Herpes simplex virus infection in pregnancy

Genital infections in pregnancy caused by herpes simplex virus types 1 and 2 are a difficult management problem. Both primary and recurrent genital herpes can range from severe, extensive ulceration to asymptomatic virus shedding. Although neonatal herpes is a well recognized complication of symptomatic maternal primary genital infection at the time of delivery, most cases are associated with asymptomatic virus shedding and absence of a history of genital herpes. Neonatal herpes may also be acquired in utero and in the postnatal period. The diagnosis of herpes simplex infection is made most reliably by virus isolation or antigen detection from samples obtained from clinically apparent lesions. Serology is useful for diagnosing primary herpes, and newer serological techniques allow the detection of HSV-2 specific antibodies. Strategies to prevent neonatal herpes are limited by the failure of currently available diagnostic tests to rapidly detect women in labour who are at risk of transmitting herpes, by the absence of proven antenatal screening tests for HSV, and by transmission of herpes to neonates from asymptomatic mothers. The most useful current strategy is careful examination of the vulva and cervix for herpes lesions in women coming to labour. Caesarean section is indicated in women with clinically apparent genital herpes at delivery. Effective and safe antiviral agents are available for treatment of maternal and neonatal herpes.