This document discusses genital herpes, including its classification, diagnosis, treatment, and risks during pregnancy. It addresses seroprevalence rates of HSV during pregnancy and recommends treatment regimens that are considered safe for breastfeeding mothers. Risk factors and differential diagnosis of genital ulcers are outlined. The document recommends women with a history of genital herpes or partner history be tested and counselled on risks of transmission to neonates. Caesarean section is recommended for women experiencing outbreaks or in third trimester of a primary infection to reduce transmission risk.

1. Genital Herpes
Perinatal Herpes enfeksiyonu
Dr. Tevfik Yoldemir BSc MSc
Marmara Üniversitesi Tıp Fakültesi
www.yoldemir.com

2. Rates of seroprevalence and seroconversion of HSV in
pregnancy
OBSTETRICAL AND GYNECOLOGICAL SURVEY 2011; Volume 66, Number 10

3. Classification of genital HSV infections
OBSTETRICAL AND GYNECOLOGICAL SURVEY 2011; Volume 66, Number 10
Clinical Designation Description
Primary genital HSV Newly acquired antibodies to
infection HSV 1 or 2 in the absence of any
preexisting antibodies
Nonprimary first-episode Newly acquired antibodies to
genital HSV infection HSV 1 or 2 in the presence of
preexisting antibodies to the
other type
Recurrent genital HSV Reactivation of genital HSV with
infection HSV type recovered from lesion
same as serum HSV type

4. Diagnosis
OBSTETRICAL AND GYNECOLOGICAL SURVEY 2011; Volume 66, Number 10
• Serologic testing (both IgG and IgM)
(+)
• viral identification by culture,
• polymerase chain reaction (PCR),
• or direct antibody fluorescence to identify the category and
subtype of HSV infection

5. Methods of diagnosing HSV
OBSTETRICAL AND GYNECOLOGICAL SURVEY 2011; Volume 66, Number 10

6. Recommended treatment regimens for HSV
outbreaks in pregnancy
OBSTETRICAL AND GYNECOLOGICAL SURVEY 2011; Volume 66, Number 10
Both valacyclovir and acyclovir are considered safe for breast-feeding women

7. OBSTETRICAL AND GYNECOLOGICAL SURVEY 2011; Volume 66, Number 10

8. OBSTETRICAL AND GYNECOLOGICAL SURVEY 2011; Volume 66, Number 10

9. OBSTETRICAL AND GYNECOLOGICAL SURVEY 2011; Volume 66, Number 10
HSV endometritis can be confirmed with an
endometrial biopsy for PCR or culture

10. Risk factors
Am Fam Physician. 2016;93(11):928-934.

11. Differential diagnosis of genital ulcers
Am Fam Physician. 2016;93(11):928-934.

12. Scenarios to consider HSV Type-Specific
Serologic Testing
Am Fam Physician. 2016;93(11):928-934.

13. SOGC Recommendations
J Obstet Gynaecol Can 2017;39(8):e199ee205
1. Women’s history of genital herpes should be evaluated early
in pregnancy (III-A).
2. Women with known recurrent genital herpes simplex virus
(HSV) should be counselled about the risks of transmission of
HSV to their neonates at delivery (III-A).
3. At delivery, women with recurrent HSV should be offered a
Caesarean section if there are prodromal symptoms or in the
presence of a lesion suggestive of HSV (II-2A).
4. Women with known recurrent genital HSV infection should be
offered acyclovir or valacyclovir suppression at 36 weeks’
gestation to decrease the risk of clinical lesions and viral
shedding at the time of delivery and therefore decrease the
need for Caesarean section (I-A).

14. SOGC Recommendations
J Obstet Gynaecol Can 2017;39(8):e199ee205
5. Women with primary genital herpes in the third trimester of
pregnancy have a high risk of transmitting HSV to their
neonates and should be counselled accordingly and should be
offered a Caesarean section to decrease this risk (II-3B).
6. A pregnant woman who does not have a history of HSV but
who has had a partner with genital HSV should have type-
specific serology testing to determine her risk of acquiring
genital HSV in pregnancy before pregnancy or as early in
pregnancy as possible. Testing should be repeated at 32 to 34
weeks’ gestation (III-B).

15. Direct methods for HSV diagnosis
Virology Journal 2009, 6:40

16. Virology Journal 2009, 6:40

17. Indirect methods for HSV diagnosis
Virology Journal 2009, 6:40

18. Mode of delivery
Virology Journal 2009, 6:40

19. Mode of delivery
Virology Journal 2009, 6:40

20. Various dietary phytochemicals with chemical structure
and role in general cancers and transplacental models

21. Maternal and fetal risks in viral infections
Clinics in Dermatology (2016) 34, 368–377

22. Thank you for your attention.
Questions and Comments:
tevfik@yoldemir.com