Herpesvirus

Herpes simplex virus type 2 (HSV-2) is the causative agent in most cases of genital herpes, with a few cases caused by HSV-1, which most often causes oropharyngeal herpes. Primary infection is most deleterious for both mother and fetus and can present as fever, malaise, inguinal lymphadenopathy, and urinary retention. At 2 to 10 days after exposure, vesicles containing numerous viral particles painfully erupt on the cervix, vagina, perineum, or rectum; ulcerate; and remain open 1 to 3 weeks. Herpetic lesions in recurrent disease last a shorter period and are most often not associated with systemic symptoms.

The fetus is most susceptible to herpesvirus infection and damage during viremia, which most often occurs in primary herpes. At that time, herpes-specific maternal IgG is not adequate for transplacental passage and protection of the fetus from serious disease. The fetus may also acquire a herpetic infection from delivery through an infected vaginal canal. If this occurs during a primary episode, the risk of congenital infection is about 50%; if during a recurrent infection, the risk is much less than 8%. Congenital herpes may be localized to skin, eyes, and oral cavity and may involve the central nervous system (CNS). Congenital infection may be disseminated and is often fatal or entirely asymptomatic (Riley, 1998).

Various surveillance protocols have been attempted to decrease perinatal transmission at delivery. At present, at labor and delivery, a careful evaluation of the genital tract for ulcers is performed. If any active lesions are found, the baby is delivered by cesarean section (Roberts et al., 1995). Prenatal use of acyclovir is controversial, but it has been used with informed consent in pregnant women with systemic disease or frequent episodes of recurrent disease.

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