Low Risk of Herpes Simplex Virus Infections in Neonates Exposed to the Virus at the Time of Vaginal Delivery to Mothers with Recurrent Genital Herpes Simplex Virus Infections

Guidelines for the management of herpes simplex virus in pregnancy

“…Presumably because of the protective passive antibodies, it is uncommon for a neonate to develop herpes infection from a mother with recurrent disease. However, if a genital HSV lesion is present at the time of vaginal birth, risk of neonatal infection is reported to be 2% to 5% [24,25]. A woman with recurrent disease who does not have a lesion evident at delivery still has a small risk of asymptomatic shedding (approximately 1%), and therefore the risk of neonatal infection can be calculated to be 0.02% to 0.05% [25,26].…”

Recommendations for the Selective Use of Herpes Simplex Virus Type 2 Serological Tests

“…Surveillance data show that 20%-30% of infected infants are born by cesarean section, with 8% of infected infants born to women with intact membranes [53,59]. Additional evidence by Prober et al [56] demonstrated that infants born to mothers with recurrent herpes have high protective neutralizing antibodies to HSV-2 and low risk of acquiring herpes; 0 of 34 infants exposed to vaginal HSV-2 developed herpesvirus infections. In a cost-effectiveness analysis of maternal and neonatal outcomes associated with cesarean section in women with recurrent herpes, assuming a 1% vertical transmission rate, 11580 excess cesarean sections would be done to prevent 1 severe neonatal HSV-2 infection and 0.57 maternal deaths caused for every neonatal death prevented [57].…”

“…More than 80% of infants with neonatal herpes are born to women without any history of symptomatic herpes during that pregnancy or at delivery [53]. The risk of neonatal HSV transmission is highest at delivery from women with a primary infection so close to term that antibodies have not yet developed (30%-50%) and lowest from women with an established genital herpesvirus infection for which protective antibodies already exist (!0.04%) [52,[55][56][57].…”

Obstetric Management of Women with a History of Recurrent Genital Herpes

“…16 In a recent series of 34 neonates inadvertently exposed to herpes simplex virus from both asymptomatic and symptomatic recurrences, none acquired an infection. 17 This is in contrast to an estimated risk of greater than 50% if a neonate is born to a woman experiencing a primary infection. 18 A crude estimate of the risk of an asymptomatic woman with a history of recurrent herpes having an affected child can be calculated.…”