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20 Cards in this Set
- Front
- Back
Neonatal congenital HSV affects how many infants?
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about 1/15000 deliveries
(1/3500 in USA) |
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What are the 3 levels of neonatal HSV disease?
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1) skin, eyes, mouth
2) CNS (w/o skin/eye/mouth) 3) disseminated (90% fatal) |
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How is HSV transmitted to the fetus/neonate? (i.e. what are the modes of transmission?)
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1) Congenital in utero (Transplacental)
2) Intrapartum from birth canal 3) Nosocomial (staff/family members) |
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How is neonatal HSV treated?
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IV Acyclovir
Consult Pediatrician/Neonatologist |
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What percentage of pregnant women are positive for HSV1/HSV2 antibodies?
What percentage of genital lesions are caused by HSV2? |
HSV1: 60%
HSV2: 20% (90% of women +HSV2 don't know it) genital tract disease is now about 50% HSV1 and 50% HSV2 **HSV1 is more often implicated in neonatal HSV in Canada |
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List 3 'types' of infection
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1) Primary
2) Non-Primary, first recognized ep. 3) Recurrent |
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List the symptoms of HSV infection.
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may be: none --> severe
usually worse with primary infection genital: lesions burning itching pain systemic fever H/A tender lymphadenopathy |
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What is the highest-risk scenario for neonatal HSV infection acquired at vaginal delivery?
What is the risk of HSV transmission to the neonate? |
Primary maternal infection in 3rd trimester
(no maternal antibodies) 50% |
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Should C/S be recommended to women with primary HSV infection identified in the 3rd trimester?
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Yes
|
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How can maternal symptoms of primary or recurrent HSV infection be treated?
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Acyclovir 400mg TID x 7-14d
Valacyclovir 500mg BID x 7-14d IV Acyclovir if severe infection |
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List indications for C/S in maternal genital HSV infection.
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1) Usual obstetrical indications
2) Primary infection, 3rd trimester 3) Prodromal symptoms or lesions (all perineal lesions) at parturition with ROM <= 4h |
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How would you manage PPROM <34wks with a history of genital HSV?
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Start prophylactic antiviral therapy as for antenatal recurrent infection protocol
(Acyclovir 400mg TID or Valacyclovir 500mg BID) |
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Has acyclovir or valacyclovir been found to teratogenic or harmful in:
a) pregnancy b) breast-feeding |
a) no
b) no |
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What is the risk of intrapartum transmission of HSV to a neonate if the mother has recurrent genital HSV and an active lesion at delivery?
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About 2-5%
|
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True or False: HSV viral shedding can occur even in the abscence of visible lesions
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True
(the risk of neonatal transmission at delivery is significantly higher if lesions are present) |
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List fetal effects of transplacental transmission of HSV (in utero)
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IUGR
microcephaly hepatosplenomegaly IUFD/stillbirth (very rare) |
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Is anti-HSV serology screening recommended for all pregnant women?
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No
|
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What counseling should be provided to discordant couples (female negative, male positive)
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Type-specific serology to predict risk
If at risk: Avoid sexual contact (oral-ano-genital) If contact: condoms prophylactic antiviral for female Repeat serology at 32-34wks |
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What intrapartum invasive devices/procedures should be avoided for women with a history of genital HSV?
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1) FSE
2) fetal scalp gas measurement 3) All intrauterine devices (e.g. IUPC) |
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How would you manage a women with a history of genital herpes leading up to parturition
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Start prophylactic antiviral medication at 35-36wks
acyclovir 400mg TID, or valacyclovir 500mg BID |