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AUSTRALIAN HERPES MANAGEMENT FORUM
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AUSTRALIAN HERPES MANAGEMENT FORUM
Management of pregnant women with recurrent genital herpes Sequential third trimester cultures to predict viral shedding at term are NOT indicated. Caesarean section to prevent neonatal herpes is only indicated for women who have genital lesions evident at delivery. Symptomatic recurrences of genital herpes during the third trimester will be brief and vaginal delivery is appropriate if no lesions are present at delivery. For those with multiple recurrences in pregnancy and in order to avoid a Caesarean section, consider suppressive aciclovir treatment at 400mg tds. Maternal specimens for HSV culture (sweep genital swab) are advised at delivery if the baby is delivered vaginally, in order to identify the babies exposed to women asymptomatically shedding HSV. Management of women with genital lesions at onset of labour Current practice is for delivery by Caesarean section, particularly if the membranes have been ruptured for less than six hours. There is evidence that the risks of viral transmission to the neonate following vaginal delivery are small and must be weighed against risks of Caesarean section to the mother. Use of invasive monitoring (foetal scalp electrode, forceps and vacuum delivery) are advised against, and should be used only for de ned obstetric indications.
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AUSTRALIAN HERPES MANAGEMENT FORUM
Breastfeeding is recommended unless the mother has lesions around the nipples. Aciclovir is excreted in breast milk but its use is not contra-indicated as it does not cause harm to the infant.
Bibliography
Arvin A, Hensleigh PA, Prober CC, et al. Failure of antepartum maternal cultures to predict the infants risk of exposure to herpes simplex virus at delivery. New England Journal of Medicine 1986;315:796-800. Brown lA, Vontver LA, Benedetti J, et al. Eects on infants of a rst episode of genital herpes during pregnancy. New England Journal of Medicine 1987;317:1246-1251. Brown ZA, Benedetti J, Ashley RL, et al. Neonatal herpes simplex virus infection in relation to asymptomatic maternal infection at the time of labor. New England Journal of Medicine 1991;324:1247-1252. Brown ZA, Selke S, Zeh J, et al. The acquisition of herpes simplex virus during pregnancy. New England Journal of Medicine 1997;337:509. Brown ZA, Wald A, Ashley R, et al. Eect of serologic status and caesarean delivery on transmission rates of herpes simplex virus from mother to infant. Journal of the American Medical Association 2003;289(2);203-209. Chuang T. Neonatal herpes: incidence, prevention and consequences. American Journal of Preventive Medicine, 1988;4:47-53. Corey L, Whitley RJ, Stone EF, Mohan K. Di erence between herpes simplex virus type 1 and type 2 neonatal herpes encephalitis in neurological outcome. Lancet 1988;8575-6:1-4. Forsgren M. Genital herpes simplex virus infection and incide nce of neonatal disease in Sweden. Scandinavian Journal of Infections 1994;69:37-41. Haddad J, Langer B, Astruc D, Messer J, Lokiec F. Oral acyclovir and recurrent genital herpes during late pregnancy. Obstetrics and Gynecology 1993;82:102-104. Jones CA, Isaacs D, McIntyre P, Cunningham A, Garland S. Neonatal herpes simplex virus infection. Tenth Annual Report of the Australian Paediatric Surveillance Unit, 2002. Lissauer T J, Shaw PJ, Underhill G. Neonatal herpes simplex pneumonia. Arch Dis Child 1984;59(7):668-670. Mindel A, Taylor J, Tideman RL, et al. Neonatal herpes prevention: a minor public health problem in some communities. Sexually Transmitted Infections 2000;76(4):287-91. Nahmias AJ, Josey WE, Nail ZN, et al. Perinatal risk associated with maternal genital herpes simplex infection. American Journal of Obstetrics and Gynecology 1971;110:825-834. Palasanthiran, P., Starr M, Jones C. (Editors) Management of Perinatal Infections. Australasian Society for Infectious Disease. 2002. http://www.racp.edu.au/asid/resources_perinatal.htm. Prober CG, Corey L, Brown lA, et al. The management of pregnancies complicated by genital infections with herpes simplex virus. Clinical Infectious Diseases 1992;15:1031-1038. Prober CG, Sullender WM, Yasukawa LL, et al. Low risk of herpes simplex virus infections in neonates exposed to the virus at the time of vaginal delivery to mothers with recurrent genital herpes. New England Journal of Medicine 1987;316:240-244. Randolph AR, Washington E, Prober CG. Caesarean deliver y for woman presenting with genital herpes lesions: efcacy, risks and costs. Journal of the American Medical Association 1993;270:77-82. Scott LL, Sanchez PJ, Jackson GL, et al. Acyclovir suppression to prevent Caesarean deliver y after rst-episode genital herpes. Obstetrics and Gynecology 1996;87:69-73. Spangler JG, Kirk JK, Knudson MP. Uses and safety of acyclovir in pregnancy. Journal of Family Practice 1994;38:186-191. Stone KM, Brooks CA, Guinan ME, Alexander ER. National Surveillance for neonatal herpes simplex virus infection. Sexually Transmitted Diseases 1989;16:152-156. Stray-Pederson B. Acyclovir in late pregnancy to prevent neonatal herpes simplex (letter). Lancet 1990;336:756. Tookey PA, Peckham CS. Neonatal herpes simplex virus infection in the British Isles. Pediatric and Perinatal Epidemiology 1996;10:432-442.
1998 First Printed 2002 Re-Printed 2004 Revised and Re-Printed 2006 Revised and Re-Printed 2009 Revised e-publication 2011 Re-edited e-publication
Disclaimer The AHMF have made considerable e orts to ensure the information upon which this guideline is based reproduces the evidence as accurately as possible. Users of this guideline are strongly recommended to con rm that the information contained within it, especially drug indications, is correct by way of independent sources, as this guideline does not indicate an exclusive course of action or serve as a standard of medical care. The AHMF accepts no responsibility for any inaccuracies, information perceived as misleading, or success of any treatment regime detailed in this guideline.
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Australian Herpes Management Forum (AHMF) C/- STIRC, Marian Villa, Westmead Hospital, Westmead NSW 2145 Australia Telephone +61 2 8230 3843 Facsimile +61 2 9845 6287 www.ahmf.com.au