Herpes Simplex Virus

Question 1

Define Herpes Simplex Virus.

Answer 1

Infection with HSV in pregnancy.

Question 2

What is the aetiology of HSV in pregnancy?

Answer 2

Transmission by physical contact with open sore e.g. Sex, vertical

Question 3

What are some risk factors for HSV in pregnancy?

Answer 3

Unprotected sex

Immunosuppression

Other STIs

Question 4

Summarise the epidemiology of HSV in pregnancy.

Answer 4

2% pregnant women

Question 5

What are some symptoms of HSV in pregnancy?

Answer 5

Burning

Pain

Prutitus

Dysuria

May be asymptomatic

Question 6

What are some signs of HSV in pregnancy?

Answer 6

Clusters of vescicles with surrounding erythema

Can progress to ulceration over time

Lymphadenopathy

Question 7

What investigations are performed for HSV in pregnancy?

Answer 7

Clincial diagnosis but support with microbiology (viral culture/PCR, STI screen)

Bloods: HSV Ab (primary infeciton in third trimester)

Question 8

What is the managament for HSV in prgenancy?

Answer 8

Antenatal: Aciclovir in primary infection

Delivery with primary HSV: If within 6wk of infection, advise C-section. If opts for vaginal, give IV ACV intrapartum, avoid PROM/FSE/FBS

Delivery with recurrent HSV: No need for Csecti-on. Womn may opt for C-section if lesions detected at onset of labour – can offer daily ACV if lesions found from 36/40

Question 9

What are the complications associated with HSV in prgenancy? What is the prognosis of HSV in pregnancy?

Answer 9

Maternal: Disseminated herpes (encephalitis, hepatitis, disseminated skin lesions) rare but more common in pregnancy.

Neonatal: 1/60k live births – can affect skin, eyes, mouth, CNS, multiple organs. Mortality 2% to 50% depending on local or disseminated.