Abstract
Objective
To provide recommendations for the management of genital herpes infection in women
who want to get pregnant or are pregnant and for the management of genital herpes
in pregnancy and strategies to prevent transmission to the infant.
Outcomes
More effective management of complications of genital herpes in pregnancy and prevention
of transmission of genital herpes from mother to infant.
Evidence
Medline was searched for articles published in French or English related to genital
herpes and pregnancy. Additional articles were identified through the references of
these articles. All study types and recommendation reports were reviewed.
Values
Recommendations were made according to the guidelines developed by the Canadian Task
Force on Preventive Health Care.
Recommendations
- 1.Women's history of genital herpes should be evaluated early in pregnancy (III-A).
- 2.Women with known recurrent genital herpes simplex virus (HSV) should be counselled about the risks of transmission of HSV to their neonates at delivery (III-A).
- 3.At delivery, women with recurrent HSV should be offered a Caesarean section if there are prodromal symptoms or in the presence of a lesion suggestive of HSV (II-2A).
- 4.Women with known recurrent genital HSV infection should be offered acyclovir or valacyclovir suppression at 36 weeks' gestation to decrease the risk of clinical lesions and viral shedding at the time of delivery and therefore decrease the need for Caesarean section (I-A).
- 5.Women with primary genital herpes in the third trimester of pregnancy have a high risk of transmitting HSV to their neonates and should be counselled accordingly and should be offered a Caesarean section to decrease this risk (II-3B).
- 6.A pregnant woman who does not have a history of HSV but who has had a partner with genital HSV should have type-specific serology testing to determine her risk of acquiring genital HSV in pregnancy before pregnancy or as early in pregnancy as possible. Testing should be repeated at 32 to 34 weeks' gestation (III-B).
Validation
These guidelines have been reviewed and approved by the Infectious Diseases Committee
of the SOGC.
Sponsor
The Society of Obstetricians and Gynaecologists of Canada
Key Words
Abbreviations:
HIV (human immunodeficiency virus), HSV (herpes simplex virus), IUFD (intrauterine fetal death), IUGR (intrauterine growth restriction), NAAT (nucleic acid amplification techniques), PCR (polymerase chain reaction), STI (sexually transmitted infection), TORCH (toxoplasmosis, other agents, rubella, cytomegalovirus, and herpes simplex)To read this article in full you will need to make a payment
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References
- Canadian Task Force on Preventive Health Care. New grades for recommendations from the Canadian Task Force on Preventive Health Care.CMAJ. 2003; 169: 207-208
- Genital herpes: gynaecological aspects. SOGC Clinical Practice Guideline No. 207, April 2008.J Obstet Gynaecol Can. 2008; 30: 347-353
- Herpes simplex virus type 2 in the United States, 1976 to 1994.N Engl J Med. 1997; 337: 1105-1111
- Antenatal seroprevalence of herpes simplex virus type 2 (HSV-2) in Canadian women: HSV-2 prevalence increases throughout the reproductive years.Sex Transm Dis. 2001; 28: 424-428
- Neonatal herpes simplex virus infection.Clin Perinatol. 1997; 24: 129-149
- Effect of serologic status and cesarean delivery on transmission rates of herpes simplex virus from mother to infant.JAMA. 2003; 289: 203-209
- Changing presentation of herpes simplex virus infection in neonates.J Infect Dis. 1988; 158: 109-116
- American Academy of Pediatrics.in: Peter G. 1997 Red Book: Report of the Committee on Infectious Diseases. 24th ed. American Academy of Pediatrics, Elk Grove Village, Ill1997: 266-276
- Current Management of herpes simplex infection in pregnant women and their newborn infant. Infectious Diseases and Immunization Committee, Canadian Paediatric Society.Paediatrics & Child Health. 2006; 11: 363-365
- A controlled trial comparing vidarabine with acyclovir in neonatal herpes simplex virus infection.N Engl J Med. 1991; 324: 444-449
- Changing epidemiology of genital herpes infection in Melbourne, Australia, between 1980 and 2003.Sex Transm Infect. 2004; 80: 277-279
- A prospective study of new infections with herpes simplex virus type 1 and 2. Chiron HSV Vaccine Study Group.N Engl J Med. 1999; 341: 1432-1438
- Neonatal herpes simplex infection.(Canadian Pediatric Society Surveillance Program Data)2002
