Genital Herpes in Pregnancy

Genital Herpes in Pregnancy

Infection with genital herpes simplex virus (HSV) remains a common viral sexually transmitted disease, often subclinical, and a major worldwide problem in women of reproductive age.

Women newly diagnosed with genital herpes will often experience psychological distress and worry about future sexual relationships and childbearing.

In the United States, approximately 45 million individuals aged 12 years or older (1 in 5) have been infected with genital herpes. Each year, 1.6 million new HSV-2 cases are diagnosed, with 21% of women having serologic evidence of HSV-2. Approximately 22% of pregnant women are infected with HSV-2, and 2% of women acquire genital herpes in pregnancy. 

About 1200-1500 new cases of neonatal HSV infection are diagnosed each year. The incidence of neonatal herpes varies considerably in international studies (about 1:3,200 births in the US and 1:60,000 in the UK). Approximately 80% of infected infants are born to mothers with no reported history of HSV infection. Untreated neonatal HSV infection is associated with a mortality rate of 60%, and even with early and appropriate treatment, survivors experience considerable disability.

Pregnant women with untreated genital herpes during the first or second trimester appear to have a greater than two-fold risk of preterm delivery compared with women not exposed to herpes, particularly in relation to premature rupture of membrane and early preterm delivery (≤ 35 wk of gestation). Pregnant women who receive antiherpes treatment have a lower risk of preterm delivery than untreated women, and their preterm delivery risk is similar to that seen in unexposed women.

This article reviews (1) the types of genital HSV infections, (2) the risks and sequelae of neonatal HSV infection, and (3) the strategies to reduce perinatal transmission of HSV.

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