Treatment

Primary infection may be treated with oral antivirals [7]:

Acyclovir 400 mg orally TID for 7 to 10 days    OR
Valacyclovir 1 gram orally BID for 7 to 10 days

Severe or disseminated infections may be treated with acyclovir intravenously:

5 to 10 mg/kg  intravenously every 8 hours for 2 to 7 days, then oral therapy to complete a 10 day course.

The American American Congress of Obstetricians and Gynecologists. (ACOG)  recommends that women with active recurrent genital herpes should be offered suppressive viral therapy from 36 weeks until delivery [7]:

Valacyclovir 500 mg orally BID   OR
Acyclovir 400 mg orally tid

Congenital Infection

Transplacental infection of the fetus is rare during pregnancy. Intrauterine HSV infection has uncommonly been associated with skin lesions, chorioretinitis, microcephaly, hydranencephaly , and microphthalmia [1,2]. While primary HSV infections in the first trimester are associated with higher rates of spontaneous abortion and stillbirth [3]. infection later in pregnancy appears more likely to be associated with preterm labor or growth restriction[4].

Of greatest concern is the risk of primary infection acquired at birth which could lead to herpetic meningitis.  The infection rate is 34 to 80% for infants born vaginally during a  primary infection. The risk falls to 1 to 5% for infants born vaginally during a recurrent infection [4, 5,6].

Cesarean section is recommended for all women in labor with active genital lesions or  prodromal symptoms such as vulvar pain.

For patients with preterm premature rupture of membranes remote from term complicated by recurrent maternal HSV infection, the risks of prematurity should be weighed against the risk of neonatal HSV disease in considering expectant management.  Prophylactic treatment with antiviral agents (eg, acyclovir) may be considered if expectant management is chosen [6-8].

REFERENCES:
1. Shepard TH. Catalog of Teratogenic Agents pp 1323. 9th ed.Baltimore, MD: Johns Hopkins University Press, 1998
2. Hutto C, Arvin A, Jacobs R, Steele R, Stagno S, Lyrene R, Willett L, Powell D, Andersen R, Werthammer J, et al. Intrauterine herpes simplex virus infections. J Pediatr. 110:97-101, 1987 PubMed
3. Freij BJ, Sever JL: Herpesvirus infections in pregnancy: Risks to embryo, fetus, and neonate. Clin Perinatol 15:203-231, 1988
4. Brown ZA, Vontver LA, Benedetti J, et al: Effects on infants of a first episode of genital herpes during pregnancy. N Engl J Med 312:1246, 1987
5. Stagno S, Whitley RJ: Herpesvirus infections of pregnancy. Part II: Herpes simplex, virus and varicella zoster infections. N Engl J Med 313:1327-1330, 1985 PubMed
6.ACOG Practice Bulletin No. 80: premature rupture of membranes. Clinical management guidelines for obstetrician-gynecologists
Obstet Gynecol 2007
7. ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. No. 82 June 2007. Management of herpes in pregnancy. Obstet Gynecol 2007