Disseminated Herpes Simplex Virus in Pregnancy: A Systematic Review of Cases

Disseminated herpes simplex virus (HSV) is more common in pregnancy and has a high mortality and morbidity. It is a rare disease, inconsistently addressed by national guidelines and lacking high-quality data to guide decision making.

This systematic review of cases of disseminated HSV in pregnant and postpartum adults aims to determine the clinical features, diagnostic methods, and maternal survival rate with and without aciclovir.

A search of MEDLINE, EMBASE and Google was undertaken.

Studies were included if they were published in English, were case reports, case series, trials or literature reviews, reported data from people assigned female at birth, and were pregnant or postpartum with a laboratory-confirmed diagnosis of disseminated HSV.

Two reviewers independently screened studies, extracted data on participant and intervention characteristics using a standardized Excel template, and assessed risk of bias.

A total of 114 cases were analyzed from 109 papers (1966-2024). 104 cases (91.2%) reported from high-income countries. Most patients were in the third trimester (n = 62, 54.4%) and had HSV-2 (n = 58, 66.7%). Clinical features were non-specific: fever (n = 99, 86.8.0%), deranged liver function tests (n = 81, 71.1%), neuropsychiatric symptoms (n = 72, 63.2%), gastrointestinal symptoms (n = 72, 63.2%). Antemortem diagnosis occurred in 89.5% (n = 102). Maternal survival rate with aciclovir was 0.88 (95% CI: 0.80-0.94) and without was 0.42 (95% CI: 0.25-0.59).

A high index of suspicion is required for diagnosis due to non-specific clinical features. Mandatory reporting and inclusion of disseminated HSV in sepsis guidelines are recommended.