2. INTRODUCTION
CLINICAL PRESENTATION.
DIAGNOSIS
TREATMENT INPREGNANCY WITH GENTIAL HERPS IN
PRIMARY AND RECURRANCE .
HOW TO MANAGE NEONATE .
CONCULSION .
3. INTRODUCTION
• Genital herpes is a common sexually
transmitted disease caused by herpes simplex
virus (HSV) and characterized by lifelong
infection and periodic reactivation.
4. CONT…
• Until recently, genital herpes was more likely
to be caused by HSV-2.
• However, the incidence of primary genital
infection with HSV-1 is now as common or
more common than HSV-2 in the United
state.
5. • Worldwide, more than 400 million persons
have genital herpes caused by HSV-2.
In the United States, nearly one in five adults
(approximately 50 million persons) has HSV-2
infection, with 1 million new infections
occurring each year
6. One in five pregnant women is seropositive
for HSV-2, and more than 60% of pregnant
women are positive for HSV-1.
Maternal primary infection with HSV-1 or
HSV-2 at the time of delivery carries a 60%
risk of neonatal herpes.
7. o Black, non-Hispanic
o Female sex
o Hormonal contraception use,
o bacterial vaginosis, and vaginal group B
streptococcus colonization
o Number of lifetime sex partners.
o Oral-genital contact
o Presence of other sexually transmitted diseases
8. o A visible outbreak consists of single or
clustered vesicles on the genitalia , perineum,
buttocks, upper thighs, or perianal areas that
ulcerate before resolving.
o Primary infections may cause malaise, fever,
or localized adenopathy.
9. CONT…
o Subsequent outbreaks are usually milder
and are caused by reactivation of latent
virus
o Primary and secondary genital HSV-1
infections tend to be milder than HSV-2
infections.
10. • HSV-2 is almost always genitally acquired,
the presence of HSV-2 antibody implies
anogenital disease, even if there is no history
of symptoms.
11.
12. oBecause HSV-1 and HSV-2 are
indistinguishable Visually should be
confirmed by type-specific testing to
guide management.
oIn the presence of active lesions PCR.
13.
14.
15. • Treatment should be based on the patient’s
disease profile, sexual practices, and
psychosocial needs.
17. • ?Topical acyclovir
• Has minimal benefit for local symptom
reduction, and does not improve episode
duration, recurrence, or transmission
rates.
18.
19. First or second trimester acquisition
(until 27+6 weeks of gestation)
1ST EPISODE
20. o There is no evidence of an increased risk of
spontaneous miscarriage with primary genital
herpes in the first trimester.
o Advise on management of genital herpes and
arrange a screen for other sexually
transmitted infections
21. CONT …
o Women with suspected genital herpes should
be referred to a genitourinary medicine
physician who will confirm or refute the
(PCR).
o The OBG should be informed.
22. • Paracetamol and topical lidocaine 2% gel can
be offered as symptomatic relief.
• aciclovir in standard doses (400 mg three
times daily, for 7 days).
24. CONT ..
• Following first or second trimester acquisition,
daily suppressive aciclovir 400 mg three
times daily from 36 weeks of gestation
reduces HSV lesions at term and hence the
need for delivery by caesarean section.
Level of evidence
Ib
Nice /aafp
26. o There is insufficient evidence to suggest an
association between HSV and stillbirth.
o As a cause of fetal death with some studies
demonstrating no association.
27. • Oral (or intravenous for disseminated HSV)
aciclovir in standard doses (400 mg TID for
5 days).
• In the third trimester, treatment will usually
continue with daily suppressive aciclovir 400
mg three times daily until delivery
Level of evidence
III
28. • Caesarean section should be the
recommended mode of delivery for all women
developing first episode genital herpes in the
third trimester, particularly those developing
symptoms within 6 weeks of expected
delivery, as the risk of neonatal transmission
of HSV is very high at 41%.
Level of evidence
IIb
29. • Women with active lesions at the time of
labor should have a cesarean delivery to
decrease vertical transmission of HSV. ( based
on one prospective cohort study.)
