Genital herpes in pregnancy

First episode genital herpes

First or second trimester acquisition (until 27 +6 weeks)

Refer women with suspected genital herpes for assessment by a GUM physician
Confirm diagnosis with HSV PCR
Complete STI screen

Aciclovir 400mg every 8 hours orally for 5 days

Severe or disseminated cases: Aciclovir 5mg/kg every 8 hours IV

Daily suppressive Aciclovir 400 mg every 8 hours orally from 36 weeks reduces HSV lesions and asymptomatic shedding at term and hence the need for delivery by caesarean

Third trimester acquisition (from 28 weeks)

Aciclovir 400mg every 8 hours orally for 5 days

Severe or disseminated cases: Aciclovir 5mg/kg every 8 hours IV

Continue daily suppressive Aciclovir 400 mg every 8 hours orally until delivery

Recommend discussion of serological testing with a virologist or GUM physician
Type-specific HSV antibody (IgG) testing is advisable to distinguish between primary and recurrent genital HSV infection

Recurrent genital herpes

Recurrences usually resolve within 7–10 days without antiviral treatment
Consider daily suppressive aciclovir 400 mg every 8 hours orally from 36 weeks

Primary or recurrent genital lesions at the onset of labour

Management will be based on clinical assessment as there will not be time for confirmatory laboratory testing:

History to ascertain if primary or recurrent episode
Viral swab from the lesion(s) - it may influence management of the neonate
The neonatologist should be informed

Primary episode

Consider intrapartum IV aciclovir for the mother (5 mg/kg 8 hourly) and the neonate (20 mg/kg 8 hourly) if opting for vaginal delivery

Recurrent genital herpes

Specific antiviral is not recommended