***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: OBJECTIVE All women seropositive for herpes simplex virus-2 are at risk for asymptomatic viral shedding at the onset of labor and neonatal transmission of the virus . Unfortunately , only 20 % to 35 % of seropositive adults give a history consistent with genital herpes . We evaluated whether more detailed question ing during pregnancy might eluci date symptoms predictive of seropositivity and therefore better identify women at risk for herpes simplex virus shedding at delivery . STUDY DESIGN During pregnancy 201 r and omly selected women were asked in-depth questions about recurrent genital symptoms and whether they " currently have or have ever had genital herpes . " An assessment was made whether the patient had a history compatible with genital herpes . This assessment and the " yes/no " history of genital herpes obtained by physicians at the initial prenatal visit were both compared with herpes simplex virus serologic studies by Western blot . RESULTS Of 201 patients interviewed , 177 gave no history of genital herpes .  Of these , 30.4 % were seropositive for herpes simplex virus-2 . Detailed histories on these 177 patients indicated that among the 159 subjects without suggestive symptoms or with somewhat suggestive symptoms the corresponding rates of seropositivity were 28 % and 30 % . Among the 18 ( 10.2 % ) subjects with highly suggestive symptoms , only 50 % were seropositive . The positive predictive values for recurrent genital symptoms to predict herpes simplex virus-2 seropositivity ranged from 30 % to 57 % . CONCLUSION A detailed history of genital symptoms is no better at identifying an herpes simplex virus-2 seropositive patient than is simply asking if she has ever had genital herpes . Serologic screening is a more accurate method of identifying women with past genital herpes or those who are at risk for acquiring genital herpes during pregnancy Objective : To continue evaluation of the use of acyclovir suppression in late pregnancy after first episode genital herpes simplex virus ( HSV ) infection , using an open-label study design . Methods : Ninety-six women diagnosed with genital herpes for the first time in the index pregnancy were prescribed suppressive acyclovir 400 mg orally three times daily from 36 weeks until delivery in an open-label fashion . Herpes cultures were obtained when patients presented for delivery . Vaginal delivery was permitted if no clinical recurrence was present ; otherwise a Cesarean delivery was performed . NeonatalHSV cultures were obtained and infants were followed clinical ly . Rates of clinical and asymptomatic genital herpes recurrences and Cesarean delivery for genital herpes were measured , and 95 % confidence intervals were calculated . Results : In 82 patients ( 85 % ) compliant with therapy , only 1 % had clinical HSV recurrences at delivery . In an intent to treat analysis of the entire cohort , 4 % had clinical recurrences ( compared with 18–37 % in historical controls ) . Asymptomatic shedding occurred in 1 % of women without lesions at delivery . Two of the four clinical recurrences were HSV-culture positive . No significant maternal or fetal side-effects were observed . Conclusions : In clinical practice the majority of patients are compliant with acyclovir suppression at term . The therapy appears to be effective at reducing clinical recurrences after a first episode of genital herpes complicating a pregnancy OBJECTIVE : To determine if suppressive acyclovir near term decreased the frequency of clinical recurrences at delivery in women with recurrent genital herpes simplex virus ( HSV ) infection . METHODS : We conducted a prospect i ve , double-blind , r and omized trial in 234 women with recurrent genital herpes . Women with genital infection of any frequency were enrolled . Patients received either suppressive oral acyclovir 400 mg three times daily or an identical placebo after 36 weeks ' gestation . Clinical lesions were identified , and HSV cultures were obtained at delivery . The frequencies of clinical and sub clinical HSV recurrences at delivery were evaluated . RESULTS : Six percent of patients treated with acyclovir , and 14 % of patients treated with placebo had clinical HSV at delivery ( p = 0.046 ) . No patients in the acyclovir group had positive HSV cultures , compared with 6 % of placebo-treated patients ( p = 0.029 ) . There was no significant difference in sub clinical HSV shedding in the acyclovir group ( 0 % ) compared with the placebo-treated group ( 3 % ) ( p = 0.102 ) . CONCLUSIONS : Suppressive acyclovir therapy significantly decreased the incidence of clinical genital herpes and the overall incidence of HSV excretion at delivery in patients with previous herpes infection Objective To evaluate the efficacy and safety of a suppressive course of acyclovir in late pregnancy in women with recurrent genital herpes infection on the incidence of viral shedding , herpes lesion development and caesarean section for recurrent genital herpes BACKGROUND In a controlled trial comparing acyclovir with vidarabine in the treatment of neonatal herpes simplex virus ( HSV ) infection , we found no significant difference between the treatments in adjusted mortality and morbidity . Hence , we sought to define for the entire cohort ( n = 202 ) the clinical characteristics that best predicted the eventual outcome in these neonates . METHODS Data were gathered prospect ively at 27 centers between 1981 and 1988 in infants less than one month of age who had virologically confirmed HSV infection . We examined the outcomes by multivariate analyses of 24 variables . Disease was classified in one of three categories based on the extent of the involvement at entry into the trial : infection confined to skin , eyes , or mouth ; encephalitis ; or disseminated infection . RESULTS AND CONCLUSIONS There were no deaths among the 85 infants with localized HSV infection . The mortality rate was significantly higher in the 46 neonates with disseminated infection ( 57 percent ) than in the 71 with encephalitis ( 15 percent ) . In addition , the risk of death was increased in neonates who were in or near coma at entry ( relative risk , 5.2 ) , had disseminated intravascular coagulopathy ( relative risk , 3.8 ) , or were premature ( relative risk , 3.7 ) . In babies with disseminated disease , HSV pneumonitis was also associated with greater mortality ( relative risk , 3.6 ) . In the survivors , morbidity was most frequent in infants with encephalitis ( relative risk , 4.4 ) , disseminated infection ( relative risk , 2.1 ) , seizures ( relative risk , 3.0 ) , or infection with HSV type 2 ( relative risk , 4.9 ) . With HSV infection limited to the skin , eyes , or mouth , the presence of three or more recurrences of vesicles was associated with an increased risk of neurologic impairment as compared with two or fewer recurrences Objective To determine if suppressive acyclovir therapy given to term gravidas experiencing a first episode of genital herpes simplex virus ( HSV ) infection during pregnancy decreases the need for cesarean delivery for that indication . Methods Forty-six pregnant women with first episodes of genital herpes during pregnancy were r and omly assigned to receive oral acyclovir 400 mg or placebo , three times per day , from 36 weeks ' gestation until delivery as part of a prospect i ve , double-blind trial . Herpes simplex virus cultures were obtained when patients presented for delivery . Vaginal delivery was permitted if no clinical recurrence was present ; otherwise , a cesarean was performed . Neonatal HSV cultures were obtained and infants were followed-up clinical ly . Results None of the 21 patients treated with acyclovir and nine of 25 ( 36 % ) treated with placebo had clinical evidence of recurrent genital herpes at delivery ( odds ratio [ OR ] 0.04 , 95 % confidence interval [ CI ] 0.002 - 0.745 ; P = .002 ) . No woman treated with acyclovir had a cesarean for herpes , compared with nine of 25 ( 36 % ) of those treated with placebo ( OR 0.04 , CI 0.002–0.0745 ; P = .002 ) . No patient in either treatment group experienced asymptomatic genital viral shedding at delivery . No neonate had evidence of herpes infection or adverse effects from acyclovir . Conclusion Suppressive acyclovir therapy reduced the need for cesarean for recurrent herpes in women whose first clinical episode of genital HSV occurred during pregnancy . Suppressive acyclovir treatment did not increase asymptomatic viral shedding and was not harmful to the term fetus Neonatal herpes affects about 1 in 15,000 newborns and the prognosis for disseminated disease with encephalitis is poor . We investigated whether acyclovir prophylaxis in late pregnancy effectively reduces the risk of viral shedding and , hence , of mother-to-child transmission at delivery . A prospect i ve study was conducted . Pregnant women who had at least one episode of genital herpes during pregnancy were r and omly assigned to two groups : group 1 ( n=167 ) received oral acyclovir from 36 weeks of gestation to term ; group 2 ( n=121 ) received no treatment .  