AAFP
30. CONT..
• The presence of antibodies of the same type as
the HSV isolated from genital swabs would
confirm this episode to be a recurrence rather
than a primary infection and elective
caesarean section would not be indicated to
prevent neonatal transmission.
Level of evidence
IV
31.
32. • Among women with recurrent genital HSV
infection, approximately 75 percent can
expect at least one recurrence during
pregnancy,
• A pproximately 14 percent will have
prodromal symptoms or clinical recurrence at
delivery.
33. • Women with recurrent genital herpes should
be informed that the risk of neonatal herpes is
low, even if lesions are present at the time of
delivery (0–3% for vaginal delivery).
Level of evidence
III
34. o There is no increased risk of preterm labour,
preterm premature rupture of membranes or
fetal growth restriction associated with
women seropositive for HSV.
o The incidence of congenital abnormalities is
not increased in the presence of recurrent
genital herpes infection
Level of evidence
IIa
35. o Vaginal delivery should be anticipated in the
absence of other obstetric indications for
caesarean section.
o Daily suppressive aciclovir 400 mg three
times daily should be considered from 36
weeks of gestation.
36. o The majority of recurrent episodes of genital
herpes are short-lasting and resolve within 7–10
days without antiviral treatment.
o Supportive treatment measures using saline
bathing and analgesia with standard doses of
paracetamol alone will usually suffice.
o Treat episodes with standard doses of aciclovir if
necessary
37.
38. • Management of babies born by caesarean
section in mothers with primary HSV
infection in the third trimester:
These babies are at low risk of vertically
transmitted HSV infection so conservative
management is recommended.
39. • Management of babies born by SVD in mothers with a
primary HSV infection within the previous 6 weeks:
• BABY WELL:
o Swabs of the skin, conjunctiva, oropharynx and rectum
should be sent for herpes simplex PCR.
o Empirical treatment with intravenous aciclovir (20 mg/kg
every 8 hours) should be initiated until evidence of active
infection is ruled out..
40. • If the baby is unwell or presents with skin
lesions:
o Swabs of the skin, lesions, conjunctiva, oropharynx and
rectum should be sent for herpes simplex PCR.
o A lumbar puncture should be performed even if CNS features
are not present.
o Intravenous aciclovir (20 mg/kg every 8 hours) should be
initiated until evidence of active infection is ruled out.
41. Management of babies born to mothers with recurrent
HSV infection in pregnancy with or without active
lesions at delivery :
o In the case of recurrent genital herpes infections in
the mother, maternal IgG will be protective in the
baby and hence the infection risk is low.
o Conservative management of the neonate is advised.
o No active treatment is advised for the baby.
42. UNWELL BABY :
o Surface swabs and blood for HSV culture and
PCR.
o Intravenous aciclovir (20 mg/kg every 8
hours) should be given while awaiting
cultures.
o Further management by the neonatal team
according to condition of the baby and test
results.
43. o There are no approved vaccines for the
treatment or prevention of genital herpes.
o There is no evidence that HSV acquired in
pregnancy is associated with an increased
incidence of congenital abnormalities.
o There are points for counseling patients with
genital herpes .
46. o Genital herpes is a common sexually
transmitted disease caused by herpes simplex
virus (HSV) and characterized by lifelong
infection and periodic reactivation.
o Early detection , early treatment , less
complication .
47. o Infection of genital herps in pregnancy need
more concern as we are dealing with
pregnant women and fetus.
o There are no approved vaccines for the
treatment or prevention of genital herpes.
48. REFERANCS
1-Genital Herpes: A Review .aafp
2-Infectious Diseases in Obstetrics and
Gynecology.
3-Management of Genital Herpes
in Pregnancy /royal of collage in obstetric 2014
51. • A 20years old women is now in her 14th weeks of pregnancy
and develops an initial outbreaks of genital herpes , you
explained to her :
• A-genital herpes is STD that can be treated in a such a ways as to prevents future
recurrences .
• B-the risk of transmission to neonate is high among women who newly acquired
genital herpes during term and low who acquired during first half of pregnancy .
• C – termination of pregnancy should be considered .
• D –antiviral medication cannot be used in pregnancy if she develops recurrences.
B
