HSV

Question 1

Past hx

Answer 1

Risk of transmission <1%

Up to 3% if in genital tract at delivery

Question 2

If first episode during pregnancy/labour, management

Answer 2

Type specific per +/- culture and hsv type serology (blood test)
If seronegative for both hsvs in blood but positive genital swab with seroconversion well before delivery - risk of transmission same as for recurrent herpes
For non-primary first episode (including if blood and swabs are different) with no seroconversion, high risk of transmission 25-50%

Question 3

Neonatal management

Answer 3

Asymptomatic and low risk- swabs and blood for hsv after 24 hours of life
Asymptomatic and high risk or signs of disease- infection screen (full) and start on aciclovir

Question 4

Risk of transmission is 50% if acquired at the one of labour or within 6/52 prior to delivery

Answer 4

Therefore deliver by c/s

If recurrent lesions at term - relative indication for Caesarean section delivery

Question 5

Primary maternal infection with transfer to fetus can result in

Answer 5

Skin lesions
Chorioretinitis 
Microcephalic
Hydrocephalus
5% of neonatal HSV infection

Question 6

Transmission rate for prior infection before pregnancy with no signs or symptoms of an outbreak at delivery

Answer 6

Risk is 0.5%

Maternal antibodies cross the placenta

Question 7

Treatment for primary outbreak

Answer 7

Valciclovire 1g BD for 7/7

Question 8

Treatment for recurrent disease suppressive therapy

Answer 8

500mg BD