HSV in pregnancy: Difference between revisions
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==Background== |
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*Infection with [[herpes simplex virus]] during pregnancy |
*Infection with [[herpes simplex virus]] during pregnancy |
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===Epidemiology=== |
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*Risk of perinatal transmission varies by maternal serostatus relative to the active infection at the time of delivery |
*Risk of perinatal transmission varies by maternal serostatus relative to the active infection at the time of delivery |
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**Newly acquired |
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***First-episode primary infection (mother has no serum antibodies to HSV-1 or -2 at onset): risk of transmission is about 60% |
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***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% |
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**Recurrent (mother has pre-existing antibodies to the HSV type that is isolated from the genital tract): risk of transmission is less than 2% |
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==Clinical Manifestations== |
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*Typical lesions of genital herpes |
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*Can |
*Can cause [[congenital HSV]] in the fetus |
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==Management== |
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*If HSV-2-positive, then if there are lesions or PCR-positivity at time of labour, could consider Cesarean section |
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*[[Cesarean section]] should be offered in the following scenarios: |
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**Prodromal symptoms or active lesions at the time of delivery |
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**First-episode genital herpes in the third trimester |
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*Women with recurrent genital herpes should be offered [[acyclovir]] or [[valacyclovir]] starting at 36 weeks gestation |
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*For the post-partum management of the neonate, refer to [[neonatal HSV]] |
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== Further Reading == |
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* 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] |
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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%
- Newly acquired
| 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 | 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
Further Reading
- SOGC Guidelines for the Management of Herpes Simplex Virus in Pregnancy. J Obstet Gynaecol Can. 2017;39(8):e199-e205. doi: 10.1016/j.jogc.2017.04.016
