How is transmission of herpes simplex virus (HSV) from mother to infant prevented?

Updated: Feb 27, 2019
  • Author: J Michael Klatte, MD; Chief Editor: Russell W Steele, MD  more...
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The transmission of herpes simplex virus from mother to infant cannot be eliminated because of asymptomatic primary or recurrent genital infection. The high prevalence of herpes simplex virus type 2 (HSV-2) infections in the United States means that women are at risk of acquiring new infections during pregnancy. One in 5 women is infected before pregnancy. Management to prevent transmission of the virus to newborns includes the following:

  • Reassure women with recurrent disease that risk of neonatal infection is low. The risk of asymptomatic reactivation is approximately 2%, and the attack rate in exposed infants is approximately 3%.

  • Because laboratory methods cannot be used to detect asymptomatic shedding in a timely manner, perform cesarean delivery if a mother has active lesions during delivery. [15] Because of the low risk of transmission, a vaginal delivery is appropriate in women with history of recurrent herpes simplex virus disease who have no active clinical disease at delivery. [81]

  • No information is available to support the empiric administration of IV acyclovir to potentially exposed infants who are without signs of infection. Observe infants delivered vaginally by mothers with active genital herpes. At approximately 24 hours, obtain testing as per American Academy of Pediatrics guidelines (see Guidelines Summary). In women with symptomatic genital herpes, antiviral suppressive treatment initiated at 36 weeks' gestation reduced both the rates of cesarean delivery due to HSV lesions and positive viral cultures or polymerase chain reaction (PCR) tests at the time of delivery. [31, 40, 82, 83] However, data are insufficient to recommend antiviral suppressive therapy to pregnant women who are HSV-2 seropositive and asymptomatic. [84, 81] Furthermore, such antenatal antiviral suppressive therapy does not completely prevent herpes disease in the newborns of mothers who receive it. [85]

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