Neonatal Herpes Aware: Diagnosis, Treatment and Prevention

Approximately 2000 newborn babies contract infection due to HSV each year in the
United States. Although HSV- 2 is responsible for most birth-acquired infections,
about 30% of infections are caused by HSV-1. If the mother has a genital infection
during the time of birth, the baby is at high risk of contamination. If this occurs, the
signs may show up between the 1st and 2nd week of life or it may even take as late
as the 4th week. This herpes aware section will educate you on diagnosis,
treatment and prevention of birth-acquired HSV.
Diagnosis:
The most common method of diagnosing the infant for herpes is HSV Culture or
PCR. Isolation of HSV in tissue culture confirms the presence or absence of virus. If
skin lesions are present, a scraping of the vesicles could act as a specimen for
diagnosis. Other sites from which specimens can be obtained for culture of HSV
include the nasopharynx, mouth, conjunctivae and rectum. If no diagnostic virology
facilities are available, cytologic evaluation via a Tzanck test of the lesion base may
be performed. However, this test is less sensitive than culture, and false-positives
also occur. Our diagnosing methods include serologic testing (only for determining
past HSV exposure), immunofluorescent microscopy, Brain biopsy or imaging
studies including magnetic resonance imaging and computed tomography.

Treatment:
Neonatal herpes is generally treated with parenteral antiviral therapy in which
suppressive medications are injected through the babys vein (intravenous).
Acyclovir, famciclovir (Famvir) and valacyclovir (Valtrex) are the most common antiviral medications used. They are nucleoside analogs that selectively suppress the
replication of virus. They reduce the duration of active painful vesicular lesions and
the duration of symptomatic and asymptomatic shedding of virus. Acyclovir was the
first drug developed for HSV and has a high safety profile.
Prevention:
If the mother has a history of getting infected with herpes virus, she must consult a
physician regarding this. If she experiences frequent outbreaks, she will be given an
anti-viral medicine to take during the last month of pregnancy so that the outbreaks
didnt occur at the time of delivery. Cesarean section is recommended for pregnant
women who have fresh herpes sore and are in labor. The use of fetal scalp electrode
monitoring during delivery also checks entry of the virus into the infant. HSV-1
lesions do not necessitate a cesarean section, but the lesions should be covered
with an occlusive dressing before vaginal delivery.
Its important that the herpes infected mothers should take great prevention while
handling their newborn babies. Herpes Aware recommends that they must speak
to their doctor to know about the best way to minimize the risk of transmitting
herpes to their infants.