Herpes Simplex And Pregnancy

Clinical description

Although its incidence is 1 in 3,000 to 10,000 live births, neonatal herpes simplex virus (HSV) infection is associated with a case fatality rate as high as 50-60%, with 60-70% of survivors suffering severe neurologic sequelae.

Neonatal HSV infection results from in utero transmission (5% of cases); contact with infected maternal genital secretions at delivery (85%); and postnatal transmission (10%).

Primary HSV infection is the first occurrence of a genital HSV lesion without pre-existing HSV-1 or HSV-2 antibodies.

Primary infections are associated with a higher risk of vertical transmission at 40-44%, with a higher risk if infection was acquired near time of delivery.

Signs and symptoms

History/Exam Classic presentation of small, very painful vesicular lesions, but suspect for any vesicular or ulcerative genital lesions with or without pain; prior history of HSV is not always elicited

Treatment

• Indication: Acyclovir dose (oral tablets)
• First clinical episode: 200 mg 5x daily for 7-14 days or 400 mg TDS for 7-14 days
• Recurrent episode(s): 200 mg 5x daily for 5 days or 400 mg TDS for 5 days
• History of HSV (daily suppressive therapy): 400 mg TDS at ≥ 36 wks gestation until delivery
• Active lesions: treat with oral acyclovir, topical lidocaine and sitz baths.
• Active lesions and PPROM: expectant management because the risks ofprematurity often outweigh the

risks of neonatal HSV infection; treat withoral acyclovir.

• Disseminated HSV or HSV-related pneumonitis, hepatitis, and/orencephalitis: treat with acyclovir IV.
• Mode of delivery
• Vaginal delivery if there are no active genital lesions or prodromalsymptoms.
• Caesarean delivery if there are active genital lesions or prodromalsymptoms even if membranes

are ruptured.

• Cesarean delivery if women presents with first episode of HSV in the 3rd trimester
• Vaginal delivery with lesions covered if there are non-genital lesions(i.e. on the thighs).
• Continue Acyclovir antiviral therapy during intrapartum period
• Infant and infected mother can be together.
• Counsel on hand washing and hygiene techniques to prevent postnataltransmission.
• Breastfeeding is contraindicated only for breast lesion(s).