Patient Management/Treatment (continued)

Genital herpes in pregnancy

The risk for transmission to neonate from infected mother is high (30%-50%) among women who acquire genital herpes near time of delivery. The risk is low (<1%) in women with histories of recurrent herpes at term or who acquire genital HSV during the first half of pregnancy.

Prevention of neonatal herpes depends on avoiding acquisition of HSV during late pregnancy and avoiding exposure of the infant to herpetic lesions during delivery.

Women without symptoms or signs of genital herpes or its prodrome can give birth vaginally. Most specialists recommend that women with recurrent genital herpetic lesions at the onset of labor be delivered abdominally to prevent neonatal herpes. However, abdominal delivery does not completely eliminate the risk for HSV transmission to the infant.

Viral cultures during pregnancy of women with or without visible herpetic lesions do not predict viral shedding at the time of delivery. Therefore, routine viral cultures of pregnant women with recurrent genital herpes are not recommended.

Women who acquire genital HSV in late pregnancy should be managed in consultation with an expert. Some experts recommend acyclovir therapy in this situation, some recommend routine abdominal delivery, and some recommend both to reduce the risk of neonatal herpes.

Acyclovir treatment near term for women with recurrent herpes reduces the frequency of abdominal deliveries and many specialists recommend such treatment.

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