Brown Z A, Vontver L A, Benedetti J, Critchlow C W, Sells C J, Berry S, Corey L
Department of Obstetrics and Gynecology, University of Washington, Seattle 98195.
N Engl J Med. 1987 Nov 12;317(20):1246-51. doi: 10.1056/NEJM198711123172002.
Although genital herpes simplex virus (HSV) infections occurring during pregnancy are known to be associated with neonatal and maternal complications, their frequency and contributing risk factors are not well understood. We prospectively followed 29 patients who acquired genital herpes during pregnancy, to evaluate the perinatal effects of the infection. The patients were classified on the basis of clinical or serologic criteria. Fifteen patients had a primary first episode of genital HSV Type 2 (HSV-2), and 14 had a nonprimary first episode. Although no patient had disseminated disease, 6 of the 15 with primary genital herpes but none of 14 with nonprimary first-episode infection had infants with serious perinatal morbidity (P less than 0.01). Four of the five infants whose mothers acquired primary HSV-2 in the third trimester had perinatal morbidity such as prematurity, intrauterine growth retardation, and neonatal infection with HSV-2. Perinatal complications occurred in one of five infants whose mothers acquired primary HSV-2 during the first trimester, as well as in one of five infants whose mothers had primary HSV-2 during the second trimester. Asymptomatic cervical shedding of HSV-2 was detected at 10.6 percent of weekly visits made after a primary first episode, as compared with 0.5 percent of visits after a nonprimary first episode (P less than 0.01). We conclude that infants born to women who acquire primary genital herpes during pregnancy are at high risk of exposure to HSV, either during premature labor at the time of the primary episode or subsequently because of asymptomatic cervical shedding of the virus. The 40 percent incidence of serious perinatal morbidity in such women suggests that studies of preventive measures such as the use of antiviral chemotherapy are warranted.
虽然已知孕期发生的单纯疱疹病毒（HSV）生殖器感染与新生儿及母体并发症有关，但其发生率及相关危险因素尚不清楚。我们对29例孕期感染生殖器疱疹的患者进行了前瞻性随访，以评估感染对围产期的影响。患者根据临床或血清学标准进行分类。15例患者为原发性首次发作的生殖器2型单纯疱疹病毒（HSV-2）感染，14例为非原发性首次发作。虽然没有患者出现播散性疾病，但15例原发性生殖器疱疹患者中有6例，而14例非原发性首次发作感染患者中无一例的婴儿出现严重围产期发病情况（P<0.01）。母亲在孕晚期感染原发性HSV-2的5例婴儿中有4例出现围产期发病，如早产、宫内生长受限和新生儿HSV-2感染。母亲在孕早期感染原发性HSV-2的5例婴儿中有1例出现围产期并发症，母亲在孕中期感染原发性HSV-2的5例婴儿中也有1例出现围产期并发症。原发性首次发作后每周随访时，HSV-2无症状宫颈脱落检出率为10.6%，而非原发性首次发作后随访时为0.5%（P<0.01）。我们得出结论，孕期感染原发性生殖器疱疹的女性所生婴儿在原发性发作时早产期间或随后因病毒无症状宫颈脱落而接触HSV的风险很高。此类女性中严重围产期发病的发生率为40%，这表明有必要开展如使用抗病毒化疗等预防措施的研究。
