Understanding health considerations during pregnancy often includes questions about herpes simplex virus (HSV) testing. This article clarifies current practices regarding HSV testing during pregnancy, providing a clear overview of how HSV is approached in prenatal care, focusing on guidelines and management strategies. The information presented will help address concerns about this viral infection in the context of maternal and infant health.
Routine Screening Practices
Routine, universal screening for HSV in asymptomatic pregnant individuals is generally not recommended by major health organizations, such as the American College of Obstetricians and Gynecologists (ACOG). This is due to factors like high false-positive rates with antibody tests and a lack of clear benefit for widespread asymptomatic screening. Testing for HSV is typically considered in specific scenarios, including when a pregnant person experiences symptoms suggestive of an HSV infection, has a sexual partner with a known HSV infection, or has a personal history of HSV. Healthcare providers will inquire about a history of symptoms that might indicate genital herpes.
Potential Risks to Mother and Baby
HSV during pregnancy presents potential health implications for both the pregnant individual and the infant. Primary, or first-time, HSV infection acquired during pregnancy carries a higher risk of transmission to the baby compared to recurrent outbreaks. This is because a newly infected mother may not have developed protective antibodies that can be passed to the fetus. If a primary infection occurs in late pregnancy, there might not be enough time for antibodies to form, increasing the risk of transmission. Primary HSV infection in early pregnancy has been associated with miscarriage, while infections in the second and third trimesters might be linked to preterm delivery.
Neonatal herpes, a serious condition, can result if the virus is transmitted to the baby, especially during vaginal delivery when active lesions are present. This infection can lead to severe outcomes, including neurological damage, central nervous system involvement, and, in rare cases, mortality. Approximately 85% to 90% of neonatal HSV infections are acquired during the birthing process. In-utero transmission, where the virus is passed from mother to fetus before birth, is rare, accounting for about 5% of neonatal HSV cases. The risk of transmission is highest when a primary infection occurs in the third trimester.
Diagnosis and Management of HSV
When there is concern about HSV, diagnosis typically involves viral detection techniques or antibody detection tests. Viral culture and polymerase chain reaction (PCR) testing of lesions are primary methods for confirming the presence of the virus. PCR assays are more sensitive and are often the test of choice for systemic infections. Blood tests for antibodies can detect past exposure to HSV-1 or HSV-2, but they have limitations for diagnosing an acute infection.
Management strategies aim to treat outbreaks and reduce the risk of transmission to the infant. Antiviral medications, such as acyclovir and valacyclovir, are commonly used and are considered safe during pregnancy. These medications can be prescribed for active outbreaks to reduce symptom severity and duration. Suppressive therapy, typically initiated at or beyond 36 weeks of gestation, is recommended for pregnant individuals with a history of recurrent genital herpes. This therapy aims to prevent outbreaks and reduce viral shedding around the time of delivery.
Delivery considerations are crucial for preventing neonatal transmission. A cesarean section is generally recommended if active genital lesions or prodromal symptoms, such as vulvar pain or burning, are present at the onset of labor. This measure significantly reduces the risk of transmitting the virus to the baby during passage through the birth canal. If there are no active lesions or symptoms, a vaginal delivery is typically considered safe. Even with suppressive therapy, a thorough genital examination is performed at the onset of labor to ensure no active lesions are present.