Vertical transmission of genital herpes: prevention and treatment options

Herpes simplex virus (HSV) transmitted from mother to child around the time of delivery can cause potentially fatal disease in the newborn. Women who experience their first genital HSV infection in pregnancy are at the highest risk of transmitting the virus to their newborn. Efforts to prevent vertically transmitted HSV disease can be directed in the following three ways: (i) prevent maternal genital HSV infection; (ii) prevent transmission during pregnancy and delivery; or (iii) postnatally prevent disease in an exposed newborn. Oral aciclovir and valaciclovir given prophylactically in late pregnancy have been shown to limit clinical recurrence of genital herpes, shedding of HSV at delivery and the rate of caesarean delivery for past HSV disease. However, there are insufficient data to determine the effect of oral antiviral prophylaxis in pregnancy on neonatal HSV disease. Neonatal HSV disease should always be treated with systemic antiviral therapy. There is currently no vaccine licensed to prevent genital herpes, although a number show promise in clinical trials. The role of intrapartum antiviral therapy and postnatal strategies to prevent neonatal HSV disease require further evaluation.