Herpes Simplex Virus HSV Infection in Pregnant women and Newborn/Neonate

Herpes Simplex (HSV)

•          There are two forms of HSV, HSV1 or HSV2

•          Primarily transmitted through the infected maternal genital tract

•          The rationale for C-section delivery prior to membrane rupture

•          Primary infection with greater transmission risk than reactivation

Clinical Manifestations:

•          Most are asymptomatic at birth

•          3 patterns of ~ equal frequency with symptoms between birth and 4wks:

•          Skin, eyes, mouth (SEM)

•          CNS disease

•          Disseminated disease (present earliest)

•          Initial manifestations very nonspecific with skin lesions NOT necessarily present

Diagnosis:

•          The culture of maternal lesions if present at the delivery

•          Cultures in an infant:

•          Skin lesions, oro/nasopharynx, eyes, urine, blood, rectum/stool, CSF

•          CSF PCR

•          Serologies again not helpful given the high prevalence of HSV antibodies in the population

Treatment;

•          High dose acyclovir 60mg/kg/day divided q8hrs

•          X21days for disseminated, CNS disease

•          X14days for SEM

•          Ocular involvement requires topical therapy as well