• 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%.

RECOMMENDATIONS

• 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.

REFERENCES
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