Asymptomatic maternal shedding of herpes simplex virus at the onset of labor: Relationship to preterm labor**
Objective
To determine if fetal growth restriction and prematurity are observed with subclinical shedding of herpes simplex virus (HSV) at the onset of labor.
Methods
Within 48 hours of delivery, cultures were taken from the cervix and external genitalia of 15,923 asymptomatic pregnant women without symptoms or signs of genital HSV infection; results were positive for HSV in 57. Each of these 57 women were compared with a control group composed of the three culture-negative women delivering immediately before and the three delivering immediately after each woman shedding HSV.
Results
The median birth weight for infants born to the 57 women with asymptomatic shedding was 3050 g, compared with 3360 g among the 342 women without asymptomatic shedding, a statistically significant difference (P < .002). These differences were due to very low birth weight (LBW) among the five infants of women with subclinical viral shedding secondary to recently acquired primary genital herpes; these five infants had a median gestational age of 33 weeks, compared with 37 weeks for the 14 infants of mothers with nonprimary, first-episode disease and 39 weeks for the 33 infants of women with reactivation disease, also a significant difference (P=.018).
Conclusions
Asymptomatic genital shedding of HSV at the onset of labor because of subclinical primary genital HSV infection is associated with preterm delivery. Women who acquire genital HSV-2 before pregnancy and are shedding subclinically at the onset of labor experience no increase in adverse outcome. Thus, prevention of the prematurity and LBW associated with genital herpes means that acquisition of the infection in late pregnancy must be prevented.
References (21)
- VontverLA et al.
Recurrent genital herpes simplex virus infection in pregnancy: Infant outcome and frequency of asymptomatic recurrences
Am J Obstet Gynecol
(1982) - HargerJH et al.
Characteristics and management of pregnancy in women with genital herpes simplex virus infection
Am J Obstet Gynecol
(1983) - CatalanoPM et al.
Incidence of genital herpes simplex virus at the time of delivery in women with known risk factors
Am J Obstet Gynecol
(1991) - BoehmFH et al.
Management of genital herpes simplex virus infection occurring during pregnancy
Am J Obstet Gynecol
(1981) - AshleyRL et al.
Use of densitometric analysis for interpreting HSV serologies based on Western blot
J Virol Methods
(1987) - BernsteinDI et al.
Serologic analysis of firstepisode nonprimary genital herpes. Presence of type 2 antibody in acute serum samples
Am J Med
(1984) - NahmiasAJ et al.
Perinatal risk associated with maternal genital herpes simplex virus infection
Am J Obstet Gynecol
(1971) - RobbJA et al.
Intrauterine latent herpes simplex virus infection. I. Spontaneous abortion
Hum Pathol
(1986) - RobbJA et al.
Intrauterine latent herpes simplex virus infection. II. Latent neonatal infection
Hum Pathol
(1986) - NavarroC et al.
Chronic viral funisitis
J Pediatr
(1977)
Cited by (77)
Microbial signatures of preterm birth
2021, The Human Microbiome in Early Life: Implications to Health and DiseasePreterm birth remains the primary cause of death in children under the age of 5 years worldwide. A causal relationship between infection and preterm birth has long been recognized. However, recent applications of molecular-based profiling techniques have provided new insights into the relationship between specific bacterial compositions of the lower reproductive tract and subsequent preterm birth risk. In this chapter, we investigate evidence for “microbial signatures” of preterm birth and examine mechanisms by which shifts in microbiome composition could contribute to an infectious etiology of preterm birth. Despite high levels of heterogeneity between studies, vaginal depletion of Lactobacillus spp. and high-diversity communities enriched for potentially pathogenic bacteria are frequently associated with preterm birth, whereas Lactobacillus spp. dominant communities appear to confer protection against preterm birth, particularly when dominated by Lactobacillus crispatus. Strategies focused toward promoting optimal microbial signatures during pregnancy may help reduce rates of preterm birth and improve maternal and neonatal outcomes.
