Use of Herpes Type-specific Serology to Prevent Neonatal Herpes Simplex Virus Infection

Abstract

After completing this article, readers should be able to: 1. Describe the three presentations of neonatal herpes. 2. Delineate the primary routes of acquisition of neonatal herpes. 3. Explain why herpes simplex virus type-specific serology should be used to identify at-risk pregnant women. 4. Describe approaches to prevention of neonatal herpes. At the midpoint of the third National Health and Nutrition Survey (NHANES) (approximately 1991), herpes simplex virus (HSV)-2 seroprevalence in the United States was approximately 22%. This represented an approximately 30% increase since the midpoint of the second NHANES study in the early 1980s. (1)(2)(3) Because sexual practices in the adult population probably have not changed, it is reasonable to assume that over the decade since the third NHANES study, HSV-2 seroprevalence in the United States increased by an additional 30%. To this must be added another 10% to account for genital herpes due to HSV-1. Accordingly, the prevalence of genital herpes in the United States may be as high as 40%, an average prevalence that suggests some regions (eg, urban and coastal) may have substantially higher rates than others (eg, central and rural). The NHANES study and others have demonstrated that women have higher seroprevalence rates than men, a finding consistent with the increased susceptibility of women to acquire sexually transmitted diseases. (1)(2)(3)(4) Finally, HSV-1 is increasingly responsible for initial episodes of genital herpes both in the United States and Europe. (5) Genital herpes is transmitted primarily from persons who have unrecognized infection or during periods of asymptomatic shedding. (4)(6) Approximately 75% to 90% of persons who have HSV-2 antibodies are unaware of their infection and are experiencing genital reactivations that take the form of either mildly symptomatic recurrences (two thirds of persons) that are attributed to problems …