Treatment of Recurrent Genital Herpes in Pregnancy
This protocol addresses recurrent genital herpes in pregnant women who are not living with HIV — a scenario where antiviral management must account for both maternal wellbeing and neonatal protection at delivery.
Clinical Scenario
Recurrent genital herpes occurring during pregnancy, in a woman not living with HIV. The priority is reducing maternal viral shedding and the presence of lesions at term to protect the neonate.
Treatment Goals
Reduced asymptomatic HSV shedding and absence of genital lesions at term.
Treatment Approach
Daily antiviral suppressive therapy initiated in later gestation is the recommended approach, with risk-stratified timing for women at elevated risk of premature delivery. The protocol also provides guidance on delivery method when genital lesions are present at the onset of labour.
Specific timing, dosing, risk thresholds, and full clinical algorithm are in the complete protocol.
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).
- This may be started earlier if there is any risk of prematurity such as from 32 weeks gestation and from 22 weeks in those identified as being at particularly high risk of premature delivery; and should be guided by national neonatal HSV epidemiology.
- Caesarean section may be considered for women with recurrent genital herpes lesions at the onset of labour but the risk of neonatal herpes following vaginal delivery is small and must be set against risks to the mother of caesarean section.
- For women with a history of recurrent genital herpes, the use of antiviral suppression has been demonstrated to reduce asymptomatic HSV shedding and lesions at term, and may also reduce premature delivery, but have not been studied sufficiently to definitively demonstrate prevention of neonatal HSV disease.
View source ↗