The risk of herpes simplex virus and human cytomegalovirus infection during pregnancy upon adverse pregnancy outcomes: A meta-analysis
2018, Journal of Clinical VirologyCitation Excerpt :The selection process is shown in Fig. S1. Finally, 20 studies [14–16,22–38] involving 8 cohorts and 12 case-control studies, were included in this study. The main characteristics of the included studies are described in Table 1.
Herpes simplex virus (HSV) and human cytomegalovirus (HCMV) are widespread infections in humans, yet their impact on adverse pregnancy outcomes is controversial. The objective of this study was to evaluate the impact of HSV and HCMV infections during pregnancy on adverse pregnancy outcomes.
A systematic literature search was performed using Web of Science, Scopus, Medline, Embase, PubMed, and the Cochrane Library database for relevant publications up to 2nd August 2017. The odds ratio (OR) and relative risk (RR), and their corresponding 95% confidence intervals (CIs) were selected as the effect size. Statistical analysis was conducted using STATA 12.0.
In total, 20 eligible studies were identified and included in the meta-analysis. Of these, 13 and 12 studies were related to the impact of HSV and HCMV upon adverse pregnancy outcomes, respectively. Collectively, the results indicated that HSV infection during pregnancy increased the risk of spontaneous abortion, premature birth and stillbirth with an OR of 3.81 (95% CI: 1.96–7.41), 3.83 (95% CI: 1.17–12.54), and 1.78 (95% CI: 1.08–2.95), respectively. HCMV infection during pregnancy also represented a risk factor for spontaneous abortion, premature birth and stillbirth with an OR of 1.61 (95% CI: 1.14–2.27), 1.86 (95% CI: 1.26–2.76) and 5.74 (95% CI: 2.04–16.12), respectively.
Maternal HSV and HCMV infection during pregnancy increase the risk of spontaneous abortion, premature birth, and stillbirth.
Management of pregnant women with first episode of genital herpes. Guidelines for clinical practice from the French college of gynecologists and obstetricians (CNGOF)
2018, Revue Sage - FemmeÉmettre des recommandations quant à la prise en charge d’un épisode initial d’herpès génital pendant la grossesse et dans le post-partum immédiat.
Consultation des bases de données MedLine et Cochrane Library et des recommandations des principales savantes.
En cas d’épisode initial d’herpès génital pendant la grossesse, il est recommandé d’initier un traitement antiviral par aciclovir (200 mg × 5 par jour) ou valaciclovir (1000 mg × 2 par jour) pendant 5 à 10 jours (grade C). Il est recommandé de proposer à la patiente une sérologie VIH si cela n’a pas été fait précédemment (grade B). Chez les femmes ayant présenté un épisode initial d’herpès génital pendant la grossesse, il est recommandé de mettre en place une prophylaxie antivirale à partir de 36 semaines d’aménorrhée par aciclovir (400 mg × 3 par jour) ou valaciclovir (500 mg × 2 par jour) (grade B). Il est recommandé de réaliser une césarienne en cas de suspicion d’épisode initial d’herpès génital au moment du travail (grade B) ou de rupture de la poche des eaux à terme (accord professionnel), ou en cas d’épisode initial d’herpès génital survenu moins de 6 semaines avant l’accouchement (accord professionnel). En cas d’épisode initial d’herpès génital découvert dans le post-partum, il est nécessaire de prévenir le pédiatre (accord professionnel). La patiente pourra être traitée selon le schéma décrit ci-dessus.
Il est recommandé de réaliser une césarienne en cas d’épisode initial d’herpès génital dans les 6 semaines précédant l’accouchement.
To provide guidelines for the management of first episode genital herpes during pregnancy and in the immediate postpartum period.
MedLine and Cochrane Library databases search and review of the main foreign guidelines.
In case of first episode genital herpes during pregnancy, antiviral treatment with acyclovir (200 mg 5 times daily) or valacyclovir (1000 mg twice daily) for 5 to 10 days is recommended (grade C). The patient should be tested for HIV if not previously done (grade B). Daily suppressive antiviral treatment with acyclovir (400 mg 3 times daily) or valacyclovir (500 mg twice daily) is recommended from 36 weeks for women who have had a first episode genital herpes during pregnancy (grade B). A cesarean section should be performed in case of suspicion of first episode genital herpes at the onset of labor (grade B) or premature rupture of the membranes at term (professional consensus), or in case of first episode genital herpes less than 6 weeks before delivery (professional consensus). In the event of first episode genital herpes highlighted in the postpartum period, the neonatologist should be informed (professional consensus). The patient may be treated according the scheme described above.
