Use of Routine Viral Cultures at Delivery to Identify Neonates Exposed to Herpes Simplex Virus

Abstract

We obtained specimens for viral culture from mothers, infants, or both at the time of 6904 deliveries, without regard to the mothers' history of genital herpes. Herpes simplex virus (HSV) was recovered in cultured specimens from 14 of the 6904 deliveries (0.20 percent); all 14 mothers were asymptomatic. All viral isolates were herpes simplex virus type 2 (HSV-2). Only 1 of the 14 women (7 percent) had a history of genital herpes, whereas 12 (86 percent) had serologic evidence of a previous infection with HSV-2. None of the infants born to these 12 women contracted neonatal herpes. However, one of the two infants born to women with serologic evidence of a primary HSV infection at the time of delivery contracted neonatal herpes. Our findings show that most infants at risk of exposure to HSV at delivery will not be identified if concern about asymptomatic shedding of virus is limited to women with a history of genital herpes infection. Most neonatal exposure to an asymptomatic maternal HSV infection at delivery is not predictable or preventable. Therefore, physicians caring for newborns need to consider neonatal herpes in the differential diagnosis when infants become ill during the first weeks of life, regardless of the presence or absence of identifiable risk factors for HSV infection.

Preinfection Prophylaxis with Herpes Simplex Virus Glycoprotein Immunogens: Factors Influencing Efficacy

“…In animals immunized with the gP2 preparation there was a relationship between the magnitude of the ELISA antibody response and protection from primary herpetic disease. This may be analogous to the inverse correlation of maternal HSV antibody levels and risk of acquiring neonatal herpes (Yeager et al, 1980;Prober et al, 1988). These results suggest it may be possible to use serological data as a predictor of protection.…”

Neonatal Herpes Simplex Infection

“…17,2004 NEONATAL HERPES SIMPLEX INFECTION 3 ital and neonatal spread of HSV infections. Among pregnant women, the incidence of viral excretion proximate to delivery ranges from 0.20 to 0.39% for all pregnant women, irrespective of past history (15,21,69). Among pregnant women with a known history of recurrent genital HSV, the incidence of excretion may be as high as 0.77% (89) to 1.4% (4).…”

Clinical and Serological Outcome of Genital Herpes Simplex Virus (HSV) Type 2 Inoculation following Oral HSV Type 1 Infection in Guinea-pigs

“…Patients who develop a latent infection after asymptomatic primary disease may later develop clinically obvious disease (Bernstein et al, 1984) or asymptomatically shed virus and expose either their sexual partner (Rooney et aL, 1986) or newborns (Prober et aL, 1988) to HSV. Prospective studies under way will help define the role of prior HSV-1 infection in genital HSV-2 disease.…”

“…These patients appear to have milder primary infection than those with true primary HSV-2 infections (Bryson et al, 1983 ;Corey et al, 1983;Whitley, 1985), although the proportion of patients who remain asymptomatic or develop such mild symptoms that they do not seek medical attention is unknown. A large proportion of HSV-2-infected patients are unaware that they have been infected (Mertz et al, 1985;Prober et al, 1988). Most if not all of these patients have HSV-2 latent in dorsal root ganglia; the virus could reactivate and cause recurrent symptomatic or asymptomatic disease (Mertz et al, 1985;Prober et al, D88, Mertz etal., 1988).…”