Hsv In Pregnancy

Front 1

Incubation period of HSV-1 and HSV-2

Back 1

2-12 days

Front 2

When are HSV antibodies detectable?

Back 2

first several weeks of infection and the persis. Usually within 2-3 weeks after infection.

Front 3

How many women report recognition of their HSV infection?

Back 3

5-15%

Front 4

Risk factors for HSV.

Back 4

Female. Duration of sexual activity. Minority ethnicity. Previous genital infection. Family income. Number of sexual partners.

Front 5

Percent of genital herpes caused by HSV-1

Back 5

80%. Most pronounced in the adolescent and young adult populations.

Front 6

Women with recurrent HSV who have an outbreak in pregnancy

Back 6

75% at least one recurrence. 14% have prodromal symptoms or clinical recurrence at delivery.

Front 7

_______ percent of HSV infected infants are born to mothers with no reported history of HSV infection.

Back 7

80%

Front 8

Classes of Neonatal HSV infection

Back 8

1. disseminated disease (25%)
2. central nervous system disease (30%).
3. disease limited to skin, eyes, or mouth (45%).

Front 9

Number of neonatal herpes infection caused by HSV-1.

Back 9

1/3-1/2

Front 10

Mortality of neonatal HSV

Back 10

1. 30% for disseminated disease.
2. 4% central nervous system disease.

Front 11

Long term effects of neonatal HSV.

Back 11

20% of survivors have long-term neurologic sequelae.

Front 12

How can the diagnosis of HSV be established?

Back 12

1. Viral detection.
2. antibody detection.

Front 13

Examples of HSV detection.

Back 13

HSV culture and PCR

Front 14

Advantages to PCR detection over HSV culture.

Back 14

3-5X more likely to be positive than cultures.
Increased sensitivity over culture.

Front 15

How to increase the positive predictive value of type-specific serologic HSV tests?

Back 15

Repeat testing with different type-specific assay.
Most important in populations at low risk. (Because the positive predictive value is influenced by the prevalence of the disease in the population tested).

Front 16

Fetal outcomes associated with primary HSV outbreak in pregnancy.

Back 16

1. neonatal chorioretinitis.
2. microcephaly.
3 skin lesions.

Front 17

Duration of treatment for primary outbreak of HSV

Back 17

can extend up to 10 days if lesions incompletely healed.

Front 18

Risk of vertical transmission with primary outbreak at time of delivery

Back 18

30-60%

Front 19

Reasons why vertical transmission more likey with primary outbreak.

Back 19

1. Reduced transplacental passage of protective antibodies.
2. Neonatal exposure may be increased.
3. Higher concentration od longer duration of viral shedding.

Front 20

Mean duration of viral shedding in primary HSV if untreated

Back 20

15 days

Front 21

Rate of transmission with vaginal delivery of women with recurrent lesions.

Back 21

3%.

Front 22

Why is transmission of recurrent HSV less than primary HSV?

Back 22

In part due to transplacental passage of antiherpes antibodies.

Front 23

Meta-analysis of acyclovir suppression for recurrent genital HSV.

Back 23

1. recurrence at delivery reduced by 75%.
2. rate oc CD reduced by 40%.
3. Viral detection at delivery was reduced by 90%.

Front 24

When is suppressive threapy recommended.

Back 24

Start at 36 weeks for either primary or recurrent disease.

Front 25

Which medication should be used for suppressive therapy.

Back 25

Meta-analysis with acyclovir. But Several trials have demonstrated efficacy of valacyclovir.

Front 26

How do doses for pregnant women differ than those for non-pregnant women.

Back 26

1. Are higher in the trials for pregnant than non pregnant patients.

Front 27

Doses of meds for primary outbreak.

Back 27

1. Acyclovir 400 mg PO TID X 7-10 d.
2. Valacyclovir 1 gram PO BID x 7-10 d.

Front 28

Doses of meds for recurrent episode of HSV.

Back 28

1. Acyclovir 400 mg PO TID X 5 days OR 800 mg BID X 5 days
2. Valacyclovir 500 mg PO BID x 3 days OR 1 g PO daily X 5 days.

Front 29

Daily suppression for HSV.

Back 29

Acyclovir 400 mg PO TID
Valacyclovir 500 mg PO BID

Front 30

Dosing for severe or disseminated HSV disease

Back 30

5-10 mg/kg IV Q 8 hour X 2-7 days, the PO to complete 10 days.

Front 31

3 main meds for HSV treatment.

Back 31

Acyclovir, Valacyclovir, famciclovir

Front 32

Mechanism of action of Acyclovir

Back 32

inhibits viral thymidine kinase

Front 33

Difference between Acyclovir and Valacyclovir.

Back 33

Acyclovir bioavailability is 20%.
Valacyclovir is prodrug of Acyclovir and has 54% bioavailability.
Can achieve doses closer to IV acyclovir with Valacyclovir.

Front 34

Benefits of Famciclovir.

Back 34

Prodrug. Changes to penciclovir. 77% bioavailability. No published data in pregnancy.

Front 35

How common is Acyclovir resistant HSV.

Back 35

Not common in immunocompotent patients, but is seen in immunocompromised patients (6-7%).

Front 36

Is there a role for routine screening for HSV during pregnancy or delivery?

Back 36

1. Routine cultures in asymptomatic patient is not recommended. Does not predict shedding at time of delivery.
2. Not cost effective to run serologic tests to determine suppressive therapy unless in a particular population or specific patient.

Front 37

When to deliver HSV positive with PPROM.

Back 37

No consensus on gestation age where risks of prmaturity outweigh risks of HSV.

Front 38

What invasive procedures are contraindicated in HSV positive women.

Back 38

Trans cervical procedures should be delayed.
Avoid fetal scalp electrodes (6 X increased risk of neonatal infection).