Type 1 is responsible for most nongenital infections Type 2 HSV is recovered almost exclusively from the genital tract.

HERPES SIMPLEX VIRUS

Genital herpes simplex virus (HSV) infection is one of the most common STD50 million adolescents and adults currently affectedIt is estimated that 0.5 to2 percent of pregnant women acquire HSV-1 or -2 during pregnancy

Pathogenesis and Transmission

Type 1 is responsible for most nongenital infections

Type 2 HSV is recovered almost exclusively from the genital tract

Neonatal transmission is by three routes: (1) intrauterine in 5 percent, (2) peripartum in 85 percent, or (3) postnatal in 10 percentNeonatal herpes is caused by both HSV-I and HSV-2, although HSV- 2 Infection predominates. Most infected infants are born to mothers with no reported history of HSV infection.

Clinical Manifestations

1-First episode primary infection Only a third of newly acquired HSV-2 genital infections are symptomatic

The typical incubation period of2 to 10 days may be followed by a "classic presentation," characterized by a papular eruption with itching or tingling, which then becomes painful and vesicular and inguinal adenopathy may be severe

2.First episode nonprimary infectionHSV-2 is isolated from genital secretions in women already expressing serum HSV-I antibodiesare characterized by fewer manifestations because of some immunity

3-Reactivation disease (recurrent infection)These lesions generally are fewer innumber, are less tender, and shed virus for shorter periods-2 to 5 days

Most primary and first-episode infections in early pregnancy are probably not associated with an increased rate of spontaneous abortion or stillbirthlate-pregnancy primary infection may be associated with pretermlabor.

Infection of eye or mouth disease 35% of cases. Central nervous system disease with encephalitis 30% Disseminated disease with involvement of multiple major organs is found in 25%

Diagnosis

HSV tests available are either virological or type-specific serological tests.

Several serological assay systems are available to detect antibody to HSV glycoproteins Gl and G2

HerpeSelect ELISA, HerpeSelect lmmunoblot, and the Captia HSV Type Specific test kit

 Prenatal Serological Screening

This is controversial, and there is no clinical evidence that it may prevent HSV transmission and neonatal infection

The American College of Obstetricians and Gynecologists (2007a) does not recommend routine HSV screening

Management

Antiviral therapy with acyclovir, famciclovir, or valacyclovir has been used for treatment of first-episode genital herpes in nonpregnant

Acyclovir appears to be safe for use in pregnant women

(More than 700 neonates exposed during the first trimester were evaluated, and they had no increased adverse effects )

primary outbreak during pregnancy----- antiviral therapy Women with HIV coinfection ----longer duration of thx severe or disseminated HSV---- intravenous acyclovir, 5 to10 mg/kg, every 8 hours for 2 to 7 days followed by oral antiviral therapy to complete at least 10 days of total therapy

peripartum Shedding Prophylaxis

Acyclovir prophylaxis given from 36 weeks to delivery

A careful examination of the vulva, vagina, and cervix should be performed and suspicious lesions cultured

Cesarean delivery is indicated for women active genital lesions or prodromal symptomsCesarean delivery is not recommended for women with a history of HSV infection but no active disease at the time of delivery.

There is no evidence that external lesions cause ascending fetal infection with preterm ruptured membranes

Women with active HSV may breast feed if there are no active HSV breast lesions.Valacyclovir and acyclovir may be used during breast feeding as drug concentrations in breast milk are low.

HUMAN PAPILLOMAVIRUS

Human papillomavirus (HPV) has become one of the most common STDs with more than 30 typesHigh-risk HPV types 16 and 18 are associated with dysplasiaMucocutaneous external genital warts are usually caused by HPV types 6 and 11

External Genital Warts

For unknown reasons, genital warts frequently increase in number and size during pregnancy.

These lesions may sometimes grow to fill the vagina or cover the perineum, thus making vaginal delivery or episiotomy difficult

Treatment

There may be an incomplete response to treatment during pregnancy,but lesions commonly improve or regress rapidly following delivery.

eradication of warts during pregnancy is not always necessary.

There are several agents available, but pregnancy limits their useTrichloroacetic or bichloracetic acid, 80- to 90-percent solution,applied topically once a week is an effective regimen for external warts. Some prefer cryotherapy, laser ablation, or surgical excision

Podophyllin resin, podofilox 0.5-percent solution or gel, imiquimod 5-percent cream, and interferon therapy are not recommended in pregnancy

Neonatal Infection

Juvenile-onset recurrent respiratory papillomatosis is a rare, benign neoplasm of the larynx.

It can cause hoarseness and respiratory distress in children and is often due to HPV types 6 or 11.

Prolonged rupture of membranes was associated with a twofold increased risk, but risk was not associated with the mode of delivery.The benefit of cesarean delivery to decrease transmission risk is unknown, and thus it is currently not recommended solely to prevent HPV transmission