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Chapter 14 : Genital Herpes and Pregnancy
To discuss the rationale of herpes simplex virus (HSV) serologic testing in the prevention of neonatal herpes and other adverse consequences of genital herpes complicating pregnancy, it is necessary to review the classification of this infection. The appropriate classification of genital herpes during pregnancy depends upon accurate serotyping of the patient by type-specific serologic assays. A recent study demonstrated that antepartum asymptomatic shedding of HSV as determined by weekly HSV cultures does not predict whether HSV will be present in the genital tract at the onset of labor. Recent studies have demonstrated that most of the morbidity and the majority of cases of neonatal herpes in pregnancy are due not to women whose genital herpes reactivated at the onset of labor but to women acquiring genital herpes, frequently asymptomatically, in late pregnancy. Even if every patient entering pregnancy with symptomatic recurrent genital herpes underwent a cesarean section, only a minority of cases of neonatal herpes would be prevented. Cesarean section may even decrease the transplacental transmission of protective anti-HSV antibodies. Acyclovir is extremely effective in suppressing both symptomatic recurrences and asymptomatic shedding in nonimmunosuppressed, nonpregnant adults. Until the prospective studies of prophylactic acyclovir in late pregnancy which are in progress have been completed and evaluated for safety and efficacy, the prophylactic use of acyclovir in late pregnancy must be approached with caution and certainly only after complete informed consent is given by the patient.