Incubation period 1-7 days shodding after primary herpes for weeks but only days after recurrence. Pregnent women in Scandinavia: 70% HSV1 antibodies and 15-30% HSV2 antibodies. Only 1 of 5 with Herpes type II knows they have infection. Neonatal herpes has untreated a high mortality and morbidity with 35% risk for sequelae in survivors. The prognosis is poor even if the child is treated. In most cases of neonatal herpes, the mother has no symptoms. HSV-2 is more severe and more common than HSV-1 in the genital tract. A positive antibody titre is not protective against the other but clinical symptoms attenuated.
culture from lesion (ELISA, PCR) can be false negative, increase in antibodies. Treatment: Acyclovir - No teratogenecity found, even in first trimester.
Recurrent herpes at delivery has very little risk of neonatal infection and result in mild disease (0-3%). Cesarean section is recommended by some authorities if acute recurrence in the birth canal and should be performed within 4 - 6 hours after the rupture of the membrane. Some disagree with this statement and for example in the Netherlands Cesarean section has not been routinely performed for this indication since 1987 with no increase in the incidence of neonatal herpes. Some do not recommend fetal blood scalp electrode or fetal blood sampling in woman at high risk for recurrent infection (virus shedding before symptoms) and the virus can infect the brain without having contact with antibodies. Infection in newborns Incubatintime 2-26 days and even longer if only cerebral affection. To avoid recurrent herpes in late pregnancy, prophylaxis with 400 mg BID from 4 weeks before term. (1) MacLean, A., et al. Infection and Pregnancy, RCOG Press 2001. (2) Management of Genital Herpes in Pregnancy. Royal College of Obstetricians and Gynecologists. Clinical Guideline No. 30, sep.2007. (3) www.infpreg.org (4) www.uptodate.com 2007
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