Guidelines for the Management of Herpes Simplex Virus in Pregnancy

Objective: To provide recommendations for the management of genital herpes infection in women who want to get pregnant or are pregnant and for the management of genital herpes in pregnancy and strategies to prevent transmission to the infant. Outcomes: More effective management of complications of genital herpes in pregnancy and prevention of transmission of genital herpes from mother to infant. Evidence: Medline was searched for articles published in French or English related to genital herpes and pregnancy. Additional articles were identified through the references of these articles. All study types and recommendation reports were reviewed. Values: Recommendations were made according to the guidelines developed by the Canadian Task Force on Preventive Health Care. Recommendations 1. Women's history of genital herpes should be evaluated early in pregnancy. (III-A) 2. Women with known recurrent genital herpes simplex virus (HSV) should be counselled about the risks of transmission of HSV to their neonates at delivery. (III-A) 3. At delivery, women with recurrent HSV should be offered a Caesarean section if there are prodromal symptoms or in the presence of a lesion suggestive of HSV. (II-2A) 4. Women with known recurrent genital HSV infection should be offered acyclovir or valacyclovir suppression at 36 weeks' gestation to decrease the risk of clinical lesions and viral shedding at the time of delivery and therefore decrease the need for Caesarean section. (I-A) 5. Women with primary genital herpes in the third trimester of pregnancy have a high risk of transmitting HSV to their neonates and should be counselled accordingly and should be offered a Caesarean section to decrease this risk. (II-3B) 6. A pregnant woman who does not have a history of HSV but who has had a partner with genital HSV should have type-specific serology testing to determine her risk of acquiring genital HSV in pregnancy before pregnancy or as early in pregnancy as possible. Testing should be repeated at 32 to 34 weeks' gestation. (III-B) Validation: These guidelines have been reviewed and approved by the Infectious Diseases Committee of the SOGC. Sponsor: The Society of Obstetricians and Gynaecologists of Canada