Advances in the treatment of neonatal herpes simplex infections

Neonatal HSV disease is a potentially devastating illness with significant mortality and morbidity. Collaborative research efforts over the past 25 years have provided therapeutic options that were beyond hope just a generation ago. The use of high-dose acyclovir for the treatment of acute neonatal HSV disease has reduced mortality rates to their lowest level ever. Application of PCR to clinical specimens from neonates suspected of having neonatal HSV infection largely has eliminated the need to perform invasive brain biopsies, while at the same time providing a new tool with which to re-define the natural history of neonatal HSV disease. A limitation of PCR is the lack of standardisation in methodologies from laboratory to laboratory, which can impede a clinician's ability to interpret the PCR results. As such, all test results, including those from PCR, must be evaluated in the context of the patient's medical condition. Areas for continued research for further means of improvement in disease outcome include raising awareness of neonatal HSV disease so that the time between disease onset and the initiation of antiviral therapy can be shortened, as well as the evaluation of monoclonal antibodies as adjunctive therapy to high-dose acyclovir. Utilisation of suppressive oral acyclovir following acute neonatal disease is another therapeutic option under clinical investigation with the potential to improve morbidity outcomes of neonatal HSV disease survivors.