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The risk of transmission of HSV during pregnancy is related to the timing of maternal infection and whether an outbreak is a primary episode, nonprimary first episode, or recurrent first episode.Most cases of neonatal herpes are acquired during exposure to HSV during delivery. The greatest risk to the newborn occurs when symptomatic primary infection occurs during the last trimester.
  • For primary infection the transmission rate is 30 -50 %.
  • For a nonprimary first episode the transmission rate is 33%.
  • For a symptomatic recurrence the transmission rate is 3%.


  • Viral cultures at the time of labor not recommended.
  • Patients with primary HSV during pregnancy should be treated with Acyclovir
        400mg TID for 7 -10 days or 200 mg 5 times a day for 7 -10 days.
  • In patients with recurrent episodes consider Acyclovir 200 mg QID or 400 mg TID
        beginning at 36 weeks to try to prevent an outbreak at the time of labor.
  • A thorough speculum exam should be performed at the time of labor to identify
        any lesions.
  • Cesarean delivery is advised for women with active genital or prodromal symptoms
        at the time of labor .
  • Cesarean delivery is not recommended for women with active nongenital lesions.
        The latter should be covered and the patient allowed to deliver vaginally.
  • The patient should be advised that C/S does not eliminate the risk of transmission
        to the infant.
  • The pediatrician should be informed of the maternal herpes history.

American College of Obstetricians and Gynecologists. Management of Herpes in Pregnancy. Practice Bullentin #8 WashingtoR DC: American College of Obstetricians and Gynecologists; 1999.
Scott LL, et al. Acyclovir suppression to prevent recurrent genital herpes at delivery. Infect Dis Obstet Gynecol.2001:9.1-7.

Scott LL, et al. Acyclovir suppression to prevent clinical recurrences at delivery after fist episode gelrital herpes in pregnancy: An open label trial. Infect Dis Obstet G}Tnecol. 2001;9:75-80.

Created: 3/1/2003 M Hellen Rodriguez, M.D
Updated: 3/1/2003 M Hellen Rodriguez, M.D

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