Preventing herpes simplex virus transmission to the neonate

Area of Science:

• Obstetrics and Gynecology
• Neonatal Medicine
• Infectious Diseases

Background:

• Neonatal herpes simplex virus (HSV) infection poses severe risks, with disseminated or CNS disease having high mortality and neurological sequelae.
• Current treatments like aciclovir can be delayed by non-specific early symptoms, and some infants still develop severe complications.
• Vertical transmission from mother to neonate during delivery is the primary route of infection.

Purpose of the Study:

• To outline optimal strategies for preventing neonatal HSV infection, focusing on maternal transmission.
• To discuss the role of serological testing and risk assessment in pregnant women.
• To evaluate current and potential interventions for reducing neonatal herpes morbidity.

Main Methods:

• Review of existing literature on neonatal HSV transmission, risk factors, and prevention strategies.
• Analysis of diagnostic methods, including serological tests (gG-specific) for classifying genital HSV infection in pregnancy.
• Consideration of clinical management options: antiviral therapy, caesarean sections, and fetal monitoring.

Main Results:

• Preventing maternal HSV acquisition in late pregnancy is crucial for reducing neonatal infection risk.
• Accurate classification of maternal HSV infection (primary, non-primary, recurrent) using laboratory testing is essential for risk assessment.
• Weekly viral cultures in pregnant women with known genital herpes are not cost-effective or predictive of infant risk.
• Caesarean sections may reduce transmission for mothers shedding HSV at delivery, though practices vary globally.
• Maternal antiviral therapy benefits must be weighed against potential risks.
• Invasive fetal monitoring should be used cautiously in HSV-2 seropositive women.

Conclusions:

• Preventing neonatal HSV acquisition at delivery through maternal risk reduction is the most effective strategy.
• Accurate maternal HSV classification and partner serostatus evaluation are vital for informed management.
• Targeted interventions, including potential caesarean delivery and judicious use of antiviral therapies, are important for high-risk pregnancies.