'd be wrong. Children died sooner when identified as having this genetic disorder at birth.

They fixed the circumstances that fed into that, but without maintaining skepticism about the intuitively right answer, that would not have happened. And when it comes to general guidelines, there is more responsibility for being rigorous than when individuals are taking the responsibility by making the request for themselves.

Anonymous wrote:

Anonymous wrote:
Wouldn't it be good information for a pregnant woman to be aware of? So many weird changes happen to your body when you're pregnant. If a woman knew that she tested positive for Herpes then she would know how important it was to report outbreaks to her doctor.

I've known people who have gone into labor at home and didn't make it to the hospital in time and wound up delivering at home or they were crowning by the time they got to the hospital with no time for a c-section.

Not really. You might think so, until you look at the data. These are evidence-based guidelines derived from population-based data.

When you chase information for the sake of information (without looking at whether it positively affects outcomes), you end up introducing unnecessary procedures and having a lot of unintended negative consequences. I mean, women are free to request the testing. Clinicians are free to offer the testing. But when you do it in the absence of symptoms brought up by the patients, or symptoms elicited in questions by the clinician, or physical exam findings noted at the regularly scheduled visits, you tend to have worse outcomes overall. You introduce more problems than you fix.

Of course, if a given individual has a more high-risk history than average, or if there is something else that makes them atypical, clinical judgment comes even more into play. You can't standardize that.

But when it comes to typical cases, this stuff isn't always intuitive -- sometimes it's counterintuitive. That's why professional organizations have published guidelines and why they lay out the level of evidence and track the studies for those who want to dig deeper.

That is the biggest double talk that I have had read.

Basically you are saying that arming women with information about their own bodies doesn't work because they are too stupid to do anything with information they get. OMG.

Anonymous wrote:

Anonymous wrote:I'm doubtful she did. But if the test comes back positive, then there is no other explanation than infidelity.

God, you're a douche. I hope your wife does well in the divorce.

+ 1,000,000

Anonymous wrote:

Anonymous wrote:I'm doubtful she did. But if the test comes back positive, then there is no other explanation than infidelity.

God, you're a douche. I hope your wife does well in the divorce.

Why am I a douche? Nothing I said is untrue

Anonymous wrote:I'm doubtful she did. But if the test comes back positive, then there is no other explanation than infidelity.

God, you're a douche. I hope your wife does well in the divorce.

Anonymous wrote:The point is HPV can be dormant in your wife, then become active and infect you. But there are typically no symptoms.

Exactly. I had HPV years ago, if me DH suddenly tests positive for an STD, we'll attribute it to that, not that either one of us was unfaithful

Anonymous wrote:Also, certain STDs can lay dormant for years before you ever show physical symptoms (HPV, strains of Herpes)

Exactly. I highly doubt your wife had time for catting around while she was home with YOUR newborn child.

Anonymous wrote:
Wouldn't it be good information for a pregnant woman to be aware of? So many weird changes happen to your body when you're pregnant. If a woman knew that she tested positive for Herpes then she would know how important it was to report outbreaks to her doctor.

I've known people who have gone into labor at home and didn't make it to the hospital in time and wound up delivering at home or they were crowning by the time they got to the hospital with no time for a c-section.

Not really. You might think so, until you look at the data. These are evidence-based guidelines derived from population-based data.

When you chase information for the sake of information (without looking at whether it positively affects outcomes), you end up introducing unnecessary procedures and having a lot of unintended negative consequences. I mean, women are free to request the testing. Clinicians are free to offer the testing. But when you do it in the absence of symptoms brought up by the patients, or symptoms elicited in questions by the clinician, or physical exam findings noted at the regularly scheduled visits, you tend to have worse outcomes overall. You introduce more problems than you fix.

Of course, if a given individual has a more high-risk history than average, or if there is something else that makes them atypical, clinical judgment comes even more into play. You can't standardize that.

But when it comes to typical cases, this stuff isn't always intuitive -- sometimes it's counterintuitive. That's why professional organizations have published guidelines and why they lay out the level of evidence and track the studies for those who want to dig deeper.

I would assume she caught it while getting preggo with AP's kid. Sorry dude.

Anonymous wrote:

Anonymous wrote:If you look at the complications that can arise in newborns exposed to Herpes...it is sort of crazy that it isn't standard procedure to test for it.

It's not crazy if the information would not cause you to do anything differently. It only makes sense if there is something you could do differently, as a medical care provider, to help improve outcomes.

You can't clear herpes with treatment. It's not like knowing she tested positive would mean you could "fix it."

