Roberta’s Laboratory Results HSV gG-based type-specific serologies: HSV-1 negative; HSV-2 positive NAAT for Chlamydia trachomatis: negative NAAT for Neisseria gonorrhoeae: negative RPR: nonreactive HIV antibody test: negative Pregnancy test: positive 4. What would you tell Roberta about her HSV infection, based on clinical manifestations and test results? Roberta most likely has an asymptomatic or unrecognized genital herpes infection. She does have evidence of exposure to HSV-2, but reports no symptoms or previous clinical episodes. Up to two-thirds of patients with identified HSV-2 infection may actually “asymptomatic” have symptomatic infection that is mild or simply unrecognized as genital herpes. Most patients with asymptomatic or unrecognized genital HSV infections will still shed virus intermittently in the genital tract. Patients such as Roberta should be taught to recognize signs and symptoms of genital herpes. She should inform her obstetric provider(s) about her HSV-2 infection status and assess whether any signs or symptoms of infection develop at the onset of labor. The risk for transmission of HSV-2 to a neonate is low (less than 1%) among women who have acquired HSV-2 infection before the second half of pregnancy. Women without symptoms of genital herpes or its prodrome and without signs of herpetic lesions on careful examination at the onset of labor can deliver vaginally. Although cesarean section does not completely eliminate the risk for HSV transmission to the infant, women with recurrent genital herpetic lesions at the onset of labor should deliver by cesarean section to prevent neonatal HSV infection. 5. Would routine viral cultures during Roberta's pregnancy be recommended? No. The results of viral cultures during pregnancy of women with or without visible herpetic lesions do NOT predict viral shedding at the time of delivery, and therefore routine viral cultures of pregnant women with recurrent genital herpes are NOT recommended. [Slide 73] Partner Management Sex partner and exposure information Franklin Patterson First sexual exposure: Sixteen months ago Last sexual exposure: One month ago
Roberta’s Laboratory Results HSV gG-based type-specific serologies: HSV-1 negative; HSV-2 positive NAAT for Chlamydia trachomatis: negative NAAT for Neisseria gonorrhoeae: negative RPR: nonreactive HIV antibody test: negative Pregnancy test: positive 4. What would you tell Roberta about her HSV infection, based on clinical manifestations and test results? Roberta most likely has an asymptomatic or unrecognized genital herpes infection. She does have evidence of exposure to HSV-2, but reports no symptoms or previous clinical episodes. Up to two-thirds of patients with identified “asymptomatic” HSV-2 infection may actually have symptomatic infection that is mild or simply unrecognized as genital herpes. Most patients with asymptomatic or unrecognized genital HSV infections will still shed virus intermittently in the genital tract. Patients such as Roberta should be taught to recognize signs and symptoms of genital herpes. She should inform her obstetric provider(s) about her HSV-2 infection status and assess whether any signs or symptoms of infection develop at the onset of labor. The risk for transmission of HSV-2 to a neonate is low (less than 1%) among women who have acquired HSV-2 infection before the second half of pregnancy. Women without symptoms of genital herpes or its prodrome and without signs of herpetic lesions on careful examination at the onset of labor can deliver vaginally. Although cesarean section does not completely eliminate the risk for HSV transmission to the infant, women with recurrent genital herpetic lesions at the onset of labor should deliver by cesarean section to prevent neonatal HSV infection. 5. Would routine viral cultures during Roberta's pregnancy be recommended? No. The results of viral cultures during pregnancy of women with or without visible herpetic lesions do NOT predict viral shedding at the time of delivery, and therefore routine viral cultures of pregnant women with recurrent genital herpes are NOT recommended. [Slide 73] Partner Management Sex partner and exposure information Franklin Patterson First sexual exposure: Sixteen months ago Last sexual exposure: One month ago
hsv-notes-2014.docx