- Intrauterine herpes simplex virus infection.Teratology. 1989; 39: 1-10
- Virologic characteristics of subclinical and symptomatic genital herpes infections.N Engl J Med. 1995; 333: 770-775
- Vitamin A supplementation and genital shedding of herpes simplex virus among HIV-1 infected women: a randomized clinical trial.J Infect Dis. 2004; 189: 1466-1471
- Congenital herpes simplex type II infection.Am J Obstet Gynecol. 1985; 152: 1000-1002
- The acquisition of herpes simplex virus during pregnancy.N Engl J Med. 1997; 337: 509-515
- Acyclovir suppression to prevent cesarean delivery after first-episode genital herpes.Obstet Gynecol. 1996; 87: 69-73
- Asymptomatic maternal shedding of herpes simplex virus at the onset of labour: relationship to preterm labor.Obstet Gynecol. 1996; 87: 483-488
- Effects on infants of the first episode of genital herpes during pregnancy.N Engl J Med. 1987; 317: 1246
- Perinatal risk associated with maternal genital herpes simplex virus infection.Am J Obstet Gynecol. 1971; 110: 825
- Acyclovir Pregnancy Registry. International final study report, 1 Jun 1984 through 30 Apr 1999. Glaxo Wellcome Inc., 1999
- Once-daily valacyclovir to reduce the risk of transmission of genital herpes.N Engl J Med. 2004; 350: 11-20
- Health Canada. Canadian STD Guidelines, 1998 Edition. Herpes simplex virus genital infections. 1998: 184-192
- Low risk of herpes simplex virus infections in neonates exposed to the virus at the time of vaginal delivery in mothers with recurrent genital herpes simplex virus infections.N Engl J Med. 1987; 316: 3240-3244
- Neonatal herpes simplex virus infection in relation to asymptomatic maternal infection at the time of labor.N Engl J Med. 1991; 324: 1247-1252
- Frequency of asymptomatic shedding of herpes simplex virus in women with genital herpes.JAMA. 1990; 263: 418-420
- Acyclovir prophylaxis to prevent herpes simplex virus recurrence at delivery: a systematic review.Obstet Gynecol. 2003; 102: 1396-1403
- Acyclovir prophylaxis in late pregnancy to prevent neonatal herpes: a cost-effectiveness analysis.Obstet Gynecol. 1996; 88: 603-610
- Neonatal herpes in Denmark 1977–1991.Acta Obstet Gynaecol Scand. 1997; 76: 355-358
- Acyclovir in late pregnancy to prevent neonatal herpes simplex.Lancet. 1990; 336: 756
- A randomised placebo controlled trial of suppressive acyclovir in late pregnancy in women with recurrent suppressive genital herpes infection.Br J Obstet Gynaecol. 1998; 105: 275
- Valacyclovir prophylaxis to prevent recurrent herpes at delivery: a randomized clinical trial.Obstet Gynecol. 2006; 108: 141-147
- Valacyclovir therapy to reduce recurrent genital herpes in pregnant women.Am J Obstet Gynecol. 2006; 194: 774-781
- Cost-effectiveness of acyclovir suppression to prevent recurrent genital herpes in term pregnancy.Am J Perinatol. 1998; 15: 57
- Pharmacokinetics of acyclovir in the term human pregnancy and neonate.Am J Obstet Gynecol. 1991; 164: 569-574
- Antiviral therapy in pregnancy.Clin Obstet Gynecol. 1990; 33: 276-289
- Failure of antepartum maternal cultures to predict the infant's risk of exposure to herpes simplex virus at delivery.N Engl J Med. 1986; 315: 796-800
- Do antepartum herpes simplex virus cultures predict intrapartum shedding for pregnant women with recurrent disease?.Infect Dis Obstet Gynecol. 1999; 7: 230-236
- Asymptomatic shedding of herpes simplex virus from the cervix and lesion site during pregnancy.Am J Dis Child. 1984; 138: 429-442
- Management of genital infection in pregnancy.Obstet Gynecol. 1988; 71: 779-780
- Prevention and Control of Occupational Infections in Health Care, Canadian Communicable Disease Report, Volume 28S1. March 2002
Article info
Publication history
No. 208, August 2017
Footnotes
This guideline has been reviewed by the Infectious Disease Committee
∗
and the Maternal Fetal Medicine Committee and approved by the Executive and Council of the Society of Obstetricians and Gynaecologists of Canada.Members of the Infectious Disease Committee include: Deborah Money, MD, Vancouver, BC; Marc Steben, MD, Montréal, QC; Thomas Wong, MD, Ottawa, ON; Andrée Gruslin, MD, Ottawa, ON; Mark H. Yudin, MD, Toronto, ON; Howard Cohen, MD, Toronto, ON; Marc Boucher, MD, Montréal, QC; Catherine MacKinnon, MD, Brantford, ON; Caroline Paquet, RM, Trois Rivières, QC; Julie Van Schalkwyk, MD, Vancouver, BC. Disclosure statements have been received from all members of the committee.
Identification
Copyright
© 2017 Published by Elsevier Inc. on behalf of The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada
