Obstetric Management of Women with a History of Recurrent Genital Herpes

Abstract

Genital herpes simplex is a common sexually transmitted disease in our society. A genital infection complicating pregnancy can result in the vertical transmission of a devastating neonatal illness. The appropriate obstetric management of women with a history of genital herpes remains controversial. Past management protocols have stressed frequent third trimester viral cultures in an attempt to identify those at risk for asymptomatic viral shedding at delivery. Cesarean section was recommended if asymptomatic shedding was suspected. Subsequent research has shown that surveillance schema aimed at identifying asymptomatic shedding in term gestations will fail to identify antepartum the majority of cases of neonatal herpes. Furthermore, weekly surveillance cultures have failed to predict intrapartum viral shedding accurately. The current literature supports mode of delivery decisions based on clinical history and careful intrapartum examination. The development of rapid diagnostic tests for intrapartum diagnoses of viral shedding as well as the prophylactic use of antiviral agents will influence future recommendations.

Cesarean delivery in women with genital herpes in Washington state, 1989-1991

“…However, less is known about rates of cesarean delivery in women who report a history of GH, but who do not evidence lesions at delivery. Current guidelines advise against cesarean delivery in this group, 9,16,17,z,zl since the likelihood of viral shedding in genital secretions at delivery in the absence of lesions is small (0.6-1.4%), as is the attack rate for neonatal infection even in the presence of asymptomatic viral shedding (2-5%). s,,z,zz Cesarean delivery has also failed to prevent neonatal HSV acquisition in some cases, possibly as a consequence of prior in utero infection.…”

The management of recurrent genital herpes infection in pregnancy: a postal survey of obstetric practice

“…Although uncommon in the United Kingdom (2 per 100,000 live births were reported to the British Paediatric Surveillance Unit, between July 1986 and December 1991, P. Tookey, personal communication), there has been much debate in the literature in the United Kingdom and the United States concerning strategies to prevent vertical transmission (Lissauer & Jeffries 1989; Sperling & Berkowitz 1989; Mercey and Mindel 1991; Gibbs & Mead 1992).…”