A cesarean section should be performed in case of first episode genital herpes less than 6 weeks before delivery.
Genital herpes and pregnancy: Epidemiology, clinical manifestations, prevention and screening. Guidelines for clinical practice from the French College of Gynecologists and Obstetrician (CNGOF)
2017, Gynecologie Obstetrique Fertilite et SenologieÉvaluer la prévalence et les conséquences engendrées par les infections herpétiques génitales chez la femme enceinte.
Consultation de la base de données MedLine et des recommandations des sociétés savantes françaises et étrangères.
La symptomatologie peut être atypique (NP2). Il n’existe pas d’étude comparant la symptomatologie clinique pendant et en dehors de la grossesse. Par comparaison indirecte, il ne semble pas y avoir de particularité de l’expression clinique de l’herpès génital pendant la grossesse (Accord professionnel). Elle est le plus souvent due à HSV2 (NP2). Soixante-dix pour cent des patientes enceintes ont un antécédent d’infection par un virus Herpès simplex, sans préjuger de la localisation génitale ou labiale, et celui-ci est dans la majorité des cas de type 1 (NP2). La prévalence des lésions cliniques d’herpès à l’accouchement en cas de récurrence est de l’ordre de 16 % contre 36 % en cas d’infection initiale (NP4). Chez les patientes HSV+, l’excrétion herpétique asymptomatique est de 4 à 10 %. Le taux d’excrétion augmente chez les patientes VIH+ (20 à 30 %) (NP2). Le risque de séroconversion HSV pendant la grossesse est de 1 à 5 % (NP2), mais peut atteindre 20 % en cas de couple séro-discordant (NP2). L’interrogatoire n’est pas toujours suffisant pour connaître l’antécédent d’infection herpétique d’une patiente et de son conjoint (NP2) et l’examen clinique peu fiable (NP2). Les hépatites herpétiques et les encéphalites sont rares et potentiellement graves (NP4). Il semble exister une association entre l’infection herpétique non traitée et l’accouchement prématuré (NP3) mais pas en cas d’infection traitée (NP4). Les fœtopathies herpétiques sont exceptionnelles (NP4). Il n’y a pas d’argument pour recommander une prise en charge spécifique de diagnostic anténatal en cas d’infection herpétique pendant la grossesse (Accord professionnel). Le port du préservatif diminue le risque d’infection initiale dans une population de femme non enceinte (NP3). Il n’y a pas d’arguments pour justifier une politique de dépistage systématique pendant la grossesse (Accord professionnel).
Il existe une forte discordance entre la prévalence de l’excrétion herpétique au moment de l’accouchement et la rareté des infections néonatales. Il existe un manque de données sur l’impact des infections herpétiques pendant la grossesse sur la femme et/ou le fœtus et/ou le nouveau-né en France. Les conséquences fœtales et maternelles sont potentiellement graves mais rares.
To analyze the consequences of genital herpes infections in pregnant women.
The PubMed database and the recommendations from the French and foreign obstetrical societies or colleges have been consulted.
The symptomatology of herpes genital rash is often atypical (NP2) and not different during pregnancy (Professional consensus). It is most often due to HSV2 (NP2). Seventy percent of pregnant patients have a history of infection with Herpes simplex virus, without reference to genital or labial localization, and this is in most cases type 1 (NP2). The prevalence of clinical herpes lesions at birth in the event of recurrence is about 16% compared with 36% in the case of initial infection (NP4). In HSV+ patients, asymptomatic herpetic excretion is 4 to 10%. The rate of excretion increases in HIV+ patients (20 to 30%) (NP2). The risk of HSV seroconversion during pregnancy is 1 to 5% (NP2), but can reach 20% in case of sero-discordant couple (NP2). Questioning is not always sufficient to determine the history of herpes infection of a patient and her partner (NP2) and the clinical examination is not always reliable (NP2). Herpetic hepatitis and encephalitis are rare and potentially severe (NP4). These diagnoses should be discussed during pregnancy and antiviral therapy should be started as soon as possible (Professional consensus). There is no established link between herpes infection and miscarriages (NP3). There appears to be an association between untreated herpes infection and premature delivery (NP3) but not in the case of treated infections (NP4). Herpetic fetopathies are exceptional (NP4). There is no argument for recommending specific prenatal diagnosis for herpes infection during pregnancy (Professional consensus). Condom use reduces the risk of initial infection in women who are not pregnant (NP3). There is no evidence to justify routine screening during pregnancy (Professional consensus).
