From the Guidelines
Cesarean delivery is the best mode of delivery for a patient with an active lesion of secondary Herpes Simplex Virus (HSV) at the time of delivery.
Rationale
- The risk of transmission to the neonate from an infected mother is high among women who acquire genital herpes near the time of delivery, with a transmission rate of 30%-50% 1.
- Women with a genital herpes prodrome or visible HSV genital lesions at the onset of labor are recommended to have a cesarean delivery to reduce the risk of transmission to the neonate 1.
- The American College of Obstetrics and Gynecology recommends against routine screening for HSV serostatus during pregnancy, but recommends screening pregnant women for a history of genital herpes 1.
- Suppressive therapy with acyclovir (400 mg TID) or valacyclovir 500 mg BID starting at 36 weeks’ gestational age has been shown to decrease the risk of viral shedding, recurrences, and cesarean deliveries in women with a history of genital herpes 1.
- Key considerations for preventing neonatal herpes include preventing acquisition of genital HSV infection during late pregnancy, and counseling susceptible women to avoid unprotected genital and oral sexual contact during late pregnancy 1.
From the Research
Mode of Delivery for Patients with Active Lesions of Secondary Herpes Simplex Virus (HSV)
The best mode of delivery for a patient with an active lesion of secondary Herpes Simplex Virus (HSV) at the time of delivery is a topic of discussion among medical professionals.
- The risk of transmitting HSV to an infant during delivery is determined in part by the mother's previous immunity to HSV, with women with primary genital HSV infections being 10 to 30 times more likely to transmit the virus to their newborn infants than are women with recurrent HSV infection who are shedding virus at delivery 2.
- Elective cesarean delivery should be performed in laboring patients with active lesions to reduce the risk of neonatal herpes 3, 4.
- When a recurrence of genital herpes is underway at the onset of labor, cesarean delivery is most likely to be considered when the membranes are intact and vaginal delivery in cases of prolonged rupture of membranes 5.
- Antiviral prophylaxis with acyclovir is recommended from 36 weeks of gestation until delivery in women with a history of genital herpes to reduce the risk of neonatal herpes 3, 5.
Key Considerations
- The risk of neonatal herpes is estimated at between 25% and 44% if a non primary and primary first genital herpes episode is ongoing at delivery, and 1% for a recurrence 5.
- Neonatal herpes is rare and mainly due to HSV-1, and in most cases, mothers have no history of genital herpes 5.
- Any newborn with suspected neonatal herpes should be treated with intravenous acyclovir before the PCR results are available 5.