Guidelines for the Management of Herpes Simplex Virus in Pregnancy

Money, Deborah; Steben, Marc; Wong, Thomas; Gruslin, Andrée; Yudin, Mark H.; Cohen, Howard; Boucher, Marc; MacKinnon, Catherine Jane; Paquet, Caroline; Schalkwyk, Julie van

doi:10.1016/s1701-2163(16)32868-7

Cited by 36 publications

(42 citation statements)

References 34 publications

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“…40,46 Additionally, women with frequent recurrent lesions during pregnancy may be offered antiviral suppressive therapy to prevent genital lesions at the time of labour. 40 This is generally given from 36 weeks of gestation until delivery.…”

Section: Current Recommendations For Neonatal Herpes Preventionmentioning

confidence: 99%

Prevention of neonatal herpes

Gardella

Brown

2010

BJOG

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Neonatal herpes can occur when the neonate is exposed to herpes simplex virus in the maternal genital tract during labour. Attack rates are highest when the mother has a newly acquired infection and, therefore, does not have antibodies to protect the neonate. Even with early therapy, there is significant morbidity and mortality associated with neonatal herpes, suggesting that preventing neonatal herpes simplex virus exposure or early recognition of exposure is important. The incidence of neonatal herpes has not declined despite national guidelines for prevention. This suggests that the prevention guidelines need to be re-addressed.Keywords Herpes, neonate, prevention.Please cite this paper as: Gardella C, Brown Z. Prevention of neonatal herpes. BJOG 2011;118:187-192. Epidemiology of genital herpesBased on serological data from a large National Health and Nutrition Examination Survey (NHANES), 22% of pregnant women in the USA are infected with herpes simplex virus 2 (HSV-2), 63% are HSV-1 seropositive, 13% have both HSV-1 and HSV-2, and 28% are seronegative. 1 In the general population, for the first time since the 1976 inception of NHANES, the seroprevalence of HSV-2 has decreased; overall, the age-adjusted HSV-2 seroprevalence was 17% in 1999-2004, compared with 21% in 1988-94, a relative decrease of 19% between the two study periods. Among those infected with HSV-2, the percentage who reported being diagnosed was 14.3% in 1999-2004 and 9.9% in 1988-94, suggesting that more providers are aware of genital herpes, and able to make appropriate diagnoses. 2 However, the vast majority of people infected with HSV-2 remain undiagnosed and, therefore, untreated and able to spread the infection. Between 75% and 90% of HSV-2-infected people are not aware of having the infection. [3][4][5][6] This is important because most sexual transmission of HSV occurs during episodes of subclinical reactivation among persons with unrecognized infection. 4,7-10 Virtually all HSV-2 seropositive people have intermittent shedding from the genital mucosa, and most have mild (and hence unrecognized and undiagnosed) disease. 5 In the absence of symptoms, HSV-2 can be detected in the genital tract, by viral culture, on 3% of days for the first year after initial infection, then on 1% of days for the next 2 years. HSV-2 DNA can be detected by polymerase chain reaction testing 15-20% of days. 11,12 Recent data suggest that HSV reactivation may occur much more frequently than previously understood, and may be characterised by frequent short bursts of viral shedding that do not correlate with symptoms. 13 As HSV-2 seroprevalence decreased, HSV-1 seroprevalence in the USA increased to 62% in 1988-94 from 57.7% in 1999-2004. 2 Among persons infected with HSV-1 but not HSV-2, a higher percentage reported a diagnosis of genital herpes in 1999-2004 compared with 1988-94 (1.8% versus 0.4%). 2 HSV-1 has emerged as a major cause of genital herpes among college-age populations, in which up to 80% of new cases of genital HSV were caused by HSV-1. [14][1...

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Section: Current Recommendations For Neonatal Herpes Preventionmentioning

confidence: 99%

Prevention of neonatal herpes

Gardella

Brown

2010

BJOG

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“…We also identified 70 specific situations guidelines published between 2002 and 2014. Of these, 91% were from the USA,25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59 UK60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76 and Canada 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88. The remaining were from Australia,89 Brazil,90 Mexico,91 Poland,92 Spain93 and Uruguay 94…”

Section: Resultsmentioning

confidence: 99%

Antenatal care for healthy pregnant women: a mapping of interventions from existing guidelines to inform the development of new WHO guidance on antenatal care

Ábalos

Chamillard

Díaz

et al. 2015

BJOG

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BackgroundThe World Health Organization (WHO) is in the process of updating antenatal care (ANC) guidelines.ObjectivesTo map the existing clinical practice guidelines related to routine ANC for healthy women and to summarise all practices considered during routine ANC.Search strategyA systematic search in four databases for all clinical practice guidelines published after January 2000.Selection criteriaTwo researchers independently assessed the list of potentially eligible publications.Data collection and analysisInformation on scope of the guideline, type of practice, associated gestational age, recommendation type and the source of evidence were mapped.Main resultsOf 1866 references, we identified 85 guidelines focusing on the ANC period: 15 pertaining to routine ANC and 70 pertaining to specific situations. A total of 135 interventions from routine ANC guidelines were extracted, and categorised as clinical interventions (n = 80), screening/diagnostic procedures (n = 47) and health systems related (n = 8). Screening interventions, (syphilis, anaemia) were the most common practices. Within the 70 specific situation guidelines, 102 recommendations were identified. Overall, for 33 (out of 171) interventions there were conflicting recommendations provided by the different guidelines.ConclusionMapping the current guidelines including practices related to routine ANC informed the scoping phase for the WHO guideline for ANC. Our analysis indicates that guideline development processes may lead to different recommendations, due to context, evidence base or assessment of evidence. It would be useful for guideline developers to map and refer to other similar guidelines and, where relevant, explore the discrepancies in recommendations and others.Tweetable abstractWe identified existing ANC guidelines and mapped scope, practices, recommendations and source of evidence.

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“…Thus, neonatal herpes is not common in recurrent herpes cases. While antiviral treatment is not recommended for recurrent atacks before the 36th week, standard treatment may be considered in severe cases [54,55]. It has been shown that suppressive treatment with acyclovir from the 36th week until labor reduces viral shedding, clinical herpes lesions, and requirement for C-section [56].…”

Section: Recurrent Atack Managementmentioning

confidence: 99%

Genital Herpes

Emre¹,

Akkus²

2017

Fundamentals of Sexually Transmitted Infections

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Genital herpes simplex virus (HSV) infections are among the most commonly seen sexually transmited infections in the world. Genital herpes is a serious health problem because the infection continues through life with remissions and relapses, it causes recurring painful ulcers, and there is no known cure for it. The real prevalence of the genital herpes infection is unknown due to asymptomatic cases. The majority of infected individuals are not aware of the infection due to short duration of symptoms and signs or its asymptomatic nature. The clinical presentation of genital herpes shows certain differences in terms of the primary atack following the irst encounter with the virus and recurrent atacks. There is a strong relationship between HSV-2 positivity and human immunodeiciency virus (HIV). A serious complication of genital herpes in the mother during pregnancy, neonatal herpes, has a mortality risk of 60% if not treated. Antiviral therapy is safe and efective, for both episodic treatment and chronic suppression of HSV. Epidemiology, clinical presentation, laboratory, and treatment options of genital herpes are summarized in this chapter.

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Guidelines for the Management of Herpes Simplex Virus in Pregnancy

Cited by 36 publications

References 34 publications

Prevention of neonatal herpes

Prevention of neonatal herpes

Antenatal care for healthy pregnant women: a mapping of interventions from existing guidelines to inform the development of new WHO guidance on antenatal care

Genital Herpes

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