HSV in pregnancy: Difference between revisions

Revision as of 01:51, 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

If acquired during pregnancy, HSV can cause spontaneous abortion and should be treated for 7 to 10 days
Can also cause congenital HSV in the fetus

Management

If HSV-2-positive, then if there are lesions or PCR-positivity at time of labour, could consider Cesarean section

@@ 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
+*If acquired during pregnancy, HSV can cause spontaneous abortion and should be treated for 7 to 10 days
+*Can also cause [[congenital HSV]] in the fetus
+== Management ==
+*If HSV-2-positive, then if there are lesions or PCR-positivity at time of labour, could consider Cesarean section