Guidance on Management of Asymptomatic Neonates Born to Women With Active Genital Herpes Lesions

Abstract

Herpes simplex virus (HSV) infection of the neonate is uncommon, but genital herpes infections in adults are very common. Thus, although treating an infant with neonatal herpes is a relatively rare occurrence, managing infants potentially exposed to HSV at the time of delivery occurs more frequently. The risk of transmitting HSV to an infant during delivery is determined in part by the mother's previous immunity to HSV. Women with primary genital HSV infections who are shedding HSV at delivery are 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. With the availability of commercial serological tests that reliably can distinguish type-specific HSV antibodies, it is now possible to determine the type of maternal infection and, thus, further refine management of infants delivered to women who have active genital HSV lesions. The management algorithm presented herein uses both serological and virological studies to determine the risk of HSV transmission to the neonate who is delivered to a mother with active herpetic genital lesions and tailors management accordingly. The algorithm does not address the approach to asymptomatic neonates delivered to women with a history of genital herpes but no active lesions at delivery. Pediatrics 2013;131:e635-e646

The incidence and presentation of neonatal herpes in a single UK tertiary centre, 2006-2013

“…New lesions or symptoms of recurrence should be pursued at the time of delivery, and this should be communicated to the neonatal and community teams who will care for the baby in the first few weeks of life. In 2013, the American Academy of Pediatrics published new guidance on the management of neonates born to women with active lesions, that included guidance on the up-to-date use of serological and viral tests, to determine in more detail the maternal infection status and, thereby, the risk to the neonate 16 17. If the UK incidence of genital herpes infection continues to increase, then the number of babies requiring assessment of infection risk will rise, and UK services may need to adopt a similar approach, and this will require more services using onsite rapid testing to facilitate this.…”

Herpes simplex virus 2 infection: molecular association with HIV and novel microbicides to prevent disease

“…These recurrences not necessarily need to be symptomatic to transmit infection, which complicates prevention of neonate infection [94,95]. Nevertheless, the highest risk of infection to neonates occurs when mothers are undergoing primary infection and present severe HSV clinical manifestations [94,96,97]. Importantly, diagnosis of primary HSV infection at the time of delivery will require the analysis of both blood and swab samples for determining the type of infection [97].…”

Clinical Focus: Infections in Pregnancy

“…178,179 The American Academy of Pediatrics has published a comprehensive algorithm detailing the management of neonates born to mothers with active genital herpetic lesions. 180 Hospital Practice Downloaded from informahealthcare.com by Nyu Medical Center on 04/12/15…”