II. Findings
III. Epidemiology
- Genital Herpes recurs during pregnancy in 75% of women with known genital HSV
- High risk of vertical transmission with primary outbreak in third trimester
IV. Management: Pregnancy
- Treat HSV 2 infections that occur at anytime during pregnancy
- Duration
- Treat primary HSV 2 outbreak for 10 days
- Treat recurrent HSV 2 outbreak for 5 days
- Agents (choose one)
- Acyclovir 200 mg orally five times daily
- Valacyclovir (Valtrex) 500 mg orally twice daily
- Duration
- Peripartum (after 36 weeks gestation)
- Culture Cervix and lesion every 3-5 days until negative
- Viral Suppression
- See below for prevention of Neonatal HSV transmission
- Cesarean Section indications
V. Complications: Vertical transmission
VI. Prevention: Neonatal Herpes Simplex Virus transmission
- Prevent transmission from HSV positive partner
- Abstinence or Condom use during pregnancy
- Consider Vaccine below
- Antiviral prophylaxis for HSV positive partner
- Avoid oral-genital contact if Oral HSV in partner
- Vaccinations as of yet are experimental (e.g. HSV-2 Glycoprotein-D-Adjuvant Vaccine)
- Identify HSV II risks in all pregnant women
- Personal history of HSV II
- Partners with HSV II
- Screen at first Prenatal Visit and perinatally
-
Cesarean Section Indications
- Active HSV 2 lesions at time of delivery
- Prodromal Genital Herpes symptoms at time of delivery
- Viral Suppression (36 weeks until delivery)
- Indicated in all pregnant women with Genital Herpes history
- Also treat any Primary Genital Herpes outbreak during pregnancy (see above)
- Also treat all women with near-term or perinatal Genital Herpes outbreak
- Agents (choose one)
- Acyclovir 400 mg orally three times daily from 36 weeks until delivery
- Valacyclovir 250 mg orally twice daily from 36 weeks until delivery
- References