If there are active lesions, or if there is a primary infection (which means active lesions and a viral syndrome with sick symptoms) during the pregnancy, then you manage the pregnancy differently -- depending on the timing, for example, you might recommend a C-section. But just having an HSV+ history without active lesions does not mean you improve outcomes by doing a C-section.

And you don't do antiviral suppressive therapy just for the hell of it, in case she is shedding virus but without active lesions. The risk-benefit analysis doesn't support it -- medications come with their own side effects.

https://www.guidelinecentral.com/summaries/management-of-herpes-in-pregnancy/#section-420
American College of Obstetricians and Gynecologists (ACOG). Management of herpes in pregnancy. Washington (DC): American College of Obstetricians and Gynecologists (ACOG); 2007 Jun. 10 p. (ACOG practice bulletin; no. 82). [68 references]

Excerpts:

Recommendations:

Women with active recurrent genital herpes should be offered suppressive viral therapy at or beyond 36 weeks of gestation.

Cesarean delivery is indicated in women with active genital lesions or prodromal symptoms, such as vulvar pain or burning at delivery, because these symptoms may indicate an impending outbreak.

Cesarean delivery is not recommended for women with a history of HSV infection but no active genital disease during labor.

And especially --

Routine antepartum genital HSV cultures in asymptomatic patients with recurrent disease are not recommended.

AND

Routine HSV screening of pregnant women is not recommended.

Wouldn't it be good information for a pregnant woman to be aware of? So many weird changes happen to your body when you're pregnant. If a woman knew that she tested positive for Herpes then she would know how important it was to report outbreaks to her doctor.

I've known people who have gone into labor at home and didn't make it to the hospital in time and wound up delivering at home or they were crowning by the time they got to the hospital with no time for a c-section.

Anonymous wrote:If you look at the complications that can arise in newborns exposed to Herpes...it is sort of crazy that it isn't standard procedure to test for it.

It's not crazy if the information would not cause you to do anything differently. It only makes sense if there is something you could do differently, as a medical care provider, to help improve outcomes.

You can't clear herpes with treatment. It's not like knowing she tested positive would mean you could "fix it."

If there are active lesions, or if there is a primary infection (which means active lesions and a viral syndrome with sick symptoms) during the pregnancy, then you manage the pregnancy differently -- depending on the timing, for example, you might recommend a C-section. But just having an HSV+ history without active lesions does not mean you improve outcomes by doing a C-section.

And you don't do antiviral suppressive therapy just for the hell of it, in case she is shedding virus but without active lesions. The risk-benefit analysis doesn't support it -- medications come with their own side effects.

https://www.guidelinecentral.com/summaries/management-of-herpes-in-pregnancy/#section-420
American College of Obstetricians and Gynecologists (ACOG). Management of herpes in pregnancy. Washington (DC): American College of Obstetricians and Gynecologists (ACOG); 2007 Jun. 10 p. (ACOG practice bulletin; no. 82). [68 references]

Excerpts:

Recommendations:

Women with active recurrent genital herpes should be offered suppressive viral therapy at or beyond 36 weeks of gestation.

Cesarean delivery is indicated in women with active genital lesions or prodromal symptoms, such as vulvar pain or burning at delivery, because these symptoms may indicate an impending outbreak.

Cesarean delivery is not recommended for women with a history of HSV infection but no active genital disease during labor.

And especially --

Routine antepartum genital HSV cultures in asymptomatic patients with recurrent disease are not recommended.

AND

Routine HSV screening of pregnant women is not recommended.

OP, is it herpes you’re looking for?

Because even if your wife is the only woman you’ve had intercourse with EVER, that doesn’t mean it was her. All those times you were getting BJs to “not have sex”, anyone with oral herpes “cold sores” could have passed it on to you genitally.

Anonymous wrote:

Anonymous wrote:^I think you quoted the wrong poster but I'm not sure.

At any rate, you are assuming 1) That Op's wife was NOT tested for Herpes 2) Never had an outbreak that her doctor saw and never brought an outbreak to her doctor's attention. And Op never noticed an outbreak on his wife while he was having sex with her.

I think that it is very unlikely.

1. I'm not assuming anything.

2. I'm saying that it is irresponsible to assume a medical provider would necessarily do testing above and beyond the standard recommendations without any additional reason to think so.

3. That's it.

Yes. That is where the "IF" comes in. Some providers test for it, others don't. And patients can opt out of the testing if they choose to do so. There is no way to know how this was handled with Op's wife. Maybe Op should actually ask his wife!

Anonymous wrote:Yes, your wife definitely cheated on you during maternity leave. She felt good, she definitely didn't feel fat, wasn't losing her hair, had plenty of sleep, wasn't sore at all, and had lots and lots of free time.

And wasn't bleeding for half the time!