Genital Herpes Complicating Pregnancy

Diagnosis of genital herpes relies on laboratory confirmation with culture or … genital herpes. Enhanced prevention strategies include identification of …

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Genital Herpes Complicating Pregnancy,
Abstract: Approximately 22% of pregnant women are infected with herpes simplex virus (HSV)-2,, and 2% of women will acquire HSV during pregnancy. Remarkably, up to 90% of these women are, undiagnosed because they are asymptomatic or have subtle symptoms attributed to other vulvovaginal disorders. Diagnosis of genital herpes relies on laboratory confirmation with culture or, polymerase chain reaction assay of genital lesions and type-specific glycoprotein G-based serologic, testing. Neonatal herpes is the most severe complication of genital HSV infection and is caused by, contact with infected genital secretions at the time of labor. Maternal acquisition of HSV in the third, trimester of pregnancy carries the highest risk of neonatal transmission.
Despite advances in the, diagnosis and treatment of neonatal herpes, little change in the incidence or serious sequelae from, this infection has occurred. As such, prevention of the initial neonatal infection is critically important. Obstetricians are in a unique position to prevent vertical HSV transmission by identifying women, with genital lesions at the time of labor for cesarean delivery, prescribing antiviral suppressive, therapy as appropriate, and avoiding unnecessary invasive intrapartum procedures in women with, genital herpes. Enhanced prevention strategies include identification of women at risk for HSV, acquisition during pregnancy by testing women and possibly their partners for HSV antibodies and, providing counseling to prevent transmission to women in late pregnancy. OBSTETRICS & GYNECOLOGY, EPIDEMIOLOGY OF GENITAL HERPES, CLINICAL CHARACTERISTICS AND, DIAGNOSIS OF HERPES SIMPLEX VIRUS IN, PREGNANCY, Brown et al, TYPE-SPECIFICIC HERPES SIMPLEX VIRUS, SEROLOGIC ASSAYS,
Table 1. Glycoprotein G-Based Type-Specific Tests for Herpes Simplex Virus Antibody, HerpeSelect, HSV-1, Captia HSV-1, ELISA and, HSV-1 and, HSV-2, biokit, Captia HSV-2, HSV-2 ELISA, Immunoblot, Rapid Test*, ELISA, Western Blot, TREATMENT OF SYMPTOMATIC HERPES, SIMPLEX VIRUS IN PREGNANCY, Primary or First-Episode Herpes Simplex Virus, Table 2. Recommended Doses of Antiviral Medication for Herpes in Pregnancy, Indication, Acyclovir, Valacyclovir, Recurrent Herpes Simplex Virus, Antiviral Drug Choice and Safety in Pregnancy, NEONATAL HERPES, Type of Herpes Simplex Virus Isolated from, the Genital Tract, RISK FACTORS FOR NEONATAL HERPES, Herpes Simplex Virus in the Genital Tract at, the Time of Labor, Invasive Obstetrical Procedures, Stage of Maternal Infection, METHODS FOR PREVENTING NEONATAL, HERPES SIMPLEX VIRUS, Cesarean Delivery For Women With Herpes, Simplex Virus in the Birth Canal at the Time, of Labor, Antiviral Suppressive Therapy, Prevent the Acquisition of Herpes Simplex, Virus by Pregnant Women, Fig. 1. Fig. 2. Avoid Unnecessary Invasive Procedures in, Labor, POSTPARTUM RECOMMENDATIONS, SUMMARY, REFERENCES

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