Acyclovir prophylaxis to prevent herpes simplex virus recurrence at delivery: a systematic review

Area of Science:

• Obstetrics and Gynecology
• Infectious Diseases
• Virology

Background:

• Genital herpes simplex virus (HSV) infection is a common sexually transmitted disease in the United States.
• Perinatal transmission of HSV to the fetus or neonate poses a significant risk during pregnancy.
• Recurrent HSV outbreaks near delivery can necessitate cesarean delivery to prevent neonatal transmission.

Purpose of the Study:

• To systematically review published data on the efficacy of prophylactic acyclovir in pregnant women.
• To estimate the effect of near-term acyclovir prophylaxis on recurrent genital herpes at delivery.
• To assess the impact on cesarean delivery rates and HSV viral detection at delivery.

Main Methods:

• Systematic review and meta-analysis of randomized clinical trials.
• Inclusion criteria: trials using acyclovir in pregnancy for women with HSV.
• Data sources: MEDLINE, LILACS, EMBASE, conference proceedings, and bibliographies (1966-March 2003).

Main Results:

• Acyclovir prophylaxis initiated at 36 weeks' gestation significantly reduced clinical HSV recurrences at delivery (OR 0.25).
• Prophylactic acyclovir decreased cesarean deliveries for clinical HSV recurrence (OR 0.30).
• Treatment markedly lowered HSV detection rates at delivery, including asymptomatic shedding (OR 0.11 and OR 0.09, respectively).

Conclusions:

• Prophylactic acyclovir, started at 36 weeks' gestation, is effective in preventing clinical HSV recurrence at delivery.
• This prophylactic regimen reduces the need for cesarean deliveries due to recurrent genital herpes.
• Acyclovir significantly lowers the risk of HSV viral shedding at the time of delivery, mitigating neonatal transmission risk.