Vertical Transmission of Herpes Simplex Virus Acquired After Primary Outbreak in Second Trimester of a Dichorionic Twin Gestation

Background: The incidence of genital herpes simplex virus (HSV) has increased in recent years, particularly among women of reproductive age. This places more neonates at risk for severe morbidity and mortality. Treatment recommendations for primary disease in pregnancy are lacking, particularly for those who acquire HSV remote from term. Case: A patient at 17 weeks of gestation carrying dichorionic twins developed primary herpes with subsequent vertical transmission of the virus and significant neonatal morbidity. Conclusion: Data regarding risks and benefits of treatments such as acyclovir and immunopro-phylaxis are lacking at a time when the incidence of HSV infection is on the rise.