Herpes Simplex Infection During Pregnancy, Results of a Tertiary Referral Center in Turkey

Abstract

Objective The present study aimed to determine herpes simplex virus (HSV) infection during pregnancy, serologic status of symptomatic patients, and the frequency of PCR and culture positivity and neonatal disease in an obstetric population.

Materials and methods Sera of 1,690 women with genital lesions were tested for HSV IgM and/or HSV IgG between 2008 and 2017. All the patients were evaluated by PCR and viral culture to demonstrate genital herpes infection.

Results The frequency of HSV IgG and IgM seropositivity was 73.8% (1245/1685) and 28.6% (484/1690). The number with a positive viral culture was 288, whereas positive PCR was 305. Five infants had localized skin lesions of HSV infection at the time of birth.

Conclusion This study shows the serologic status, viral culture and PCR testing results of pregnant women who had a symptomatic genital HSV infection and efficacy of management strategies to prevent neonatal herpes infection.

Key words

HSV - pregnancy - neonatal herpes - acyclovir

• References

• 1 Beksaç MS, Özlü T, Dikensoy E. et al. Management of severe non-immune hydrops fetalis cases: The role of diagnostic and/or therapeutic interventions. Gynecol Obstet Reprod Med 2009; 15: 85-88
• 2 Stephenson-Famy A, Gardella C. Herpes simplex virus infection during pregnancy. Obstet Gynecol Clin North Am 2014; 41: 601-614
• 3 Mercolini F, Verdi F, Eisendle K. et al. Congenital disseminated HSV-1 infection in preterm twins after primary gingivostomatitis of the mother: Case report and review of the literature. Z Geburtshilfe Neonatol 2014; 218: 261-264
• 4 Patel R, Green J, Clarke E. et al. 2014 UK national guideline for the management of anogenital herpes. Int J STD AIDS 2015; 26: 763-776
• 5 ACOG Practice Bulletin . Clinical management guidelines for obstetrician-gynecologists. No. 82 June 2007. Management of herpes in pregnancy. Obstet Gynecol 2007; 109: 1489-1498
• 6 Aran T, Osmanağaoğlu M, Bozkaya H. Analysis of non-immune hydrops fetalis: Evaluation of 15 cases. Gynecol Obstet Reprod Med 2012; 18: 131-133
• 7 Dolar N, Serdaroglu S, Yilmaz G. et al. Seroprevalence of herpes simplex virus type 1 and type 2 in Turkey. J Eur Acad Dermatol Venereol 2006; 20: 1232-1236
• 8 Brown Z. Preventing herpes simplex virus transmission to the neonate. Herpes 2004; 11 (Suppl. 03) 175A-186A
• 9 Brown ZA, Wald A, Morrow RA. et al. Effect of serologic status and cesarean delivery on transmission rates of herpes simplex virus from mother to infant. JAMA 2003; 289: 203-209
• 10 Kimberlin DW. Neonatal herpes simplex infection. Clin Microbiol Rev 2004; 17: 1-13
• 11 Fleming DT, McQuillan GM, Johnson RE. et al. Herpes simplex virus type 2 in the United States, 1976–1994. N Engl J Med 1997; 337: 1105-1111
• 12 Langenberg AG, Corey L, Ashley RL. et al. A prospective study of new infections with herpes simplex virus type 1 and type 2. Chiron HSV Vaccine Study Group. N Engl J Med 1999; 341: 1432-1438
• 13 Scoular A. Using the evidence base on genital herpes: Optimising the use of diagnostic tests and information provision. Sex Transm Infect 2002; 78: 160-165
• 14 Ashley RL. Performance and use of HSV type-specific serology test kits. Herpes 2002; 9: 38-45
• 15 Odievre MH, Cointe D, Thebaud B. et al. The assessment of IgG avidity in the evaluation of perinatal herpes simplex virus infection. J Perinatol 2002; 22: 669-671
• 16 Wald A, Huang ML, Carrell D. et al. Polymerase chain reaction for detection of herpes simplex virus (HSV) DNA on mucosal surfaces: Comparison with HSV isolation in cell culture. J Infect Dis 2003; 188: 1345-1351
• 17 Pasternak B, Hviid A. Use of acyclovir, valacyclovir, and famciclovir in the first trimester of pregnancy and the risk of birth defects. JAMA 2010; 304: 859-866
• 18 Sheffield JS, Hollier LM, Hill JB. et al. Acyclovir prophylaxis to prevent herpes simplex virus recurrence at delivery: A systematic review. Obstet Gynecol 2003; 102: 1396-1403
• 19 Watts DH, Brown ZA, Money D. et al. A double-blind, randomized, placebo-controlled trial of acyclovir in late pregnancy for the reduction of herpes simplex virus shedding and cesarean delivery. Am J Obstet Gynecol 2003; 188: 836-843
• 20 Scott LL, Hollier LM, McIntire D. et al. Acyclovir suppression to prevent recurrent genital herpes at delivery. Infect Dis Obstet Gynecol 2002; 10: 71-77
• 21 Scott LL, Sanchez PJ, Jackson GL. et al. Acyclovir suppression to prevent cesarean delivery after first-episode genital herpes. Obstet Gynecol 1996; 87: 69-73
• 22 Brown ZA, Vontver LA, Benedetti J. et al. Effects on infants of a first episode of genital herpes during pregnancy. N Engl J Med 1987; 317: 1246-1251
• 23 Hensleigh PA, Andrews WW, Brown Z. et al. Genital herpes during pregnancy: Inability to distinguish primary and recurrent infections clinically. Obstet Gynecol 1997; 89: 891-895
• 24 Hollier LM, Wendel GD. Third trimester antiviral prophylaxis for preventing maternal genital herpes simplex virus (HSV) recurrences and neonatal infection. Cochrane Database Syst Rev 2008; DOI: 10.1002/14651858. CD004946.pub2 CD004946
• 25 Stanberry LR, Spruance SL, Cunningham AL. et al. Glycoprotein-D-adjuvant vaccine to prevent genital herpes. N Engl J Med 2002; 347: 1652-1661