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• 1.
  Victoria Okpiabhele GPST2
• 2.
  Importance Risk of transmissionof HSV to neonate during delivery – 40% in 5 large studies Neonatal Herpes- severe neurological impairment and death HSV -2 neonatal infection has worse prognosis than HSV- type 1 Factors affecting transmission include type of maternal infection , presence of maternal antibodies, mode of delivery , duration of rupture of membrane before delivery.
• 3.
  Important questions Is thisa primary or recurrent infection? What trimester of pregnancy is the woman in?
• 4.
  First episode in1st and 2nd trimester of pregnancy Same day referral to GUM Confirm diagnosis with viral swabs Aciclovir given within 5 days of onset of symptoms – 200mg 5times daily or 400mg 3 times daily. Aciclovir good safety record in pregnancy and no teratogenicity reported Inform obstetrician Aim for vaginal delivery
• 5.
  First episode in3rd trimester Refer, diagnose and treat Refer to obstetrician Serology typing to distinguish type 1 and type 2.( IgG specific antibody testing compared with swab cultures) Caesarean section is recommended for women with first episode within 6 weeks of EDD. Intravenous aciclovir for the mother intra-partum is considered
• 6.
  Recurrent Herpes Much smallerrisk of transmission – 3% Presence of maternal antibodies protect baby Confirm diagnosis Antiviral treatment not usually indicated. Refer obstetrician Aim for vaginal delivery if no lesions present during labour if genital lesions are present at onset of labour, current UK practice is caesarean section., but risk very small. If vaginal delivery with active lesions then GP and midwife should monitor for signs of neonatal HSV.
• 7.
  Primary V recurrentHerpes Primary herpes bilateral lesions – ulcer, fissure, blisters flu-like prodrome 5-7 days, tender inguinal nodes, local edema, tingling pain in genitals untreated episodes last 3 weeks Recurrent herpes Unilateral lesions Last less than 10 days without treatment