Advice for pregnant women with known recurrent genital herpes.

  • Genital herpes is most frequently caused by infection with herpes simplex virus type 2 (HSV-2) but can also be caused by HSV-1. Genital HSV-1 acquired through orogenital contact is increasingly common in Western Europe and North America. Recurrent genital herpes episodes occur more commonly in infections caused by HSV-2.
  • Women with recurrent genital herpes can deliver normally if they do not have overt genital ulcers at the time of delivery.
  • Repeat viral cultures during pregnancy are of no clinical value in predicting recurrences or viral shedding at the time of delivery.
  • Women with a recurrence at the time of delivery are currently delivered by lower segment caesarean section tom prevent intrapartum viral transmission.
  • If recurrent lesions are present at the time of delivery there is a low risk of neonatal herpes even with vaginal delivery. This risk must be offset against the maternal risks of surgical delivery and some obstetricians may agree to vaginal delivery after discussion with the pregnant woman to obtain her informed consent.
  • Suppression therapy during the third trimester may reduce the risk of recurrence at the time of delivery in women with frequent recurrence but this does not reduce viral shedding so the benefit is uncertain.

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