How is herpes simplex virus (HSV) infection treated during pregnancy?

Updated: Feb 16, 2018
  • Author: Sean P McGregor, DO, PharmD; Chief Editor: William D James, MD  more...
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Answer

Transmission rates of HSV to neonates during pregnancy are low in women with nonprimary HSV infections, but they approach 50% in women with primary infections. [48] Routine screening for HSV in pregnancy is not indicated, and diagnostic testing should be performed in suspected cases of genital herpes. [48] Management of genital herpes in pregnancy is accomplished through careful history and physical examination, especially during delivery. Vaginal delivery can be performed in the absence of signs or symptoms of genital herpes infection. [35] However, cesarean delivery should be performed in women with primary or recurrent genital herpes at the time of labor to reduce the risk of neonatal transmission. [35] Systemic antivirals can be used safely during pregnancy and can reduce the need for cesarean delivery. [35] However, neonatal transmission is still possible. [35]

Suppressive therapy for recurrent genital herpes in pregnancy is as follows:

  • Acyclovir 400 mg PO 3 times per day (starting at 36 weeks’ gestation)

  • Valacyclovir 500 mg PO twice daily (starting at 36 weeks’ gestation)


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