Introduction
Epidemiology of HSV infection, maternal infection and maternal-foetal transmission
Genital herpes: clinical features
Management of pregnant women with a first or recurrent episode of genital herpes
Diagnostic procedures
Method | Tissue sampled | Sensitivity | Specificity | Advantages | Disadvantages |
---|---|---|---|---|---|
Virus isolation by cell culture1 | Skin/mucosal lesions (stage): | Specialized laboratories | |||
- vesicular content | >90% | Gold standard | Virus transport medium | ||
- ulcers | 95% | ~100% | Simplicity of sampling | Transport rapid, cooled, protected from light | |
- scabs | 70% | Virus typing | Results in 2/7 days | ||
- mucosa without lesions | 30% | Resistance phenotype determination | Not suitable for CFS | ||
Unknown | Arrangement with laboratory necessary | ||||
Biopsies | |||||
Conjunctival smear/corneal | |||||
Neonates | |||||
Cytologic diagnosis (Tzanck's smear)35 | Skin/mucosal lesions | 73–100% | 100% | Easy, quick, reproducible and inexpensive | Optimal lesions are fresh, intact bisters of 1/3 days' duration |
Biopsies | |||||
Conjunctival smear/corneal | |||||
IF (detection of infected cells)30 | Smears, tissue sections, smears from base of vesicle | 41–70% | >95% | Rapid (<4 h possible) Typing possible | Fresh vesicles |
Specialised laboratories | |||||
Technically demanding | |||||
Not standardized | |||||
Virus antigen detection by EIA o ELISA30 | Smears from lesions, vesicular content with base of vesicle | 41–80% | 80% | Simplicity of sampling | Suitable only for fresh vesicles |
Does not require the integrity of the specimen | |||||
Rapid (<4 h possible) | |||||
Typing possible | |||||
PCR: | |||||
Most sensitive method | |||||
Virus DNA detection by PCR30 or Real-time PCR31 | CSF | 9798% | ~100% | Result within 24–48 h | Only in specialised laboratories |
Aqueous or vitreous humour | Virus typing and resistance genotyping | Not standardised | |||
Method of choice for CSF | Not validated for all samples | ||||
Risk of contamination (PCR) | |||||
Real-time PCR: | High costs (real-time PCR) | ||||
Skin lesions, vesicular content or mucosa without lesions | Rapid amplification | ||||
Quantitative analysis | |||||
Reduced risk of contamination | |||||
Method of choice for skin lesions |
Method | Tissue sampled | Sensitivity | Specificity | Advantages | Disadvantages |
---|---|---|---|---|---|
Distinguish between HSV-1 and 2 | |||||
Western Blot2 | Serum | ~100% | ~100% | Detect early seroconversion to HSV-2 in patient with prior HSV-1 infection. | Not commercially available Expensive 2–3 days for results |
Commercially available | |||||
EIA2 | Serum | 93–98% | 93–98% | Distinguish between HSV-1 and HSV-2 | Lack of sensitivity (compared to amplified tests)2 |
Serum | Less expensive than western blot2 | Commercially available only for HSV-22 | |||
Point of care tests2 | Capillary blood37 | 96% | 87–98% | Accurate results rapidly (6 min.)37 | Expensive36 |
Easily performer37 | Not for large volume screening36 | ||||
Detects seroconversion within 4 weeks of presentation of 80% of patients with HSV-2 episodes37 | Complexity nonwaived (moderate)36 |
Therapeutic measures
First episode | Recurrent episodes | |||||
---|---|---|---|---|---|---|
Pregnanc |
Antiviral drug
|
Recommended daily dosage
|
Length of therapy
|
Antiviral drug
|
Recommended daily dosage
|
Length of therapy
|
Episodic treatment
| Acyclovir | Orally: 5 × 200 mg | 10 days | Acyclovir | Orally: 5 × 200 mg | 5 days |
Valacyclovir | Orally: 2 × 500 mg | 10 days | Valacyclovir | Orally: 2 × 500 mg | 5 days | |
Suppressive treatment
| Acyclovir | Orally: 3 × 400 mg | Acyclovir | Orally: 3 × 400 mg | ||
Valacyclovir | Orally: 2 × 250 mg | From week 36 until delivery | Valacyclovir | Orally: 2 × 250 mg | From week 36 until delivery |
Mode of delivery
Neonatal hsv infections
Mode of acquisition and clinical manifestations
Diagnostic procedures
Antiviral therapy and prognosis
Infants |
Antiviral drug
|
Recommended daily dosage
|
Length of therapy
|
---|---|---|---|
Localised infections: 14 days | |||
Treatment of neonatal hsv infection | Acyclovir | Intravenously: 3 × 10–20 mg/kg | CNS or disseminated infections: 21 days |
Suppressive treatment of cutaneous recurrences after neonatal herpes | Acyclovir | Orally: 2–3 × 300 mg/m2 | For weeks to months |