Asymptomatic genital shedding of HSV at the onset of labor because of subclinical primary genital HSV infection is associated with preterm delivery. Infection with genital herpes simplex virus (HSV) (see the image below) remains a common viral sexually transmitted disease, often subclinical, and a major worldwide problem in women of reproductive age. Infection with genital herpes simplex virus (HSV) (see the image below) remains a common viral sexually transmitted disease, often subclinical, and a major worldwide problem in women of reproductive age. 23 Pregnant women who receive antiherpes treatment have a lower risk of preterm delivery than untreated women, and their preterm delivery risk is similar to that seen in unexposed women. Related News and Articles. Genital herpes is a chronic, life-long viral infection. The clinical diagnosis of genital herpes can be difficult, because the painful multiple vesicular or ulcerative lesions typically associated with HSV are absent in many infected persons. Recurrences and subclinical shedding are much more frequent for genital HSV-2 infection than for genital HSV-1 infection (322,323). Antiviral therapy for recurrent genital herpes can be administered either as suppressive therapy to reduce the frequency of recurrences or episodically to ameliorate or shorten the duration of lesions.
The risk of maternal transmission of this virus to the fetus or newborn is a major health concern. Primary Infection: Initial genital due to herpes may be either asymptomatic or associated with severe symptoms. Asymptomatic genital shedding of herpes from a subclinical primary genital infection may be associated with preterm delivery. Symptomatic and asymptomatic primary genital HSV infections are associated with preterm labor and low-birth-weight infants. The diagnosis of neonatal HSV can be difficult, but it should be suspected in any newborn with irritability, lethargy, fever or poor feeding at one week of age. Many of the infections result from asymptomatic cervical shedding of virus after a primary episode of genital HSV in the third trimester. Genital HSV infection can be either clinically apparent (eg, genital lesions) or inapparent (asymptomatic, or subclinical). The risk of transmitting HSV to the newborn infant during delivery is influenced directly by the mother’s previous immunity to HSV; women who have primary genital HSV infections who are shedding HSV at delivery are 10 to 30 times more likely to transmit the virus to their newborn infants than women with a recurrent infection. Some practitioners advocate evaluation and treatment immediately after delivery if the infant is preterm or there has been prolonged rupture of membranes (CIII).
A subclinical infection (sometimes called a preinfection) is an infection that, being subclinical, is nearly or completely asymptomatic (no signs or symptoms). A subclinically infected person is thus an asymptomatic carrier of a microbe, intestinal parasite, or virus that usually is a pathogen causing illness, at least in some individuals. For example, in the case of urinary tract infections in women, this infection may cause preterm delivery if the person becomes pregnant without proper treatment. Primary genital HSV (no Ab to either HSV-1 or HSV-2 at time of infection)–may be asymptomatic; if symptomatic, tends to be more severe than recurrent and may be accompanied by systemic sx–see above–but otherwise hard to distinguish Treatment–7-14d of either: Valacyclovir 1g BID. Persons who have tested positive for herpes simplex virus type 2 (HSV-2) but do not have symptoms or genital lesions still experience virus shedding during subclinical (without clinical manifestations) episodes, suggesting a high risk of transmission from persons with unrecognized HSV-2 infection, according to a new study. 1 percent) in 410 persons with symptomatic genital HSV-2 infection compared with 519 of 5,070 days (10. Subclinical genital shedding rates were higher in persons with symptomatic infection compared with asymptomatic infection (2,708 of 20,735 13. The primary concern of many HSV-2-seropositive persons is the risk of transmission to sexual partners; in our experience this is the main source of angst in patients with genital herpes. RELATED TOPICS.
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The primary route of acquisition of HSV-2 infections is via genital-genital sexual contact with an infected partner (56, 101, 102, 167). As compared with recurrent episodes of genital herpes, first episodes of genital herpes infection may have associated systemic symptoms, involve multiple sites including nongenital sites, and have longer lesion duration and viral shedding (49). The importance of asymptomatic (subclinical) viral shedding on the epidemiology and transmission of HSV cannot be overstated (243). The association of genital tract shedding of HSV-2 with hormonal contraceptive use is, however, less clear. However, extension of these results to an HIV-seronegative population of women or to women using hormonal contraceptives for more-extended periods may not be warranted. However, pregnant women with heavy vaginal GBS colonization at 23 26 weeks’ gestation have a significantly increased risk of delivery of a preterm, low-birth-weight infant, compared with pregnant women with either no or light GBS colonization 19. Virologic characteristics of subclinical and symptomatic genital herpes infections. Genital herpes, however, is often asymptomatic, although viral shedding may still occur during periods of remission and therefore it is possible to transmit the disease during remission. Early stages of orofacial herpes and genital herpes are harder to diagnose and laboratory testing is usually required. Prevalence of herpes simplex virus (HSV) infections varies throughout the world with poor hygiene, overcrowding, lower socioeconomic status, and birth in an undeveloped country identified as risk factors associated with increased HSV-1 childhood infection. In the case of oral herpes, following a primary infection, the virus enters the nerves at the site of primary infection, migrating to the ganglion associated with the local nerve (trigeminal, or 5th cranial nerve) supply (the trigeminal ganglion).