Managing Herpes During the 1st and 2nd Trimester Pregnancy - Virology Hub

Managing Herpes During the 1st and 2nd Trimester Pregnancy

First or Second Trimester Acquisition

• With primary genital herpes during the first trimester, no evidence has been reported of an increased possibility of spontaneous miscarriage.

• Women who suspect to have genital herpes must be directed to a genitourinary doctor who will refute or confirm the diagnosis via viral PCR (polymerase chain reaction), advice on genital herpes management, and set up a screen for other STDs.

• On the other hand, treatment shouldn’t be delayed. The woman’s management ought to be consistent with her clinical state and will typically involve using oral or intravenous (for disseminated herpes) aciclovir in doses of 400 mg thrice daily, typically for five days. The use of such agent is linked to a decrease in the severity and duration of the herpes symptoms and a reduction in the period of viral shedding.

For use in pregnant women, aciclovir isn’t licensed but is deemed as safe and hasn’t been linked with a rise in birth defect incidence. Transient neutropenia in new-borns has been reported, but there have been no clinically substantial adverse neonatal or maternal effects reported. Aciclovir is tolerated during pregnancy.

• A dose adjustment is not necessary for treatment courses. There’s no evidence of a rise in birth defect risk with aciclovir, valaciclovir, or famciclovir if utilized in the initial trimester.

• Safety data for aciclovir could be generalized to valaciclovir during late pregnancy since it’s the valine ester, yet as there’re less experience and knowledge with the use of famciclovir or valaciclovir, they aren’t endorsed as a first line treatment.

• The obstetrician ought to be informed.

• Topical lidocaine 2% gel and paracetamol can be provided as symptomatic relief. There’s no evidence that either agent is damaging to pregnancy in standard doses.

• Women who suspect to have genital herpes and are having a midwifery-led care ought to be directed for examination by an obstetrician, preferably after examination by the genitourinary medicine doctor.

• If the delivery does not follow within the following six weeks, the pregnancy ought to be managed expectantly as well as vaginal delivery anticipated. No evidence has been reported that HSV contracted during pregnancy is linked to an increased occurrence of congenital abnormalities.

• After the first or second trimester acquisition, suppressive Acyclovir 400 mg thrice a day from 36 weeks of gestation decreases HSV lesions at term and therefore the necessity for delivery by C-section. Moreover, it has been established to decrease asymptomatic viral shedding (comparable results have been observed with Valaciclovir, though valaciclovir isn’t recommended for use during pregnancy considering the insufficient experience with the agent’s use).

While herpes isn’t necessarily transmitted during pregnancy, we still can’t ignore the risks and every expecting mother should know how to prevent transmitting the disease during pregnancy. Living a clean and healthy lifestyle and constantly taking anti-viral drugs can definitely help in preventing herpes infection. It would be best to research more about the subject for the best results.

Source by Louis V Lim

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