Genital herpes and pregnancy--preventive measures.

Genital herpes is particularly dangerous during pregnancy because of the risk of neonatal infection. This is discussed in four situations of genital herpes associated with pregnancy. Choosing the most appropriate method of delivery, i.e. carrying the least risk of transmission from mother to baby, is based on our knowledge of the natural history of genital herpes infection, the risk to the newborn (estimated from epidemiological studies), and, lastly, the possible preventive measures available.

[Herpes in the pregnant woman and the newborn infant]. / L'herpès chez la femme enceinte et le nouveau-né.

Herpesvirus infection of the newborn is a rare though extremely grave disease that poses difficult problems for the obstetrician. It is nearly always due to genital herpes during pregnancy though in more half the cases this was unsuspected by the mother. Prophylactic measures exist--disinfection of the genital tract, elective cesarean section, administration of antivirals and Acyclovir in particular. The main difficulty resides in making the correct decision and the excessive recourse to cesarean section should not be replaced by the unreasoned prescription of antivirals taking into account the current uncertainly about their real efficacy and their long-term effects after administration in early life. The risk of neonatal herpes should therefore be evaluated from the clinical findings and 4 categories of women may be defined: those with the clinical manifestations of primary genital herpes on delivery or during the month before; those with the clinical manifestations of recurrent genital herpes on delivery or during the week before; those with only a previous history of genital herpes and finally all other women with no clinical manifestations or history of genital herpes. Only first two categories benefit from cesarean section and Acyclovir is only prescribed in exceptional cases as complementary therapy for the newborn infant. In the third category, clinical and virological monitoring alone is required and is currently prescribed during the perinatal period as it is reasonable to stop the systematic weekly virological monitoring at the end of pregnancy when this has been shown to be inappropriate. However, it remains true that more than half the cases of neonatal herpes arise in women in the fourth category. The only means of prevention that can be proposed is that they refrain from sexual or orogenital relationships during the last two months of pregnancy. According to our current knowledge, Acyclovir remains contraindicated during pregnancy except in exceptional cases when the mother's life is in danger.