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Anna Wald, MD, MPH, Department of Medicine, Epidemiology, and Laboratory Medicine, University of Washington, 600 Broadway, Suite 400, Seattle, WA 98122, 206-720-4340, annawald@u.washington.edu
Genital herpes ranks among the most common STDs worldwide, and transmission of herpes simplex virus (HSV) to the neonate is the most severe outcome of HSV infection. Even with antiviral therapy, neonatal herpes results in significant mortality, and most survivors have long-term neurologic impairment. The precise magnitude of neonatal herpes is unknown, as the disease is not reportable in most states. A recent study conducted in Washington State estimated the frequency of neonatal herpes at 1 per 3,196 live births (32 per 100,000). However, the rate depends on the distribution of HSV-1 and HSV-2 in the population, and this may vary regionally. Viral shedding in the genital tract at delivery is the greatest risk factor for HSV transmission (RR >300). Other risk factors include acquisition of genital HSV-1 or HSV-2 in late pregnancy, vaginal delivery, and use of invasive monitoring. The availability of and patient demand for type-specific serologies open the possibility of a prevention program for neonatal herpes. Two approaches have been proposed: 1) testing all pregnant women, or 2) testing all pregnant women and partners of those susceptible to infection. Either approach relies on behavior change, such as condom use or abstinence, for efficacy. Biomedical interventions are also possible, with antiviral treatment of the male partner to reduce risk of transmission. The potential for effective interventions highlights the need for accurate estimates of the number of neonatal HSV cases. Reporting of this severe illness is consistent with reportable status of other infectious diseases, especially those with severe outcomes.
Learning Objectives:
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.