Obstetric Management of Women with a History of Recurrent Genital Herpes

ABSTRACT

Genital herpes simplex is a common sexually transmitted disease in our society. A genital infection complicating pregnancy can result in the vertical transmission of a devastating neonatal illness. The appropriate obstetric management of women with a history of genital herpes remains controversial. Past management protocols have stressed frequent third trimester viral cultures in an attempt to identify those at risk for asymptomatic viral shedding at delivery. Cesarean section was recommended if asymptomatic shedding was suspected. Subsequent research has shown that surveillance schema aimed at identifying asymptomatic shedding in term gestations will fail to identify antepartum the majority of cases of neonatal herpes. Furthermore, weekly surveillance cultures have failed to predict intrapartum viral shedding accurately. The current literature supports mode of delivery decisions based on clinical history and careful intrapartum examination. The development of rapid diagnostic tests for intrapartum diagnoses of viral shedding as well as the prophylactic use of antiviral agents will influence future recommendations.