Abstract
To determine if suppressive acyclovir near term decreased the frequency of clinical recurrences at delivery in women with recurrent genital herpes simplex virus (HSV) infection. We conducted a prospective, double-blind, randomized trial in 234 women with recurrent genital herpes. Women with genital infection of any frequency were enrolled. Patients received either suppressive oral acyclovir 400 mg three times daily or an identical placebo after 36 weeks' gestation. Clinical lesions were identified, and HSV cultures were obtained at delivery. The frequencies of clinical and subclinical HSV recurrences at delivery were evaluated. Six percent of patients treated with acyclovir, and 14% of patients treated with placebo had clinical HSV at delivery (p = 0.046). No patients in the acyclovir group had positive HSV cultures, compared with 6% of placebo-treated patients (p = 0.029). There was no significant difference in subclinical HSV shedding in the acyclovir group (0%) compared with the placebo-treated group (3%) (p = 0.102). Suppressive acyclovir therapy significantly decreased the incidence of clinical genital herpes and the overall incidence of HSV excretion at delivery in patients with previous herpes infection.
Highlights
The purpose of this study was to determine if acyclovir suppressive therapy, administered in the last few weeks of pregnancy, would decrease the frequency of symptomatic genital herpes simplex virus (HSV) at delivery in women who have a history of recurrent genital herpes
In an effort to prevent intrapartum HSV transmission, obstetricians generally resort to Cesarean delivery when a patient presents for delivery with recurrent genital herpes lesions or prodromal symptoms
Acyclovir therapy suppresses recurrent genital HSV outbreaks in the nonpregnant adult[4], and it has been suggested that this treatment be considered as a means to prevent herpes reactivation at delivery[2]
Summary
To determine if suppressive acyclovir near term decreased the frequency of clinical recurrences at delivery in women with recurrent genital herpes simplex virus (HSV) infection. To avoid intrapartum HSV exposure and neonatal infection, it is currently recommended that pregnant women with visible genital herpes lesions or prodromal symptoms at the time of labor have a Cesarean delivery. Gravidas without visible lesions or prodromal symptoms should be allowed to continue in labor because they have a low risk of neonatal HSV transmission[1,2] Using these guidelines, it is estimated that one poor neonatal outcome from HSV infection is averted for every 1580 Cesarean deliveries performed for maternal clinical HSV recurrences[3] (at a cost of US$2.5 million). The purpose of this study was to determine if acyclovir suppressive therapy, administered in the last few weeks of pregnancy, would decrease the frequency of symptomatic genital HSV at delivery in women who have a history of recurrent genital herpes
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