Herpes
        2008
        Department of Obstetrics and Gynaecology
        Incubation period 1-7 days shodding after primary herpes for weeks but only days after recurrence.
        Pregnent women in Scandinavia: 70% HSV1 antibodies and 15-30% HSV2 antibodies. Only 1 of 5 with Herpes type II knows they have infection.
        Neonatal herpes has untreated a high mortality and morbidity with 35% risk for sequelae in survivors. The prognosis is poor even if the child is treated. In most cases of neonatal herpes, the mother has no symptoms. HSV-2 is more severe and more common than HSV-1 in the genital tract. A positive antibody titre is not protective against the other but clinical symptoms attenuated.

        Definiition:
      • Primary herpes - First outbreak (incubation aproximately 4 days (2-12 days)
      • Non-Primary herpes - First outbreak but with anti-bodies against the other type.
      • Recurrences herpes - Outbreak of herpes 1 or 2 with antibodies against the actual herpes type.
      • First time herpes - First clinical observed outbreak
        • If father has recurrent genital herpes and mother has herpes negative antibodies, it is strongly advised not to have sex at the time of known recurrence - use condom in the last six weeks of pregnancy.

        Shedding (primary mean 11 days, recurrent mean 4 days).

        Diagnosis:
        culture from lesion (ELISA, PCR) can be false negative, increase in antibodies.

        Treatment:
        Acyclovir - No teratogenecity found, even in first trimester.

          1 & 2 or suspicion. Acyclovir 200 mg x 6 in 5 days. Primary herpes within six weeks of expected date of delivery: There is 30-50% risk of neonatal herpes if the infant are delivered vaginally. Elective Cesarean section is recommended especially if no specific antibodies found. Intravenous aciclover intrapartum to the mother and subsequently to the neonate may reduce the risk. 5% risk of intrauterine infection.
          Recurrent herpes at delivery has very little risk of neonatal infection and result in mild disease (0-3%). Cesarean section is recommended by some authorities if acute recurrence in the birth canal and should be performed within 4 - 6 hours after the rupture of the membrane. Some disagree with this statement and for example in the Netherlands Cesarean section has not been routinely performed for this indication since 1987 with no increase in the incidence of neonatal herpes. Some do not recommend fetal blood scalp electrode or fetal blood sampling in woman at high risk for recurrent infection (virus shedding before symptoms) and the virus can infect the brain without having contact with antibodies.
          Infection in newborns Incubatintime 2-26 days and even longer if only cerebral affection. To avoid recurrent herpes in late pregnancy, prophylaxis with 400 mg BID from 4 weeks before term.

        Complications: Herpes simplex hepatitis (page 36)

        References:
        (1) MacLean, A., et al. Infection and Pregnancy, RCOG Press 2001.

        (2) Management of Genital Herpes in Pregnancy. Royal College of Obstetricians and Gynecologists. Clinical Guideline No. 30, sep.2007.

        (3) www.infpreg.org
        (4) www.uptodate.com 2007

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