HSV in pregnancy
- All patients and their partners should be asked about a history of
genital and orolabial HSV infection.
- Rates of vertical transmission at delivery
– Primary HSV infection 50%
– Non-primary – first episode 33%
– Recurrent 0-3%
- Genital herpes acquired during pregnancy does not seem to increase
rates of neonatal illness or congenital HSV infection as long as HSV
seroconversion has completed by time labor begins.
- Genital HSV outbreaks During pregnancy: (7-14 days for the
(400 mg PO BID-TID)
- Valacyclovir (500 mg PO QD)
- Suppressive therapy:
- Women with active recurrent genital herpes should be
offered suppressive viral therapy at or beyond 36 weeks of
- Acyclovir 400 mg po TID daily from 36 weeks until delivery
- Valacyclovir 500 mg po BID daily from 36 weeks until
- If a genital HSV outbreak
occurs during labor.
- Consider C-section for any patient with active genital lesions.
- Systemic neonatal herpetic infection from passage through the
- Neonatal herpes has a 50% mortality rate.
Source: AAFP review course 2015