Today I saw a mom with a history of herpes (not on nipples in past) who has
been pumping with some limited latch-ons to right breast while her full
term, otherwise healthy baby is in the Special Care Nursery for periodic
apnea.  Mom's left breast has an inverted nipple and baby has never really
latched onto it.  Originally she was pumping about 60ml per side every 3
hours, now she has developed clear fluid filled blisters entirely covering
the tip of both nipples.  The little crevices normal on all nipples that
form little islands of tissue are ALL covered with individual little
blisters. I'd estimate 15 - 20 blisters per nipple.  Her left (the inverted
- now partially everted) nipple is also deeply (1/4 inch) fissured between
the blisters.  Her supply has dwindled to less than 30 ml on the everted
right side and less than 20 ml on the inverted left side. She is also
extremely engorged, going from a "DD" cup size to an "H".  No flu like
symptoms, mom is tired (exhausted & sleep deprived and mega stressed out)but
not "sick feeling". Mom has no fever.

She was pumping on full suction without gradual increases to start.   This
may have been the causative factor with blisters forming, blocking drainage
and compounding engorgement.  She is using a hospital grade piston pump with
a double kit.

She has now cut down to minimal suction for 10 minutes every 2 hours.  The
pain is very bad, with tender nipple tips, painful to hand express on
areola, and deep breast pain especially in the upper outer quadrant where
the engorgement is most extreme.

                       OR she may have herpes on the nipple.

The nipples are being cultured for herpes. The breastmilk is on hold.  The
neonatologist is not too excited about the baby's possible exposure to
herpes as the baby did receive 3 days of acyclovar during the first 3 days
of life.

Baby is 7 days old now, going home tomorrow on apnea monitor.

Other comfort/treatment measures for mom are being employed including
cabbage &/or ice between feeds, warm wet compresses prior to pumping,
minimal pressures on pump, more rest, ibuprophen, lansinoh and air drying.

My question and request to the group is have you ever seen nipple herpes?
If so please describe it.  (I've seen Chele's areolar herpes picture - this
is different)

Many thanks in advance for your speedy (please) replies.


-- Carla (just north of Washington, DC)