Treatment of Recurrent Genital Herpes During Pregnancy
Recurrent genital herpes in a pregnant woman who is not living with HIV requires careful, individualised management. Pregnancy changes which antiviral approaches are appropriate, and decisions cannot follow a one-size-fits-all algorithm.
Clinical Scenario
A pregnant woman experiencing recurrent genital herpes who is HIV-negative. Both the safety profile of antiviral options and the mode of treatment must be assessed in the context of pregnancy — not all standard regimens apply, and the choice of agent matters.
Treatment Approach
In early pregnancy, antiviral therapy — whether given continuously or episodically — may be considered, but the decision must be made on a case-by-case basis. Not every antiviral used for genital herpes is appropriate here; the full protocol specifies which agents are permitted and how therapy should be managed throughout pregnancy.
References
DOI: 10.1111/jdv.20450
Daily suppressive aciclovir 400 mg three times a day from 36 weeks gestation should therefore be offered to all women with a history of genital herpes (1, A).
Continuous or episodic therapy is not licensed for use in early pregnancy but has not been associated with adverse effects in a large pregnancy registry.
A decision on its use should be made on a case-by-case basis.
Famciclovir should not be used and the dose of aciclovir titrated down to the minimum effective level.
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