Perinatal Herpes Simplex Virus Infections

Because of the relative paucity of data on the epidemiology and management of perinatal herpes simplex virus (HSV) infections, the following recommendations represent the best current judgments of the Committees on Fetus and Newborn and Infectious Diseases of the American Academy of Pediatrics. HSV infection of the newborn is associated with a case fatality rate of 60% and at least half of the survivors have significant neurologic or ocular sequelae, or both. Approximately 75% of isolates from affected neonates are HSV-2 and 25% are HSV-1. Although preliminary data suggest that antiviral chemotherapy is effective in reducing mortality and morbidity resulting from neonatal HSV infections, measures designed to prevent infection of newborns are currently the most important means of controlling neonatal infections. A maternal source of infection can be found in about 90% of neonatal cases. Maternal HSV infection is usually caused by type 2 strains and involves the labia, cervix, and/or vagina. The majority of genital infections are asymptomatic and difficult to recognize on clinical examination, making identification of women whose infants are in jeopardy very difficult. EPIDEMIOLOGY Maternal Infection Primary HSV infection during pregnancy may be associated with spontaneous abortion, prematurity, and rarely with congenital anomalies. The risk of infection to the newborn appears to be the highest in primary genital infection of the pregnant woman, but is also high in recurrent infection. Women with a history of recurrent genital HSV infection, those with active disease during the current pregnancy, and those whose sexual partners have proven genital HSV infection should be monitored with virologic or cytologic studies, or both, at least twice during the last six weeks of pregnancy.