Genital Herpes in Pregnancy

1. See Also
   1. Neonatal Herpes Simplex Virus
   2. Genital Herpes
   3. Primary Genital Herpes
   4. Secondary Genital Herpes
2. Findings
   1. See Genital Herpes
   2. See Primary Genital Herpes
   3. See Secondary Genital Herpes
3. Management: Pregnancy (> 36 weeks gestation)
   1. Treat primary HSV II infections on Primary Genital Herpes protocol
   2. Culture Cervix and lesion every 3-5 days until negative
   3. Acyclovir if indicated
      1. See below for prevention of Neonatal HSV transmission
   4. Cesarean Section indications
      1. HSV II Culture positive
      2. All women with active HSV II lesions
4. Complications: Vertical transmission
   1. Neonatal Herpes Simplex Virus
5. Prevention: Neonatal Herpes Simplex Virus transmission
   1. Prevent transmission from HSV positive partner
      1. Abstinence or Condom use during pregnancy
      2. Consider Vaccine below
      3. Antiviral prophylaxis for HSV positive partner
      4. Avoid oral-genital contact if Oral HSV in partner
      5. Vaccinations as of yet are experimental (e.g. HSV-2 Glycoprotein-D-Adjuvant Vaccine)
         1. Stanberry (2002) N Engl J Med 347:1652-61 [PubMed]
   2. Identify HSV II risks in all pregnant women
      1. Personal history of HSV II
      2. Partners with HSV II
      3. Screen at first Prenatal Visit and perinatally
   3. Cesarean Section for all women with active lesions
   4. Acyclovir
      1. Acyclovir 400 mg orally twice daily from 36 weeks until delivery
         1. Indicated in all pregnant women with Genital Herpes history
      2. Also treat any Primary Genital Herpes outbreak during pregnancy
      3. Also treat all women with near-term or perinatal Genital Herpes outbreak
   5. References
      1. Sheffield (2003) Obstet Gynecol 102:1396-403 [PubMed]
6. References
   1. Beauman (2005) Am Fam Physician 72(8):1527-34 [PubMed]
   2. Groves (2016) Am Fam Physician 93(11): 928-34 [PubMed]
   3. Nadelman (2000) Postgrad Med 107(3):189-95 [PubMed]