HSV in pregnancy: Difference between revisions

Latest revision as of 02:30, 21 July 2020

Background

Infection with herpes simplex virus during pregnancy

Epidemiology

Risk of perinatal transmission varies by maternal serostatus relative to the active infection at the time of delivery
- Newly acquired
  - First-episode primary infection (mother has no serum antibodies to HSV-1 or -2 at onset): risk of transmission is about 60%
  - First-episode nonprimary infection (mother has a new infection with one HSV type in the presence of antibodies to the other type): risk of transmission is less than 30%
- Recurrent (mother has pre-existing antibodies to the HSV type that is isolated from the genital tract): risk of transmission is less than 2%

Serology	Infected with	Risk of perinatal transmission	Neonatal HSV per 100,000 births
Negative	HSV-1 or -2	60%	54
HSV-1 only	HSV-2	≤30%	26
HSV-2 only	HSV-1	≤30%	35
HSV-1 + HSV-2	HSV-1 or -2	≤2%	12
HSV-2 ± HSV-1			22

Clinical Manifestations

Typical lesions of genital herpes
Can cause congenital HSV in the fetus

Management

If acquired during pregnancy, can be treated for 7 to 10 days if severe
Cesarean section should be offered in the following scenarios:
- Prodromal symptoms or active lesions at the time of delivery
- First-episode genital herpes in the third trimester
Women with recurrent genital herpes should be offered acyclovir or valacyclovir starting at 36 weeks gestation
For the post-partum management of the neonate, refer to neonatal HSV

@@ Line 1: / Line 1: @@
+==Background==
-* Infection with [[herpes simplex virus]] during pregnancy
-* Highest risk for transmission is perinatal primary infection
+*Infection with [[herpes simplex virus]] during pregnancy
+===Epidemiology===
+*Risk of perinatal transmission varies by maternal serostatus relative to the active infection at the time of delivery
+**Newly acquired
+***First-episode primary infection (mother has no serum antibodies to HSV-1 or -2 at onset): risk of transmission is about 60%
+***First-episode nonprimary infection (mother has a new infection with one HSV type in the presence of antibodies to the other type): risk of transmission is less than 30%
+**Recurrent (mother has pre-existing antibodies to the HSV type that is isolated from the genital tract): risk of transmission is less than 2%
 {| class="wikitable"
+!Serology
-|+ Risk of neonatal acquisition of HSV based on maternal serostatus
+!Infected with
-! Serology      !! Neonatal HSV per 100,000 births
+!Risk of perinatal transmission!!Neonatal HSV per 100,000 births
 |-
-| Negative      || 54
+|Negative
+|HSV-1 or -2
+|60%||54
 |-
-| HSV-1 only    || 26
+|HSV-1 only
+|HSV-2
+| rowspan="2" |≤30%||26
 |-
-| HSV-2 only    || 35
+|HSV-2 only
+|HSV-1||35
 |-
-| HSV-1 + HSV-2 || 12
+|HSV-1 + HSV-2
+|HSV-1 or -2
+|≤2%||12
 |-
-| HSV-2 ± HSV-1 || 22
+|HSV-2 ± HSV-1
+|
+| ||22
 |}
+==Clinical Manifestations==
-* If acquired during pregnancy, HSV can cause spontaneous abortion and should be treated for 7 to 10 days
-* If HSV-2-positive, then if there are lesions or PCR-positivity at time of labour, could consider Cesarean section
+*Typical lesions of genital herpes
+*Can cause [[congenital HSV]] in the fetus
+==Management==
+*If acquired during pregnancy, can be treated for 7 to 10 days if severe
+*[[Cesarean section]] should be offered in the following scenarios:
+**Prodromal symptoms or active lesions at the time of delivery
+**First-episode genital herpes in the third trimester
+*Women with recurrent genital herpes should be offered [[acyclovir]] or [[valacyclovir]] starting at 36 weeks gestation
+*For the post-partum management of the neonate, refer to [[neonatal HSV]]
+== Further Reading ==
+* SOGC Guidelines for the Management of Herpes Simplex Virus in Pregnancy. ''J Obstet Gynaecol Can''. 2017;39(8):e199-e205. doi: [https://doi.org/10.1016/j.jogc.2017.04.016 10.1016/j.jogc.2017.04.016]