Group 3 ( n=201 ) comprised women  not given prophylaxis  who had a history of genital herpes , but no active episodes during pregnancy . No specific instruction were set up for obstetrical management except for cesarean section in case of a suspected herpes lesion at the time of labor . The rate of Cesarean section was 8.4 % in group 1 , 16.5 % in group 2 , and 9.9 % in group 3 ( p<0.001 ) . 75 % of cesareans in group 2 and 10 % in group 3 were done for genital herpes . Percentage of viral shedding was , respectively , 0 % ( group1 ) , 5 % ( group2 ) , and 0.5%(group3 ) ( p<0.05 ) . These findings underline the value of antiviral prophylaxis in late pregnancy for women with a known history of genital herpes . Such prophylaxis only partly prevents neonatal herpes infection , because it is not applicable to patients with no known clinical history but may excrete the virus Reactivation of herpes simplex virus type 2 ( HSV-2 ) occurs intermittently as perceived clinical ly and by viral culture . We performed a series of studies to evaluate the frequency and pattern of HSV-2 reactivation using both viral isolation and HSV PCR assay . Daily sample s of genital secretions were obtained from 27 HSV-2 seropositive women ; a subset of subjects obtained sample s while receiving oral acyclovir 400 mg PO twice a day . HSV DNA was detected in genital swab specimens on 28 % of 1,410 d compared with 8.1 % of days by viral isolation . 11 of 20 women had HSV DNA detected on > 20 % of days , 4 on > 50 % , and 2 on > 75 % of days ; in contrast , none of the women shed on > 21 % of days by viral isolation . The daily administration of oral acyclovir promptly reduced the frequency of HSV DNA detection by a median of 80 % . Within 3 - 4 d of discontinuing daily acyclovir , HSV DNA again appeared in the genital area . HSV-2 shedding in the genital mucosa occurs much more frequently than previously appreciated . This frequent reactivation likely plays a role in the epidemic spread of genital herpes worldwide Genital herpes continues to spread in the United States . A recent nationwide survey conducted by the Centers for Disease Control and Prevention indicates that more than one in five adults older than 15 years of age have been infected with herpes simplex virus type 2 ( HSV-2 ) ( Johnson R. Personal communication ) . The virus is often transmitted to sexual partners and infants through contact with infected secretions during periods of sub clinical shedding [ 1 - 4 ] . Daily administration of the antiviral drug acyclovir has been shown to decrease the frequency and duration of symptomatic shedding of genital herpes [ 5 - 10 ] . However , no systematic study of the effects of acyclovir on sub clinical HSV shedding , the predominant means by which transmission occurs , has been done [ 11 - 13 ] . To determine whether acyclovir suppresses sub clinical shedding of HSV-2 in the genital tract , we conducted a placebo-controlled , crossover trial of suppressive acyclovir therapy in women with recently acquired genital HSV-2 infection . Methods Study Participants and Design Because natural history studies of sub clinical HSV shedding have indicated that recent acquisition of genital herpes and infection with HSV-2 alone are risk factors for sub clinical shedding [ 14 , 15 ] , only women with these clinical characteristics were considered for enrollment in our study . Other entry criteria included general good health without clinical or laboratory evidence of immunosuppression and without the use of immunosuppressive medication . Potential study participants were recruited by newspaper advertisements and through information distributed to local health care providers . We screened 103 women with the above-mentioned clinical characteristics and enrolled 34 ( 33 % ) . Among the 69 women who were not enrolled , 29 ( 42 % ) were not eligible because serologic testing indicated that they had infection other than that with HSV-2 alone [ 16 ] . Of the 40 eligible women , 19 ( 28 % ) decided not to participate in the study because of the time that it required . Women were also not en 
    Output:
    
The results of this meta- analysis indicate that prophylactic acyclovir beginning at 36 weeks ' gestation reduces the risk of clinical HSV recurrence at delivery , cesarean delivery for recurrent genital herpes , and the risk of HSV viral shedding at delivery