Infection of the lower genital tract by herpes simplex virus type 2 (HSV-2) is a common sexually transmitted disease of potential seriousness to pregnant women and their newborn infants. Although up to 20% of women in an obstetric practice may have antibodies to HSV-2, a history of the infection is unreliable and the incidence of neonatal infection is low (1:20,000-1:3000 live births). Most infected neonates are born to women with no symptoms, signs, or history of infection.
Women who have had primary herpes infection late in pregnancy are at high risk of shedding virus at delivery. Some authors suggest use of prophylactic acyclovir, 400 mg orally twice daily, to decrease the likelihood of active lesions at the time of labor and delivery.
Women with a history of recurrent genital herpes have a neonatal attack rate of 5% and should be followed by clinical observation and culture of any suspicious lesions. Since asymptomatic viral shedding is not predictable by antepartum cultures, current recommendations do not include routine cultures in individuals with a history of herpes without active disease. However, when labor begins, vulvar and cervical inspection and cultures should be performed, with prompt treatment of a newborn after a positive culture.
The use of acyclovir in pregnancy is acceptable when there is significant fetal or neonatal risk.
Cesarean section is indicated at the time of labor if there are prodromal symptoms, active genital lesions, or a positive cervical culture obtained within the preceding week.
ACOG Practice Bulletin. Management of herpes in pregnancy. Number 8 October 1999. Clinical management guidelines for obstetrician-gynecologists. Int J Gynaecol Obstet 2000; 68:165.
Sheffield JS et al: Acyclovir prophylaxis to prevent herpes simplex virus recurrence at delivery: a systematic review. Obstet Gynecol 2003;102:1396.
Revision date: July 3, 2011
Last revised: by Janet A. Staessen, MD, PhD