Genital herpes
ICD-10 A60 · ICD-11 1A94

Treatment of Recurrent Genital Herpes in HIV-Positive Pregnant Women

This protocol covers the management of recurrent genital herpes in a pregnant woman who is HIV antibody-positive and has a known history of genital herpes — a clinical setting where coordinated management is essential to reduce the risk of viral transmission, particularly when vaginal delivery is planned.

Clinical Scenario

Women who are HIV antibody-positive with a prior history of genital herpes face a distinct risk profile during pregnancy. Recurrent genital herpes in this population requires a suppressive approach calibrated to gestational stage, with particular attention to the mode of delivery and the potential for preterm labour.

Treatment Approach

Management centres on daily suppressive therapy initiated from a specific gestational threshold, with provision for earlier commencement in women considered to be at particularly high risk of preterm delivery. The complete regimen, exact timing, and individualised clinical guidance are available in the full protocol.

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References

DOI: 10.1111/jdv.20450

Women who are HIV antibody positive and have a history of genital herpes should be offered daily suppressive aciclovir 400 mg three times a day from 32 weeks gestation to reduce the risk of transmission of HIV-1 infection especially in women where a vaginal delivery is planned.

Starting therapy at an earlier gestation than usual should be considered in view of the increased possibility of preterm labour and consideration may be given to starting at 22 weeks of gestation in those at particularly high risk of premature delivery (1, D).

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