Guidance on Management of Asymptomatic Neonates Born to Women With Active Genital Herpes Lesions

PEDIATRICS (Impact Factor: 5.3). 01/2013; 131(2). DOI: 10.1542/peds.2012-3216
Source: PubMed

ABSTRACT Herpes simplex virus (HSV) infection of the neonate is uncommon, but genital herpes infections in adults are very common. Thus, although treating an infant with neonatal herpes is a relatively rare occurrence, managing infants potentially exposed to HSV at the time of delivery occurs more frequently. The risk of transmitting HSV to an infant during delivery is determined in part by the mother's previous immunity to HSV. Women with primary genital HSV infections who are shedding HSV at delivery are 10 to 30 times more likely to transmit the virus to their newborn infants than are women with recurrent HSV infection who are shedding virus at delivery. With the availability of commercial serological tests that reliably can distinguish type-specific HSV antibodies, it is now possible to determine the type of maternal infection and, thus, further refine management of infants delivered to women who have active genital HSV lesions. The management algorithm presented herein uses both serological and virological studies to determine the risk of HSV transmission to the neonate who is delivered to a mother with active herpetic genital lesions and tailors management accordingly. The algorithm does not address the approach to asymptomatic neonates delivered to women with a history of genital herpes but no active lesions at delivery.

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    • "Neonatal HSV infection is typically acquired through exposure to infected maternal genital secretions during delivery. The risk of acquiring neonatal infection is influenced by several factors, including the type of maternal infection and maternal antibody status, as well as prolonged rupture of membranes and the use of fetal scalp monitoring [9] [10]. Infants born to women who have a first episode genital HSV infection near term are at a much greater risk of developing neonatal HSV infection when compared to mothers with a history of recurrent HSV infection [11]. "
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