Genital Herpes In Pregnant Women

 

Genital Herpes In Pregnancy

Genital herpes is a virus that can also be commonly contracted by pregnant women, who are at risk of transmitting it to the fetus by contact at the time of delivery. The incidence of this infection is 5-80 cases per 100,000 live births.

 In many cases, however, these are old herpes infections already before pregnancy itself, for this reason, the patient's personal history should be studied already at the beginning of the first trimester of gestation. In addition, women who have experienced recurrent herpes in their lives should be well informed about the risk of herpes transmission at the time of delivery.

Neonatal herpes is a severe systemic viral infection contracted in almost all cases through direct contact with maternal secretions at the time of delivery (rare cases of postnatal transmission are also reported).

Factors affecting the likelihood of transmission are the type of infection (primary or recurrent), the presence of protective maternal antibodies capable of crossing the placenta, the length of time between rupture of membranes and delivery, the use of monitoring on the fetal scalp and mode of delivery. Exceptionally, the congenital infection can be transmitted via the placenta.

 

The personal history of genital herpes should be investigated in every pregnant woman and their partners.

The risk of transmission to the newborn from an infected mother is high (30% -50%) in case of a primary infection contracted near the term of pregnancy. The risk of transmission to the newborn is low (<1%) in case of a primary infection contracted in the first half of pregnancy or case of recurrent episodes near the term of pregnancy.

The frequency of recurrent episodes in pregnancy, much higher than that of the first episode of infection, means that the proportion of newborns infected by a mother with recurrent infection remains consistent.

Given the possibility of asymptomatic infections, the first clinical episode may not coincide with the first infection so the distinction between primary or recurrent infection can be difficult. In case of a first clinical episode of genital herpes in the third trimester of pregnancy, it is advisable to perform an immunoassay (anti-HSV IgG assay 1 and 2), since the type of infection influences the probability of transmission and the mode of delivery.

How To Prevent Neonatal Herpes

The prevention of neonatal infection is based on two fundamental aspects:

 

1) preventing primary infection in women during the last trimester of pregnancy.

To this end, pregnant women should refrain from having sexual intercourse with infected or suspected partners during the last trimester of pregnancy.

Performing specific serological tests may be considered in pregnant women with HSV-infected partners. The efficacy of antiviral drug therapy in reducing the risk of transmission to pregnant women has not been studied.

 

2) Avoid exposure of the newborn to herpetic lesions during birth.

Viral cultures performed during pregnancy in women with or without visible genital lesions do not predict the possibility of virus shedding during childbirth and should not be performed routinely.

 

Cesarean section is recommended if genital herpetic lesions are present at the time of delivery, but not always.

In the case of primary infection, a cesarean section is recommended for lesions present at the time of delivery or appearing within 6 weeks of the term of pregnancy.

In the presence of active lesions from recurrent infection, not everyone agrees in recommending a cesarean section. According to the Royal College of Obstetricians and Gynaecologists, the low risk of neonatal transmission should be assessed in conjunction with the maternal risks associated with the surgery. The recommendation is not to perform the cesarean section routinely, but to agree on the mode of delivery based on the clinical circumstances and preferences of the woman. During vaginal delivery, invasive maneuvers (e.g. electrode on the fetal scalp) should be avoided.

Cesarean section is not recommended in case of a primary infection contracted in the first-second trimester of pregnancy, or a case of recurrent infection during pregnancy, due to the very low risk of transmission to the newborn.

The cesarean section does not eliminate the risk of transmission.

 
How Is Genital Herpes Diagnosed?

If you have blisters in your genital area, your doctor may order tests to diagnose genital herpes. Your doctor may take a sample of cells from the fluid inside the protrusion or order a blood test.

 

Therapy Of Genital Herpes

Oral acyclovir can be started during pregnancy in the event of an infectious episode to reduce the extent and duration of symptoms and shorten the virus shedding period. Treatment is well tolerated in late pregnancy, requires no dosage adjustment, and there is no evidence of maternal-fetal toxicity. In the case of therapy in the first trimester, some data report overlapping risks between women exposed to the drug and the general population, but given the limited number of pregnancies studied, it is not possible to draw definitive conclusions.

Acyclovir should therefore be used with caution before the 20th week of gestation, should be proposed in case of severe symptoms, or administered intravenously in disseminated forms. It is rarely needed in case of a recurring episode.

Studies on valacyclovir and famciclovir are still too scarce.

 

Suppressive therapy with acyclovir during the last 4 weeks of pregnancy reduces the presence of genital lesions at the time of delivery in women with recurrent herpes, thereby lowering the frequency of cesarean sections.

 

There are no studies to support the use of antiviral therapy in women serologically positive for HSV but without a history of genital herpes.

Infants exposed to the virus during birth should be closely monitored. Some specialists recommend carrying out cultures to identify the virus before the onset of the clinical picture, others recommend carrying out therapy with acyclovir on the newborn in case of primary maternal infection in the third trimester, given the high risk of transmission.

 

It is important to avoid herpes infection during pregnancy. The first episode during pregnancy can increase the risk of transmission to the newborn baby. However, it is rare for women with genital herpes to infect their babies. If you have active disease at the time of delivery, a cesarean section may be recommended.