Management of perinatal infections

Question 1

A women has a history of genital HSV (laboratory confirmed). When would you offer suppressive HSV antiviral treatment.

Answer 1

Consider use of suppressive antiviral therapy from 36 weeks in women with multiple recurrent over lesions or prior if frequent symptomatic recurrences.

Question 2

What intrapartum factors can increase risk of spread of HSV to the baby (even without any active lesions)?

Answer 2

FSE, forceps and vacuum delivery may increase risk of transmission.

Question 3

In terms of HSV infection, when would you consider a CS?

Answer 3

Consider if:

• First genital HSV inefction diagnosed during labour
• If lesions develop for the first time in late (3rd trimester) pregnancy don’t already have IgG to serotype in blood (i.e. no seroconversion), consider suppressive antiviral therapy from 36 weeks and caesarean section.

Question 4

What medications and doses are used for suppressive viral therapy against HSV in pregnancy? (2)

Answer 4

1. oral aciclovir 400mg PO TDS or valaciclovir 500mg PO BD redues clinical recurrrences, asympatomic shedding, rate of caesarean section and virus in genital tract