Herpes simplex infections in newborn infants

Abstract

Concomitant with the increase in herpes simplex virus (HSV)-2 seroprevalence in the United States, the incidence of neonatal HSV infection has increased. The risk for infection to a child born vaginally to a mother with active primary or first-episode genital infection is 33 to 50 percent, compared with 1 to 3 percent during a recurrence. The presenting nonspecific signs of neonatal infection in the two-thirds of neonates who lack the classic vesicular eruption render diagnosis difficult. Newborns with unexplained cerebrospinal fluid lymphocytosis or bacterial culture-negative and progressive sepsis syndrome should be evaluated and treated empirically for HSV infection. Polymerase chain reaction for HSV DNA, along with viral cultures, has become an important diagnostic tool. Acyclovir remains the mainstay of therapy. Outcome depends on the stage of viral spread. Cesarean section may prevent infection in neonates of women with primary infection, but it has become more controversial in those with recurrent disease.