Genital Herpes in Pregnancy

by Richard Fischer, MD,
Co-Division Head, Maternal-Fetal Medicine, Professor, Department of Obstetrics and Gynecology, Section of Maternal-Fetal Medicine, Cooper University Hospital

Updated: Apr 11, 2006

Introduction
Infection with genital herpes simplex virus (HSV) is a major gynecological health problem.

•As of this writing, in the United States, approximately 45 million individuals aged 12 years or older (1 in 5) have been infected with genital herpes. Each year, 1.5 million new cases are diagnosed.
•Five percent of all women of childbearing age report a history of genital herpes, and up to 30% have antibodies to herpes simplex virus 2 (HSV-2).
•Two percent of women acquire genital HSV during pregnancy.
•Approximately 1500-2000 new cases of neonatal HSV infection are diagnosed each year. Neonatal HSV infection may lead to long-term neurologic impairment and death.
Despite strategies designed to prevent perinatal transmission, the number of cases of neonatal HSV infection continues to rise, mirroring the rising prevalence of genital herpes infection in women of childbearing age.


In 1999, the American College of Obstetricians and Gynecologists (ACOG) published a practice bulletin regarding HSV in pregnancy. Their conclusions were as follows:

Level B recommendations (based on limited or inconsistent scientific evidence)


•Women with primary HSV infection during pregnancy should be treated with antiviral therapy.
•Cesarean delivery should be performed on women with first-episode HSV infection who have active genital lesions at delivery.
•For women at or beyond 36 weeks of gestation with a first episode of HSV infection occurring during the current pregnancy, antiviral therapy should be considered.
Level C recommendations (based on consensus or expert opinion)


•Cesarean delivery should be performed on women with recurrent HSV infection who have active genital lesions or prodromal symptoms at delivery.
•Expectant management of patients with preterm labor or premature rupture of membranes and active HSV infection may be warranted.
•For women at or beyond 36 weeks of gestation who are at risk for recurrent HSV infection, antiviral therapy may be considered, although such therapy may not reduce the likelihood of cesarean delivery.
•In women with no active lesions or prodromal symptoms during labor, cesarean delivery should not be performed on the basis of a history of recurrent disease.
Currently, recurrent HSV infections account for only a small proportion of neonatal HSV infections. However, routine HSV suppression with antiviral agents, especially in pregnant women with a history of frequent recurrences, may suppress clinical recurrences during labor and may reduce the need for cesarean deliveries in these women.

In order to truly reduce the incidence of neonatal HSV infection, physicians and researchers must focus on the prevention and recognition of asymptomatic primary genital HSV infections. In the future, this might require a combination of PCR analysis for faster diagnosis, as well as type-specific serology to identify pregnancies at risk for primary HSV infections.

http://emedicine.medscape.com/article/274874-overview