The management of recurrent genital herpes infection in pregnancy: a postal survey of obstetric practice

1. Up to 80% of neonatal herpes is transmitted from mothers with no previous history of infection, therefore focusing on women with a positive history would ignore the majority of atrisk newborn infants. Sadly, a reliable, rapid and inexpensive test for women in labour is as yet unavailable. 2. It is recognised that primary herpetic attacks are most likely to cause significant neonatal problems, with a vertical transmission rate of 75%, whereas less than 5 % of infants exposed to secondary maternal lesions at delivery become infectede. One can therefore argue that in well documented cases of secondary herpes (with transplacental passage of maternal immunoglobulins), performing a caesarean section for active lesions at delivery is unnecessary and may result in overall maternal deaths exceeding potential neonatal deaths prevented. Moreover, the routine practice of abdominal delivery within 4 h of ruptured membranes in active disease was based on a poorly designed compilation study of 26 women from whom four noninfected babies were born by caesarean section within 4 h of rupture of membranes3. 3. Although maternal HSV-2 infection is traditionally associated with the more lethal perinatal disease, significant neonatal morbidity particularly in the form of encephalitis has also been documented in cases of HSV-1 infection. In clinical practice there is little point in discriminating betweeq the two types. 4. Postnatal nosocomial transmission is a hazard and appropriate measures, such as hand washing, should be taken.