Neonatal herpes refers to infection acquired around the time of birth, whereas congenital herpes refers to infection acquired in utero and is extremely rare. Diagnosis and treatment are important to reduce symptoms, reduce viral shedding and to reduce the risk of recurrence or asymptomatic viral shedding around the time of delivery. Refer, diagnose and treat as for first trimester, then continue suppressive aciclovir therapy. Prevention of acquisition of herpes simplex virus for the mother and neonate. Symptomatic and asymptomatic primary genital HSV infections are associated with preterm labor and low-birth-weight infants. Symptomatic and asymptomatic primary genital HSV infections are associated with preterm labor and low-birth-weight infants.6,7 Because of the high prevalence of HSV among adults, physicians should be aware of the risk of a primary HSV infection in a pregnant woman and its potential consequences to the fetus. This case illustrates the nonspecificity of the signs and symptoms of an HSV infection in a neonate, the lack of a history of HSV in the mother and the often tragic outcome of this disease. HSV infections should be considered in all neonates who present in the first month of life with nonspecific symptoms such as fever, poor feeding, lethargy or seizure. The risk of transmission of maternal-fetal-neonatal herpes simplex can be decreased by performing a treatment with antiviral drugs or resorting to a caesarean section in some specific cases. (6 in the general population and 14 in pregnant women) 6, 7. For example, in US, approximately 22 of pregnant women are infected with HSV-2, and 2 of women acquire genital herpes during pregnancy, placing their newborn at risk for herpes infection. The mother is the most common source of infection for the first two routes of viral transmission.
Compared to all the other possible risks in a pregnancy, the risk of neonatal herpes is extremely small. There is a high risk of transmission if the mother has an active outbreak, because the likelihood of viral shedding during an outbreak is high. Mothers who acquire genital herpes during the last trimester of pregnancy may also lack the time to make enough antibodies to send across the placenta. Genital herpes is a chronic, life-long viral infection. Because nearly all HSV-2 infections are sexually acquired, the presence of type-specific HSV-2 antibody implies anogenital infection. Even persons with first-episode herpes who have mild clinical manifestations initially can develop severe or prolonged symptoms. Most mothers of newborns who acquire neonatal herpes lack histories of clinically evident genital herpes (373,374). For every 10 neonatal herpes infections, 6 to 7 are acquired because the mother acquires an asymptomatic first outbreak. Transmission of the herpes simplex.
Virology Journal20096:40. In Italy, the number of women who acquire HSV infection during pregnancy is about 3 22. Transmission of HSV from mother to foetus during pregnancy is uncommon; about 85 of perinatal transmission occurs during the intrapartum period 25. The apparently asymptomatic phases between clinical outbreaks of genital herpes are important, since HSV can reactivate periodically in latently infected cells of sensory ganglia travelling via the neuronal axons back to the genital mucosa, without clinical signs or symptoms. Neonatal herpes simplex is a rare but serious condition, usually caused by vertical transmission of herpes simplex virus from mother to newborn. Around 1 in every 3,500 babies in the United States contract the infection. Detection and prevention is difficult because transmission is asymptomatic in 60 – 98 of cases. Infants born to mothers who have a first episode of genital HSV infection near term and are shedding virus at delivery are at much greater risk of developing neonatal herpes than are infants whose mothers have recurrent genital herpes (Fig 1).
Herpes And Pregnancy
Herpetic sycosis is a recurrent or initial herpes simplex infection affecting primarily the hair follicles. Previous HSV-1 infection appears to reduce the risk for acquisition of HSV-2 infection among women by a factor of three. Serologic test results are also helpful in making a specific diagnosis of neonatal herpes. 6. For every 10 neonatal herpes infections, 6 to 7 are acquired because the mother acquires an asymptomatic first outbreak. Transmission of the herpes simplex virus to a newborn (neonate) can have devastating effects. Most infections are transmitted by those who are asymptomatic. The clinical manifestations of first-episode genital HSV infections differ greatly from recurrent episodes and will be discussed separately. Prevention of neonatal herpes depends both on preventing the acquisition of HSV during late pregnancy and avoiding exposure of the infant to herpetic lesions during delivery. The primary route of acquisition of HSV-2 infections is via genital-genital sexual contact with an infected partner (56, 101, 102, 167). Viral shedding as detected by culture lasts 10-12 days, and lesions resolve over 16-20 days. Thus, first clinical episode of genital herpes does not necessarily equate with acquisition of HSV in the genital tract, a fact that should be remembered in counseling couples in long-term monogamous relationships in whom one partner has a first clinically recognized case of genital herpes. The risk of maternal transmission of this virus to the fetus or newborn is a major health concern. Most newborns acquire the virus from asymptomatic mothers without identified lesions, and it occurs in the perinatal period from contact with infected maternal secretions (1). Primary Infection: Initial genital due to herpes may be either asymptomatic or associated with severe symptoms. However, when secondary bacterial or mycotic infection is present and not treated, the lesions may persist up to 6 weeks.
Herpes Simplex Virus Infection In Pregnancy And In Neonate: Status Of Art Of Epidemiology, Diagnosis, Therapy And Prevention
Because latent virus probably does not replicate in the latent phase, it is not susceptible to antiviral drugs that affect viral DNA synthesis. The high incidence of relatively asymptomatic primary HSV-2 in pregnancy may be explained in part by the high prevalence of HSV-1 antibody, particularly among women in lower socioeconomic groups. Local symptoms increase during the first 6 to 7 days, when the skin lesions are in the vesicular stage (see Fig. Genital herpes simplex virus is epidemic among sexually active women. 10 years.1 The 1600 cases of neonatal herpes infection occurring annually in the United States make this more than just a gynecologic problem. Today, every physician who provides primary care for women must be well-informed about HSV epidemiology, diagnosis, transmission and shedding, and management of flares and future pregnancies.