Herpes in Pregnancy

Herpes simplex virus infection (predominantly HSV2) in pregnancy can be a cause of maternal morbidity. The more serious cause of concern is perinatal transmission of infection resulting in neonatal morbidity and mortality. Genital HSV infection can be primary, non-primary first episode or recurrent infection. Clinical and laboratory diagnosis in pregnant women is similar to non-pregnant women. Direct viral testing (PCR) from lesion's and type specific serology are required to classify type of infection. Vertical transmission occurs during labor and delivery. The risk is higher in primary and non-primary first episode near the time of delivery. Antiviral treatment with Acyclovir or Valacyclovir is recommended for acute episode to reduce lesion duration and viral shedding. Acyclovir as suppressive therapy from 36 weeks onwards reduces clinical recurrences and need for caesarean delivery. Caesarean section reduces but does not eliminate the risk of vertical transmission and is recommended for a woman has an acute infection episode at the time of labor or within 6 weeks before delivery. Clinical management of preterm premature rupture of membranes in a woman with HSV infection should be individualized. All neonates born to these mothers should be carefully handled and monitored for development of neonatal herpes.