2. Importance
Risk of transmission of HSV to neonate during
delivery – 40% in 5 large studies
Neonatal Herpes- severe neurological impairment and
death
HSV -2 neonatal infection has worse prognosis than
HSV- type 1
Factors affecting transmission include type of
maternal infection , presence of maternal antibodies,
mode of delivery , duration of rupture of membrane
before delivery.
3. Important questions
Is this a primary or recurrent infection?
What trimester of pregnancy is the woman in?
4. First episode in 1st and 2nd
trimester of pregnancy
Same day referral to GUM
Confirm diagnosis with viral swabs
Aciclovir given within 5 days of onset of symptoms –
200mg 5times daily or 400mg 3 times daily.
Aciclovir good safety record in pregnancy and no
teratogenicity reported
Inform obstetrician
Aim for vaginal delivery
5. First episode in 3rd trimester
Refer, diagnose and treat
Refer to obstetrician
Serology typing to distinguish type 1 and type 2.( IgG
specific antibody testing compared with swab
cultures)
Caesarean section is recommended for women with
first episode within 6 weeks of EDD.
Intravenous aciclovir for the mother intra-partum is
considered
6. Recurrent Herpes
Much smaller risk of transmission – 3%
Presence of maternal antibodies protect baby
Confirm diagnosis
Antiviral treatment not usually indicated.
Refer obstetrician
Aim for vaginal delivery if no lesions present during labour
if genital lesions are present at onset of labour, current UK
practice is caesarean section., but risk very small.
If vaginal delivery with active lesions then GP and midwife
should monitor for signs of neonatal HSV.
7. Primary V recurrent Herpes
Primary herpes
bilateral lesions – ulcer, fissure, blisters
flu-like prodrome 5-7 days, tender inguinal nodes,
local edema, tingling pain in genitals
untreated episodes last 3 weeks
Recurrent herpes
Unilateral lesions
Last less than 10 days without treatment
