Prolonged Preterm Rupture of Membranes Associated with Neonatal Disseminated Herpes Simplex Virus Type 1 at Birth: Is There a Role for Preemptive Test and Treat Strategies in High-Risk Populations?

Abstract

Neonatal herpes simplex virus (HSV) prevention focuses on mothers with prior or current genital disease [1]. However, primary asymptomatic maternal HSV-1 or HSV-2 cause most cases [2–5]. Prolonged membrane rupture is a major risk [6]. This newborn was born at 29 weeks after 14 days of ruptured membranes to an asymptomatic mother. No maternal HSV testing was performed. Vesicular lesions were present at birth with HSV DNA in skin, blood, and CSF; placental histology demonstrated viral particles (Figure 1). Primary maternal HSV-1 without protective antibody-dependent cellular cytotoxicity (ADCC)-mediating antibodies and limited placental antibody transfer were documented (Table 1) [7–10]. This case highlights the need for screening and preemptive treatment of high-risk subpopulations. Financial support. This work was supported by grants from National Institutes of Health, R01AI134367, R21AI147992, R01HD098977, and the Price Family Foundation. AMM is supported by Einstein-Montefiore CTSA training grant (TL1 TR002557).