Herpes simplex virus infection in the neonate: clinical presentation and management

Herpes simplex virus (HSV) infections in the neonate can be acquired during pregnancy and during and following the birth process. The most common mode of transmission is from exposure to the virus in the birth canal at the time of delivery. HSV is among the less common infections in neonates. This often leads to delay in diagnosis and treatment, increasing the risk of a poor or fatal outcome. Clinically, HSV infection often presents in preterm or term infants with signs and symptoms similar to those of bacterial sepsis. Their immature immune systems puts preterm infants at higher risk for serious disease. A positive maternal history of HSV is not needed to support diagnosis; typically the mother is asymptomatic. Primary maternal infection usually leads to more serious disease in the neonate. It is important that caregivers recognize the subtle signs and symptoms of HSV infection so early diagnosis and prompt treatment can be instituted.