There is a strong discrepancy between the prevalence of herpetic excretion at the time of delivery and the scarcity of neonatal infections. There is a lack of data on the impact of herpes infections during pregnancy in France. Fetal and maternal consequences are potentially serious but rare.
Management of pregnant women with recurrent herpes. Guidelines for clinical practice from the French College of Gynecologists, Obstetricians (CNGOF)
2017, Gynecologie Obstetrique Fertilite et SenologieDéfinir la prise en charge d’une femme enceinte présentant une lésion d’herpès génital pendant la grossesse et ayant un antécédent d’herpès génital connu.
Consultation des bases de données MedLine et Cochrane Library et des recommandations des principales sociétés savantes.
Devant une lésion génitale typique d’un herpès chez une femme ayant un antécédent d’herpès génital connu, il s’agit d’une récurrence herpétique et une confirmation virologique n’est pas nécessaire (Grade B). En cas de récurrence herpétique en cours de grossesse, un traitement par aciclovir ou valaciclovir peut être proposé, néanmoins, son bénéfice sur la durée et l’intensité des symptômes est modeste (Grade C). Le traitement consiste en de l’aciclovir à raison de 1 cp à 200 mg per os 5 fois par jour pendant 5 jours, ou du valaciclovir à raison de 1 cp à 500 mg per os 2 fois par jour pendant 5 jours (Grade C). En cas de récurrence herpétique lors de l’accouchement, le risque d’herpès néonatal est estimé à environ 1 % (NP3). Une prophylaxie antivirale doit être proposée aux femmes ayant une récurrence herpétique en cours de grossesse, à partir de 36 SA et jusqu’à l’accouchement (Grade B). Chez les femmes ayant un antécédent d’herpès génital et pour lesquelles le dernier épisode de récurrence est antérieur à la grossesse, le bénéfice du traitement prophylactique n’est pas démontré. Il n’est donc pas recommandé de proposer systématiquement une prophylaxie antivirale aux femmes qui n’ont pas eu de récurrence pendant la grossesse (Accord professionnel). À l’entrée en travail, un prélèvement ne doit être réalisé qu’en cas de lésion (Accord professionnel). En cas de récurrence herpétique en début de travail, une césarienne sera d’autant plus à considérer que les membranes sont intactes, et/ou en cas de prématurité et/ou de séropositivité au VIH (Accord professionnel). En revanche, un accouchement par voie vaginale sera d’autant plus à considérer qu’il existe une rupture des membranes prolongée, après 37 SA et en l’absence de séropositivité au VIH (Accord professionnel).
En cas de récurrence herpétique en début de travail à membranes intactes, un accouchement par césarienne est à considérer. En cas de récurrence herpétique et de rupture prolongée des membranes à terme, le bénéfice de la césarienne est plus discutable et un accouchement par voie vaginale est possible.
To provide guidelines for the management of woman with genital herpes during pregnancy or labor and with known history of genital herpes.
MedLine and Cochrane Library databases search and review of the main foreign guidelines.
