The Natural History of Herpes Simplex Virus Infection of Mother and Newborn

Abstract

The controlled evaluation of vidarabine as therapy of neonatal herpes simplex virus (HSV) infection provided an opportunity to collect data to further assess the natural history of maternal and newborn infections. Women delivering infected babies were young, nulliparous, and infrequent aborters. Nearly 50% of the gestations ended in premature labor. Maternal infection was asymptomatic in 39 of 56 (70%) of the mothers, at the time of delivery. However, risk factors included a past history of genital herpes at any time and exposure to a sexual partner with presumed HSV lesions. Associated diseases in children born to these women were common. Premature infants had an incidence of respiratory distress of 52% (14 of 27). Eight of 29 (28%) term newborns had a bacterial infection, antedating the onset of neonatal HSV infection. Virologic studies on infected newborns confirmed that skin lesions were the most frequent site for virus retrieval. Progression of disease from isolated skin lesions was common, occurring in 70% of babies whose presenting sign was skin vesicles. CSF was virus-positive from 14 babies and more frequently in those with localized CNS disease. Importantly, brain biopsy was necessary for diagnosis in four cases. Finally, neither the presence or absence of antibodies to HSV was useful in predicting either presentation or outcome of infection. These studies further emphasize the complex nature of HSV infections of the newborn and need for tertiary care.

Maternal immunization confers protection against neonatal herpes simplex mortality and behavioral morbidity

“…The risk of vertical transmission of HSV is substantially higher during maternal primary infections (>55%) than during reactivation (<1%) (10,11). This discrepancy in risk is consistent with the hypothesis that protection is conferred through transfer of maternal antibodies (16,17), which are absent during primary infection.…”

“…HSV-1 and HSV-2 are neurotropic pathogens that infect epithelial tissues and nerve termini, before retrograde spread within the peripheral nervous system, wherein viral latency is established (9). Although primary infection or reactivation of virus can result in visible lesions, they are frequently asymptomatic, which renders diagnoses and preventative measures challenging, especially during the perinatal period (10,11). Most nHSV infections are acquired via mucosal and cutaneous contact during birth.…”

Herpes Simplex Mastitis in an Adolescent Woman: Clinical and Ultrasound Features

“…HSV infection of the breast is very rare. The majority of herpetic breast infections are related to HSV-1 infection, and HSV-2 infection is exceptional ( 2 3 4 5 6 7 8 ). The common clinical features of a herpetic breast infection are pruritus and painful swelling with dermatologic manifestations, including swelling, erythema, small vesicles, and excoriation.…”

Congenital Infections of the Nervous System

“…Before the discovery of antiviral therapy, half of infants with HSV encephalitis died, and the majority of survivors were left with significant developmental delays 42 . With high-dose IV acyclovir, the mortality rate of HSV encephalitis dropped to 4%, but the morbidity of HSV encephalitis remains high: Only about one-third of infants with HSV encephalitis have normal developmental outcomes 43 .…”

“…Before the discovery of antiviral therapy, half of infants with HSV encephalitis died, and the majority of survivors were left with significant developmental delays. 42 With high-dose IV acyclovir, the mortality rate of HSV encephalitis dropped to 4%, but the morbidity of HSV encephalitis remains high: Only about one-third of infants with HSV encephalitis have normal developmental outcomes. 43 Early initiation of treatment may be protective, but large-scale randomized studies are not feasible for definitive confirmation because of the unethical nature of delaying approved treatment for HSV encephalitis.…”