1. Epidemiology

HSV shedding occurs in 0,1% to 0.4% of deliveries.

Frequency of neonatal infection is 0.01% to 0.04% of deliveries.

Transmission rate of primary maternal infection to exposed neo­nate is estimated at 30% to 50%.

Transmission rate with recurrent maternal infection is estimated less than 1%.

The risk of asymptomatic lower genital tract HSV infection on day of delivery is 1.4% in women with a confirmed history of recurrent herpes.

Nosocomial infection may also cause neonatal infection, most often HSV-1, at a rate of approximately 10%. Parents, family mem­bers, and health care workers may transmit the disease.

Neonatal infection

Infection may result from HSV-1 or HSV-2.

Neonatal complication is severe with third-trimester maternal infection.

Seventy percent of neonates with severe HSV infection are delivered from asymptomatic mothers.

The risk of neonatal herpes from an asymptomatic mother with a history of recurrent genital herpes infection is estimated at less than 1 in 1000.

Neonatal complications of perinatal HSV

  1. Active HSV infection leads to a 50% chance of complications in primary episode HSV infection.

Neonatal death may occur in 60% of cases.

Fifty percent of surviving neonates have significant sequelae,

including the following:


Mental retardation



Retinal dysplasia




Onset of neonatal herpes is often insidious. Delay in diagnosis

without lesions approximates 72 hours.

  1. Management: The American College of Obstetricians and Gynecolo­gists has endorsed the following recommendations for pregnant women with HSV infections or a history of


HSV infections:


Cultures should be done when a women has active HSV lesions during pregnancy to confirm the diagnosis. If there are no vis­ible lesions at the onset of labor, vaginal delivery is acceptable.

Weekly surveillance cultures of pregnant women with a history of HSV infection, but no visible lesions, are not necessary and vaginal delivery is acceptable.

Amniocentesis in an attempt to rule out intrauterine infection is not recommended for mothers with HSV at any stage of gestation.



Cesarean section in women with active infection will signifi­cantly decrease but not eliminate the risk and incidence of neonatal HSV infection.

The American College of Obstetricians and Gynecologists recommends that term patients who have visible lesions and are in labor, or who have ruptured membranes, should undergo cesarean delivery.

Cultures for HSV obtained at delivery in women with a history of HSV may aid in identifying potentially exposed neonates.

Medical therapy

The safety of systemic acyclovir therapy among pregnant women has not been established.

Acyclovir is indicated for life-threatening and disseminated HSV infection (e.g., encephalitis, pneumonitis, hepatitis).

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