Prevention and management of genital herpes simplex infection during pregnancy and delivery: Guidelines from the French College of Gynaecologists and Obstetricians (CNGOF)

Abstract Objective Identifymeasures to diagnose, prevent, and treat genital herpesinfection during pregnancy and childbirth as well as neonatal herpesinfection. Materials and methods Bibliographic search from the Medline and Cochrane Library databases and review of international clinical practice guidelines. Results Genital herpeslesions are most often due to HSV-2 (LE2). The risk of HSV seroconversion during pregnancy is 1–5% (LE2). Genital herpeslesions during pregnancy in a woman with a history of genital herpesis a recurrence. In this situation, there is no need for virologic confirmation (Grade B). In pregnant women with genital lesions who report they have not previously had genital herpes, virological confirmation by PCR and identifying the specific IgG type is necessary (professional consensus). A first episode of genital herpesduring pregnancy should be treated with aciclovir(200 mg 5 times daily) or valaciclovir(1000 mg twice daily) for 5–10 days (Grade C), and recurrent herpesduring pregnancy with aciclovir(200 mg 5 times daily) or valaciclovir(500 mg twice daily) (Grade C). The risk of neonatal herpesis estimated at between 25% and 44% if a non primary and primary first genital herpesepisode is ongoing at delivery (LE2) and 1% for a recurrence (LE3). Antiviral prophylaxis should be offered to women with either a first or recurrent episode of genital herpesduring pregnancy from 36 weeks of gestation until delivery (Grade B). Routine prophylaxis is not recommended for women with a history of genital herpesbut no recurrence during pregnancy (professional consensus). A cesarean delivery is recommended if a first episode of genital herpesis suspected (or confirmed) at the onset of labor (Grade B) or if it occured less than 6 weeks before delivery (professional consensus) or in the event of premature rupture of the membranes at term. When a recurrence of genital herpesis underway at the onset of labor, cesarean delivery is most likely to be considered when the membranes are intact and vaginal delivery in cases of prolonged ruptureof membranes(professional consensus). Neonatal herpesis rare and mainly due to HSV-1 (LE3). In most cases of neonatal herpes, mothers have no history of genital herpes(LE3). When neonatal herpesis suspected, various samples (blood and cerebrospinal fluid) for HSV PCR must be taken to confirm the diagnosis (professional consensus). Any newborn with suspected neonatal herpesshould be treated with intravenous acyclovir (20 mg/kg 3 times daily) (grade A) before the PCR results are available (professional consensus). The duration of the treatment depends on the clinical form (professional consensus) Conclusion There is no formal evidence that it is possible to reduce the risk of neonatal herpesin genital herpesduring pregnancy. However, appropriate care can reduce the symptoms associated with herpesand the risk of recurrence at term, as well as cesarean rate because of herpeslesions.