Herpes simplex virus (HSV) infection is prevalent across the world among women of reproductive age. The major complication of maternal herpes during pregnancy is herpes simplex virus (HSV) transmission to the newborn, as neonatal infection can cause severe illness. It can affect their central nervous system or multiple organs, such as the liver and lungs. The infection may lead to the death of the newborn.
Neonatal Herpes Transmission
Transmission of HSV to neonates usually occurs during childbirth as a result of direct contact with the virus that is shed from infected sites (vulva, vagina, cervix, perianal area). Viral shedding can occur even in the absence of signs and symptoms in the mother. The highest risk for neonatal infection occurs in women who have a newly acquired (primary or nonprimary first-episode) genital HSV infection near the time of delivery of the baby. If you were infected before you became pregnant, the risk of transmitting the virus is low. The risk of neonatal disease is extremely low in women with recurrent HSV infection. However, it’s very important to ensure that there is no outbreak at the time of birth.
Women without a history of genital herpes
For women without any known history of genital HSV who present with a new genital ulcer during pregnancy, antiviral therapy is started even if the results of viral studies are not available as yet. The first-line treatment is with oral acyclovir 400 mg three times daily for 7 to 10 days. An alternative treatment option includes valacyclovir. It can lead to fewer maternal and fetal complications.
Suppressive therapy at 36 weeks of pregnancy
For all those women who present with a genital HSV lesion anytime during pregnancy, whether with a primary, nonprimary first-episode or recurrent infection, daily suppressive therapy at 36 weeks of gestation is recommended until the onset of childbirth. Daily suppressive therapy has an advantage over no other treatment at all, as it reduces the risk of recurrence of HSV delivery, and hence the likelihood of cesarean delivery. Although safety data regarding valacyclovir is limited, the use of acyclovir is safe for the fetus at any time during pregnancy.
Cesarian delivery
Cesarian delivery can potentially decrease the risk of newborn infection. However, sometimes it may even fail to do so. Women with a history of HSV and genital HSV lesions or symptoms at the time of labor usually benefit from cesarean delivery.
Screening pregnant women for HSV
Although some experts can recommend against it, serologic screening with accurate tests is available. Screening has been proposed to identify women without any known history of herpes simplex virus (HSV) so that they can take precautions to avoid acquiring an HSV infection. Screening can also identify women with a past medical history of HSV so they can be offered suppressive antiviral therapy, examined carefully for lesions at the onset of labor, and offered cesarean delivery if needed.
Maternal and fetal monitoring
Acyclovir is often well-tolerated by both the mother and the fetus and does not require any kind of monitoring. Moreover, weekly genital cultures or polymerase chain reaction (PCR) testing for HSV during late gestation are not recommended, as they do not predict shedding at the time of delivery, which is the source of neonatal infection. Maternal HSV is not an indication for antepartum fetal monitoring (nonstress test, biophysical profile) since the fetus and placenta (from which fetus attaches to the womb takes its nutrition) are typically not infected.
Antepartum obstetric procedures
Procedures that are performed through the cervix (birth canal) (e.g., cerclage, chorionic villus sampling) are typically avoided in women with genital lesions to reduce the risk of infecting the womb but may be performed in patients who do not have genital lesions. Procedures that are performed through the abdomen (e.g., amniocentesis, fetal blood sampling) can be performed even in women with active genital disease.