Genital herpes ulceration during pregnancy in a woman with history of genital herpes correspond to a recurrence. In this situation, there is no need for virologic confirmation (Grade B). In case of recurrent herpes during pregnancy, antiviral therapy with acyclovir or valacyclovir can be administered but provide low efficiency on duration and severity of symptoms (Grade C). Antiviral treatment proposed is acyclovir (200 mg 5 times daily) or valacyclovir (500 mg twice daily) for 5 to 10 days (Grade C). Recurrent herpes is associated with a risk of neonatal herpes around 1% (LE3). Antiviral prophylaxis should be offered for women with recurrent genital herpes during pregnancy from 36 weeks of gestation and until delivery (Grade B). There is no evidence of the benefit of prophylaxis in case or recurrence only before the pregnancy. There is no recommendation for systematic prophylaxis for women with history of recurrent genital herpes and no recurrence during the pregnancy. At the onset of labor, virologic testing is indicated only in case of genital ulceration (Professional consensus). In case of recurrent genital herpes at the onset of labor, cesarean delivery will be all the more considered if the membranes are intact and/or in case of prematurity and/or in case of HIV positive woman and vaginal delivery will be all the more considered in case of prolonged rupture of membranes after 37 weeks of gestation in an HIV negative woman (Professional consensus).
In case of recurrent genital herpes at the onset of labor and intact membranes, cesarean delivery should be considered. In case of recurrent genital herpes and prolonged rupture of membranes at term, the benefit of cesarean delivery is more questionable and vaginal delivery should be considered.
Management of pregnant women with first episode of genital herpes. Guidelines for clinical practice from the French college of gynecologists and obstetricians (CNGOF)
2017, Gynecologie Obstetrique Fertilite et SenologieÉmettre des recommandations quant à la prise en charge d’un épisode initial d’herpès génital pendant la grossesse et dans le post-partum immédiat.
Consultation des bases de données MedLine et Cochrane Library et des recommandations des principales savantes.
En cas d’épisode initial d’herpès génital pendant la grossesse, il est recommandé d’initier un traitement antiviral par aciclovir (200 mg × 5 par jour) ou valaciclovir (1000 mg × 2 par jour) pendant 5 à 10 jours (grade C). Il est recommandé de proposer à la patiente une sérologie VIH si cela n’a pas été fait précédemment (grade B). Chez les femmes ayant présenté un épisode initial d’herpès génital pendant la grossesse, il est recommandé de mettre en place une prophylaxie antivirale à partir de 36 semaines d’aménorrhée par aciclovir (400 mg × 3 par jour) ou valaciclovir (500 mg × 2 par jour) (grade B). Il est recommandé de réaliser une césarienne en cas de suspicion d’épisode initial d’herpès génital au moment du travail (grade B) ou de rupture de la poche des eaux à terme (accord professionnel), ou en cas d’épisode initial d’herpès génital survenu moins de 6 semaines avant l’accouchement (accord professionnel). En cas d’épisode initial d’herpès génital découvert dans le post-partum, il est nécessaire de prévenir le pédiatre (accord professionnel). La patiente pourra être traitée selon le schéma décrit ci-dessus.
Il est recommandé de réaliser une césarienne en cas d’épisode initial d’herpès génital dans les 6 semaines précédant l’accouchement.
To provide guidelines for the management of first episode genital herpes during pregnancy and in the immediate postpartum period.
MedLine and Cochrane Library databases search and review of the main foreign guidelines.
In case of first episode genital herpes during pregnancy, antiviral treatment with acyclovir (200 mg 5 times daily) or valacyclovir (1000 mg twice daily) for 5 to 10 days is recommended (grade C). The patient should be tested for HIV if not previously done (grade B). Daily suppressive antiviral treatment with acyclovir (400 mg 3 times daily) or valacyclovir (500 mg twice daily) is recommended from 36 weeks for women who have had a first episode genital herpes during pregnancy (grade B). A cesarean section should be performed in case of suspicion of first episode genital herpes at the onset of labor (grade B) or premature rupture of the membranes at term (professional consensus), or in case of first episode genital herpes less than 6 weeks before delivery (professional consensus). In the event of first episode genital herpes highlighted in the postpartum period, the neonatologist should be informed (professional consensus). The patient may be treated according the scheme described above.
A cesarean section should be performed in case of first episode genital herpes less than 6 weeks before delivery.
- **
Supported by grant no. A130731 from the National Institutes of Allergy and Infectious Disease and a grant from the March of Dimes Birth Defects Foundation.