Diagnosis

A. PCR to detect HSV DNA from lesions or genital secretions is recommended for diagnosis. The gold standard for diagnosis of acute HSV infection is viral culture. Although the highest yield is from vesicular fluid of skin lesions, cultures may be obtained from the eyes, mouth, cerebral spinal fluid, rectum, urine, and blood.

Clinical Designation of Genital Herpes Simplex Virus Infection

Primary genital HSV infection

Antibodies to both HSV-1 and HSV-2 are absent at the time the patient acquires genital HSV due to HSV-1 or HSV-2

Nonprimary first episode genital HSV infection

Acquisition of genital HSV-1 with pre-existing antibodies to HSV-2 or acquisition of genital HSV-2 with pre-existed antibodies rto HSV-1

Recurrent genital HSV infection

Reactivation of genital HSV in which the HSV type recovered from the lesion is the same type as antibodies in the serum

III. Maternal treatment

A. Primary infection. Acyclovir therapy (200 mg PO five times per day or 400 mg PO TID for 7 to 14 days) is recommended. Acyclovir is safe in pregnancy. Acyclovir should be administered to pregnant women experiencing a first episode of HSV during pregnancy to reduce the duration of active lesions. Suppressive therapy (400 mg PO BID) for the remainder of pregnancy should also be considered.

B. Recurrent infection. Women with one or more HSV recurrence during pregnancy benefit from suppression given at 36 weeks of gestation through delivery.

C. Cesarean delivery should be offered to women who have active lesions or symptoms of vulvar pain or burning at the time of delivery in those with a history of genital herpes. However, delivery by cesarean birth does not prevent all infections. Approximately 20 to 30 percent of HSV-infected infants are born by cesarean. Prophylactic cesar-ean delivery is not recommended for women with recurrent hSv and no evidence of active lesions at the time of delivery. Lesions which have crusted fully are considered healed and not active.

D. Prevention

1. Nongenital invasive procedures (eg, amniocentesis) should be delayed if there is evidence of systemic disease. Use of fetal scalp electrodes should be avoided among women who are known to have recurrent HSV, and who are in labor.

2. Mothers with active lesions should cover their lesions, and hands should be washed before touching the baby. Breastfeeding is not contrain-dicated as long as there are no breast lesions.

References: See page 184.

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