MANAGEMENT OF
GENITAL HERPES IN
PREGNANCY
NTRODUCTION
• Genital Herpes is a sexually transmitted disease caused by
herpes simplex virus characterized by lifelong infection and
periodic reactivation.
• Herpes simplex is a DNA virus classified as
1. HSV-1
2. HSV-2
• HSV-1 cause oral labial lesions
• HSV-2 cause genital lesions
CLASSIFICATION OF GENITAL
HERPES
• Primary:
First occurrence of a genital HSV lesion in a patient with no pre-
existing HSV-1 or HSV-2 antibodies.
• Non Primary first episode:
First occurrence of a genital lesion in a patient pre-existing
HSV antibodies of different type.
• Recurrent episode:
Recurrence of clinical symptoms due to reactivation of
existing HSV-1 or HSV-2 infection after a period of latency.
CLINICAL PRESENTATION
• Painful genital ulcers, vesicles or pustules occurring
single or in groups
• Pruritus
• Dysuria
• Fever
• Tender inguinal lymphadenopathy
• Headache
• More severe can cause hepatitis, pneumonia or
encephalitis
• The non Primary infection tends to be milder than
primary infection
• Recurrent infections have mild prodromal symptoms
such as pruritus, burning or pain before few localized
non tender or atypical lesions are visible with mo
systemic findings.
TRANSMISSION AND DIAGNOSIS
• Genital Herpes is transmitted via direct contact with
lesions :
• Sexual contact
• Skin to skin contact
• Saliva
• Asymptomatic shedding
• Vertical transmission from mother to baby during
delivery
• Diagnosis is made on the basis of history,
examination and investigations.
• Investigations include:
[Link] detection via culture
[Link] detection via PCR
[Link] detection by serology
Management
• Standard dose of antiviral therapy:
[Link] ACICLOVIR 400mg*TDS for 5 days
[Link] VALACICLOVIR 500mg *BD for 5 days
[Link] ACICLOVIR 10mg/kg TDS for disseminated
disease
• Symptomatic Relief :
[Link]
• Antiviral suppression in pregnancy:
[Link] 400mg 3 times a day orally from 32 weeks
[Link] 500mg 2 times a day orally from 32
weeks
• High risk of preterm delivery:
[Link] 400mg 2 times a day orally from 22 weeks,
then 3 times a day orally from 32 weeks
[Link] 500mg once a day orally from 22 weeks,
then 2 times a day orally from 32 weeks
Management in PPROM
• Multidisciplinary management involving Obstetricians ,
Neonatologists and Genito -urinary medicine physicians.
• ACICLOVIR 5mg/kg IV every 8 hours
• ACICLOVIR 400mg 3 times a day orally from 32 weeks
• VALACICLOVIR 500mg 2 times a day orally from 32
weeks
• Prophylactic steroid cover
• If presents in labor and this is within 6 weeks of
primary episode, LSCS may offer some benefit in spite of
the PPROM.
Recurrent Genital Herpes:
[Link] < 34 weeks, expectant management with oral acyclovir
400mg TDS for the mother.
[Link] > 34 weeks, follow RCOG guidelines on PPROM and
shouldn’t be influenced by presence of lesions.
Management in HIV patients
• Primary HSV infection :
Management is in accordance to the recommendations
for all women with primary HSV infection .
• Recurrent HSV infection :
In women with a history of genital herpes, consider
daily suppressive acyclovir 400mg tds from 32 weeks onwards.
POST DELIVERY MANAGEMENT
• The risk of neonate having infection at the time of birth
is 85% immediate post natal period is 10%.
• Factors associated with transmission include type of
infection, timing, absence of antibodies, duration of
rupture of membranes, mode of delivery.
• In neonates it can have affects on:
[Link], eyes, mouth
[Link]
[Link] infection i.e: liver,
lungs ,brain
• It is important to involve the neonatal team immediately
• Baby born via SVD with primary infection within 6 weeks
or baby is unwell:
Take swab for culture , Lumber puncture if CNS
involvement + empirical therapy with IV acyclovir
• Baby is well or born to mothers with recurrent infection or via
LSCS:
Conservative management
Prevention
• Safe sexual practice:
using condoms
Avoiding sexual contact during outbreak
Avoiding multiple sexual partner , oral
sex
• Antiviral therapy
