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Genital Herpes in Pregnancy

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Genital Herpes in Pregnancy, Genital HSV in Pregnancy, Herpes Simplex Virus 2 in Pregnancy

  • See Also
  1. Neonatal Herpes Simplex Virus
  2. Genital Herpes
  3. Primary Genital Herpes
  4. Secondary Genital Herpes
  • Findings
  1. See Genital Herpes
  2. See Primary Genital Herpes
  3. See Secondary Genital Herpes
  • Epidemiology
  1. Genital Herpes recurs during pregnancy in 75% of women with known genital HSV
  2. High risk of vertical transmission with primary outbreak in third trimester
  • Management
  • Pregnancy
  1. Treat HSV 2 infections that occur at anytime during pregnancy
    1. Duration
      1. Treat primary HSV 2 outbreak for 10 days
      2. Treat recurrent HSV 2 outbreak for 5 days
    2. Agents (choose one)
      1. Acyclovir 200 mg orally five times daily
      2. Valacyclovir (Valtrex) 500 mg orally twice daily
  2. Peripartum (after 36 weeks gestation)
    1. Culture Cervix and lesion every 3-5 days until negative
    2. Viral Suppression
      1. See below for prevention of Neonatal HSV transmission
    3. Cesarean Section indications
      1. HSV II Culture positive
      2. All women with active HSV II lesions
  • Complications
  • Vertical transmission
  1. Neonatal Herpes Simplex Virus
  1. Prevent transmission from HSV positive partner
    1. Abstinence or Condom use during pregnancy
    2. Consider Vaccine below
    3. Antiviral prophylaxis for HSV positive partner
    4. Avoid oral-genital contact if Oral HSV in partner
    5. Vaccinations as of yet are experimental (e.g. HSV-2 Glycoprotein-D-Adjuvant Vaccine)
      1. Stanberry (2002) N Engl J Med 347:1652-61 [PubMed]
  2. Identify HSV II risks in all pregnant women
    1. Personal history of HSV II
    2. Partners with HSV II
    3. Screen at first Prenatal Visit and perinatally
  3. Cesarean Section Indications
    1. Active HSV 2 lesions at time of delivery
    2. Prodromal Genital Herpes symptoms at time of delivery
  4. Viral Suppression (36 weeks until delivery)
    1. Indicated in all pregnant women with Genital Herpes history
    2. Also treat any Primary Genital Herpes outbreak during pregnancy (see above)
    3. Also treat all women with near-term or perinatal Genital Herpes outbreak
    4. Agents (choose one)
      1. Acyclovir 400 mg orally three times daily from 36 weeks until delivery
      2. Valacyclovir 250 mg orally twice daily from 36 weeks until delivery
  5. References
    1. Sheffield (2003) Obstet Gynecol 102:1396-403 [PubMed]
  • References
  1. Beauman (2005) Am Fam Physician 72(8):1527-34 [PubMed]
  2. Groves (2016) Am Fam Physician 93(11): 928-34 [PubMed]
  3. Nadelman (2000) Postgrad Med 107(3):189-95 [PubMed]
  4. Straface (2012) Infect Dis Obstet Gynecol +PMID: 22566740 [PubMed]