Management of Genital Herpes in Pregnancy
Publication Date: May 1, 2020
Last Updated: March 14, 2022
Summary of Recommendations
In pregnancy, suspected genital herpes virus infections should be confirmed with type-specific laboratory testing. However, retesting is not warranted in pregnant women with a history of laboratory-confirmed genital HS. (B)
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Women with a clinical history of genital herpes should be offered suppressive viral therapy at or beyond 36 weeks of gestation. For primary outbreaks that occur in the third trimester, continuing antiviral therapy until delivery may be considered. (B)
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Because of enhanced renal clearance, the doses of antiviral medication used for suppressive therapy for recurrent HSV infection in pregnancy are higher than the corresponding doses in nonpregnant women. (B)
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Cesarean delivery is indicated in women with active genital lesions or prodromal symptoms, such as vulvar pain or burning at delivery, because these symptoms may indicate viral shedding. (B)
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Routine HSV screening of pregnant women is not recommended. In addition, routine antepartum genital HSV cultures in asymptomatic patients with recurrent disease are not recommended. (C)
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In general, cesarean birth is not recommended for women with a history of HSV infection but no active genital lesions or prodromal symptoms during labor. However, for women with a primary or nonprimary first-episode genital HSV infection during the third trimester of pregnancy, cesarean delivery may be offered due to the possibility of prolonged viral shedding. (C)
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Cesarean delivery is not recommended for women with nongenital lesions (eg, lesions on back, thigh, buttock). These lesions may be covered with an occlusive dressing and the patient can give birth vaginally. (C)
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In women with preterm prelabor rupture of membranes, there is no consensus on the gestational age at which the risks of prematurity outweigh the risks of HSV. When expectant management is elected, treatment with an antiviral is recommended. (C)
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Recommendation Grading
Overview
Title
Management of Genital Herpes in Pregnancy
Authoring Organization
American College of Obstetricians and Gynecologists
Publication Month/Year
May 1, 2020
Last Updated Month/Year
January 9, 2023
Document Type
Consensus
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Female, Adult
Health Care Settings
Ambulatory, Hospital
Intended Users
Nurse midwife, nurse, nurse practitioner, physician, physician assistant
Scope
Management
Diseases/Conditions (MeSH)
D011247 - Pregnancy, D006561 - Herpes Simplex, D011248 - Pregnancy Complications, D006558 - Herpes Genitalis, D011251 - Pregnancy Complications, Infectious
Keywords
pregnancy, Genital herpes simplex virus, HSV