On presentation for delivery, a woman with a history of HSV should be questioned regarding prodromal symptoms such as vulvar burning or itching. A careful examination of the vulva, vagina, and cervix is performed, and women without genitalrlesions may proceed with labor and delivery. Use of a fetal scalp electrode can raise the transmission risk. But, electrode placement is reasonable if needed in the absence of active lesions (American College of Obstetricians and Gynecologists, 2016b).
Suspicious lesions should be cultured or PCR tested. Cesarean delivery is indicated for women with genital lesions or prodromal symptoms. It is not recommended for women with a history of HSV infection but no active genital disease at the time of delivery. Moreover, an active lesion in a nongenital area is not an indication for cesarean delivery. Instead, an occlusive dressing is placed, and vaginal delivery is allowed.
With preterm ruptured membranes, no evidence suggests that external lesions cause ascending fetal infection. Major and associates (2003) described expectant management of preterm premature membrane rupture in 29 women at gestational ages <31 weeks. There were no cases of neonatal HSV, and the maximum infection risk was calculated to be 10 percent. Antiviral treatment is recommended. For women with a clinical recurrence at delivery, there is not an absolute duration of membrane rupture beyond which the fetus would not beneit from cesarean delivery (merican College of Obstetricians and Gynecologists, 2016d).
Women with active HSV may breastfeed if there are no active breast lesions. Strict hand washing is essential. Val acyclovir and acyclovir may be used for symptomatic maternal lesions during breastfeeding, as drug concentrations in breast milk are low. One study found the acyclovir concentration to be only 2 percent of that used for therapeutic dosing of the neonate (Sheield, 2002a).
Haemophilus ducryi can cause painul, nonindurated genital ulcers termed sot chancres. At times, these are accompanied by painul suppurative inguinal lymphadenopathy. Although common in some developing countries, only 11 cases were reported in the United States in 2015 (Centers for Disease Control and Prevention, 20 16c). Appropriate media are not widely accessible, and no Food and Drug Administration (FDA)-cleared PCR test is yet available. Instead, painul genital ulcer(s) and negative screening for syphilis or HSV leads to a presumptive diagnosis. Treatment in pregnancy is azithromycin, 1 g orally as a single dose; erythromycin base, 500 mg orally three times daily for 7 days; or cetriaxone, 250 mg in a single intramuscular dose (Workowski, 2015).
This is a common STD, and more than 40 types infect the genital tract. In the United States from 2005 to 2006, the overall HPV prevalence was 40 percent in females aged 14 to 59 years (Liu, 2016). Prevalence is highest in younger women, and some of this seroprevalence now relects HPV vaccination in this age group (Brouwer, 2015). Most reproductive-aged women become infected within a few years of becoming sexually active, and most infections are asymptomatic and transient. High-risk types are those with the most oncogenic potential. Of these, HPV types 16 and 18 are oten associated with dysplasia (Chap. 63, p. 1193). Mucocutaneous external genital warts termed condyloma acuminata are usually caused by types 6 and 11r.