Dear Jennifer:  I believe you are right on every point, but I would
definitely get an informed and caring physician's opinion to be sure.  I
would call Ruth Lawrence if you cannot find another informed physician, as
she is considered an expert.

On the other hand, I'm not sure anyone's opinion matters this late in the
process anyway, except to confirm that mom should keep bf.

There is an over-the-counter topical medication in the US which is very
effective against herpes.  The brand name is Abreva, and it is a cream
containing 10% docosanol, made by Avanir Pharmaceuticals and distributed by
GlaxoSmithKline out of Pittsburgh, Pennsylvania.  It is fairly new, and you
may need to get an opinion from Tom Hale on safety if it is nursed off after
application, but considering the type of drug it is, and that it would
mostly be absorbed and that it is approved for application to the lips, I
doubt there will be a problem.

I am also puzzled over the doctor's choice of systemic antiviral.  Valtrex
is easier to take appropriately (fewer doses) and is considered by some to
be more effective at preventing future outbreaks than acyclovir.
Considering the convenience of Valtrex, I would ask why he specifically
chose to go with the more cumbersome Zovirax instead.
 
"Antivirals used for treatment of herpes are:

Acyclovir (ZoviraxR) 
Docosanol (AbrevaR) 
Penciclovir (DenavirR) 
Valacyclovir (ValtrexR) 
Famciclovir (FamvirR) 

     Which of the medicines can help stop the herpes from coming back again?

     Either valacyclovir or famciclovir can help suppress future outbreaks."


[abbreviated from
http://tristatehealthsystem.client.web-health.com/web-health/topics/GeneralH
ealth/generalhealthsub/generalhealth/STDs/herpes_Rx.html]

Your idea about covering the wound with a hydrogel dressing seems eminently
reasonable if position allows it, and should eliminate any possible concerns
with the Abreva as well.  I would be very interested in hearing a qualified
professional address this.

Finally, why is no one treating the four-year-old prophylactically with
antiviral?  And, why no systemic antiviral for the toddler with the
outbreak?


Arly Helm, MS, IBCLC

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