Brown Zane
Department of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195-6460, USA.
Herpes. 2004 Aug;11 Suppl 3:175A-186A.
Neonatal herpes simplex virus (HSV) infection can have severe consequences. Skin, eye and mouth infection is rarely fatal, but disseminated or central nervous system (CNS) disease has a mortality rate of 80% in the absence of therapy, and most surviving infants have neurological sequelae. Aciclovir therapy can improve the outcome of neonatal herpes, but is often delayed due to the early non-specific symptoms of the disease. Even with early therapy, some infants develop disseminated infection or CNS complications. The virus is usually vertically transmitted to the neonate from an infected mother during delivery. As such, the optimal strategy for reducing the morbidity of neonatal herpes is to prevent the neonate from acquiring HSV infection at delivery. The highest risk of neonatal infection occurs when the mother sheds HSV at labour, which happens more frequently in women who acquire genital herpes in the third trimester. Therefore, one approach for reducing maternal-fetal transmissions is to prevent HSV acquisition in late pregnancy. Definitive classification of genital HSV infection during pregnancy as either primary, non-primary first episode or recurrent can be accomplished only when clinical evaluation is accompanied by laboratory testing, including the use of gG-specific serological tests. The serological status of the mother's sexual partner should be considered when determining her risk of infection. The use of weekly viral cultures in pregnant women with confirmed genital herpes is not warranted, as they do not predict an infant's risk of acquisition of HSV at delivery and are not cost-effective. High-risk susceptible women should be counselled about abstinence and reducing oral-genital contact near term. Observational studies suggest that caesarean section can reduce transmission of neonatal herpes, and is warranted for women who shed HSV at delivery, although different countries vary in their approach to caesarean sections and so universal recommendations are not available. If maternal antiviral therapy is considered, the potential benefits of treatment should be balanced against potential adverse outcomes for mother and fetus, although it may be warranted when the mother has severe or life-threatening disease. Studies on the use of antiviral prophylaxis in women with known recurrences at labour are ongoing. Invasive fetal monitoring can increase the risk of neonatal herpes, and should only be used in HSV-2 seropositive women for defined obstetrical indications.
新生儿单纯疱疹病毒（HSV）感染可产生严重后果。皮肤、眼睛和口腔感染很少致命，但播散性或中枢神经系统（CNS）疾病在未经治疗时死亡率为80%，且大多数存活婴儿有神经后遗症。阿昔洛韦治疗可改善新生儿疱疹的预后，但由于该病早期非特异性症状，治疗常被延误。即使早期治疗，一些婴儿仍会发生播散性感染或中枢神经系统并发症。该病毒通常在分娩期间从受感染母亲垂直传播给新生儿。因此，降低新生儿疱疹发病率的最佳策略是防止新生儿在分娩时获得HSV感染。当母亲在分娩时排出HSV时，新生儿感染风险最高，这在妊娠晚期感染生殖器疱疹的女性中更常见。因此，减少母婴传播的一种方法是预防妊娠晚期获得HSV。只有在临床评估同时进行实验室检测（包括使用gG特异性血清学检测）时，才能对妊娠期生殖器HSV感染进行明确分类，确定为原发性、非原发性初发或复发性。在确定母亲的感染风险时，应考虑其性伴侣的血清学状态。对确诊为生殖器疱疹的孕妇每周进行病毒培养并无必要，因为这无法预测婴儿在分娩时获得HSV的风险，且不具有成本效益。应建议高危易感女性在接近足月时禁欲并减少口交接触。观察性研究表明，剖宫产可减少新生儿疱疹的传播，对于在分娩时排出HSV的女性有必要进行剖宫产，不过不同国家在剖宫产方法上存在差异，因此无法给出通用建议。如果考虑进行母亲抗病毒治疗，应权衡治疗的潜在益处与对母亲和胎儿的潜在不良后果，尽管当母亲患有严重或危及生命的疾病时可能有必要进行治疗。关于对已知在分娩时有复发的女性使用抗病毒预防措施的研究正在进行中。侵入性胎儿监测会增加新生儿疱疹的风险，仅应用于有明确产科指征的HSV - 2血清阳性女性。
