HSV

Question 1

What are the manifestations of disseminated maternal herpes?

Answer 1

Encephalitis, hepatitis, disseminated skin lesions or a combination

Rare, but more common in pregnancy, particularly if immunocompromised

High maternal mortality

Question 2

Co-infection with HSV and HIV results in…

Answer 2

Increased replication of both viruses

Question 3

If HIV positive with history of HSV, management:

Answer 3

Daily suppressive Aciclovir 400mg tds from 32/40
Reduce risk of transmission of HIV, especially if VD is planned
Start early if possibility of PTL

Question 4

What are the manifestations of congenital herpes?

Answer 4

Skin, eyes, CNS involvement
IUGR
IUFD

Question 5

What proportion of neonatal herpes is HSV1 vs HSV2

Answer 5

50%

50%

Question 6

What are factors that increase the risk of HSV transmission in labour?

Answer 6

Primary infection
New infection in third trimester, particularly within 6 weeks of delivery
- viral shedding may persist
- baby is likely to be born before the development of protective maternal antibodies

Duration of ROM before delivery
FBS
Mode of delivery

Question 7

In maternal HSV, what is the risk of neonatal transmission in

• primary episode in labour
• primary episode in trimester 3, from 28/30

Answer 7

41% with vaginal delivery

Therefore CS recommended

Question 8

In maternal HSV, what is the risk of neonatal transmission in

• recurrent episode antenatally
• recurrent episode in labour

Answer 8

0-3%
If antenatal: aim vaginal delivery
If antenatal or in labour: offer VS or CS, maternal decision but VD is safe
I

Question 9

In maternal HSV, what are the recommendations re breastfeeding?

Answer 9

Continue

Unless herpetic lesions around nipple