Genital Herpes (Herpes Simplex Virus Infection) in Pregnancy
Joint BASHH and RCOG National UK Guideline for the Management of Herpes Simplex Virus (HSV) in Pregnancy and the Neonate (2024 Update). NICE CKS Herpes Simplex - Genital. Last revised May 2024.
Background Information
There are 3 main forms of disease presentation:
- Skin, eye and mouth disease (SEM)
- Vesicular lesions or ulcers on skin / eye / mouth
- No CNS or visceral organ involvement
- , apart from risk of recurrent SEM disease during childhood
- CNS disease (meningoencephalitis)
- Lethargy, poor feeding, seizures
- +/- SEM disease
- Disseminated disease
- Commonly present as sepsis-like picture
Guidelines
Refer suspected cases to GUM
Do not delay treatment whilst awaiting test result.
- 1st line: swab for viral PCR
- Other investigations
- HSV serology (esp. in 3rd trimester and if type is not known)
- Full STI screening
Do not delay treatment whilst awaiting test result.
General advice:
Self-care measures
- Increase fluid intake
- Urinate in a bath or with water flowing over the area
- Abstinence from sexual contact during lesion recurrences / prodromes
Self-care measures
- Saline bathing
- Analgesia (paracetamol / ibuprofen)
- Topical petroleum jelly / anaesthetic agent (e.g. 5% lidocaine ointment)
Antiviral therapy is indicated in all pregnant patients with primary herpes infection, it reduces duration and severity of symptoms, and importantly duration of viral shedding thus risk of neonatal transmission
Choice of drug (either):
Duration of treatment:
Choice of drug (either):
- Oral aciclovir 400mg TDS
- Oral valacyclovir 500mg BD
Duration of treatment:
- 1st / 2nd trimester infection
- Start from 32 weeks of gestation and continue until delivery
- If high risk of premature delivery → start from 22 weeks of gestation instead
- 3rd trimester infection → start immediately and continue until delivery
Caesarean section is the recommended mode of delivery if any of the following:
- 3rd trimester infection (from 28 weeks onwards)
- Delivery expected within next 6 weeks
- Adivce that recurrent episodes are short-lasting and usually resolve 7-10 days without antiviral therapy
- Antiviral therapy NOT routinely recommended
- If indicated, follow regimen as if primary infection
- Antiviral therapy is recommended for all patients (regardless whether recurrence occur during pregnancy)
- Same regimen as if primary infection (aciclovir from 32 weeks)
- This alone is NOT an indication for Caesarean section
- Antivirals used to herpes are not harmful to infants
- It is safe to breastfeed if there is no herpetic lesion on the breast
- Avoid milk contamination (e.g. touching the breast during hand expression / via the pump)
