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

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