Acyclovir Suppression to Prevent Recurrent Genital Herpesat Delivery

Abstract

OBJECTIVE: To determine if suppressive acyclovir near term decreased the frequency of clinical recurrences at delivery in women with recurrent genital herpes simplex virus (HSV) infection. METHODS: We conducted a prospective, double-blind, randomized trial in 234 women with recurrent genital herpes. Women with genital infection of any frequency were enrolled. Patients received either suppressive oral acyclovir 400 mg three times daily or an identical placebo after 36 weeks' gestation. Clinical lesions were identified, and HSV cultures were obtained at delivery. The frequencies of clinical and subclinical HSV recurrences at delivery were evaluated. RESULTS: Six percent of patients treated with acyclovir, and 14% of patients treated with placebo had clinical HSV at delivery (p = 0.046). No patients in the acyclovir group had positive HSV cultures, compared with 6% of placebo-treated patients (p = 0.029). There was no significant difference in subclinical HSV shedding in the acyclovir group (0%) compared with the placebo-treated group (3%) (p = 0.102). CONCLUSIONS: Suppressive acyclovir therapy significantly decreased the incidence of clinical genital herpes and the overall incidence of HSV excretion at delivery in patients with previous herpes infection.

Neonatal Herpes Simplex Virus Infections in Canada: Results of a 3-Year National Prospective Study

“…Other studies showed that between 60% and 100% of infants with NHSV are born to mothers with no history of genital HSV infection, 4,9,18 which has clear implications for prenatal screening and overall prevention of NHSV infection. There is a growing body of research outlining ways to decrease transmission of HSV from mother to child, including studies outlining the safety, effectiveness, and cost-effectiveness of using acyclovir suppression near term to decrease the risk of viral shedding and lesion recurrence, [19][20][21][22][23] as well as studies showing a significant reduction in transmission of HSV through cesarean section for women with primary lesions or active disease near term. 24,25 There has been much debate regarding the risks and benefits of performing type-specific screening for HSV in prenatal care.…”

Neonatal Herpes Simplex Infection

“…During the course of this registry, deliberate utilization of acyclovir near the end of pregnancy to suppress genital HSV recurrences became increasingly common in clinical practice, and several small studies investigated the use of acyclovir suppressive therapy during the last weeks of pregnancy (18,20,78,79,83). These trials suggest that suppressive treatment decreases the occurrence of clinically apparent genital HSV disease at the time of delivery (18,78,79), with an associated decrease in cesarean section rates for the indication of genital HSV among women receiving active drug (18,79,83). However, they are too small for us to draw definitive conclusions regarding safety and efficacy in treating a disease such as genital herpes which affects one-quarter of the U.S. population.…”

Herpes simplex virus infections of the newborn

“…Consequently, acyclovir therapy has been used to manage maternal infections and reduce the need for cesarean section [23][24][25]. The risks and benefits of maternal therapy for the fetus and newborn require additional study [2•,25].…”