Sénat M-V, Anselem O, Picone O, Renesme L, Sananès N, Vauloup-Fellous C, Sellier Y, Laplace J-P, Sentilhes L
Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Université Paris-Sud, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France.
Maternité Port-Royal, université Paris-Descartes, groupe hospitalier Cochin-Broca Hôtel-Dieu, AP-HP, 12, rue de l'École-de-Médecine, 75006 Paris, France.
Gynecol Obstet Fertil Senol. 2017 Dec;45(12):705-714. doi: 10.1016/j.gofs.2017.10.007. Epub 2017 Nov 11.
Identify measures to diagnose, prevent and treat genital herpes infection during pregnancy and childbirth and neonatal infection.
Bibliographic search from Medline, Cochrane Library databases and research of international clinical practice guidelines.
Genital herpes lesion is most often due to HSV2 (LE2). The risk of HSV seroconversion during pregnancy is 1 to 5% (LE2). Genital herpes ulceration during pregnancy in a woman with history of genital herpes corresponds with a recurrence. In this situation, there is no need for virologic confirmation (grade B). In case of genital lesions in a pregnant woman that do not report any genital herpes before, it is recommended to perform a virological confirmation by PCR and HSV type specific IgG (Professional consensus). In case of first episode genital herpes during pregnancy, antiviral treatment with acyclovir (200mg 5 times daily) or valacyclovir (1000mg twice daily) for 5 to 10 days is recommended (grade C). In case of recurrent herpes during pregnancy, antiviral therapy with acyclovir (200mg 5 times daily) or valacyclovir (500mg twice daily) can be administered (grade C). The risk of neonatal herpes is estimated between 25% and 44% in case of initial episode (LE2) and 1% in case of recurrence (LE3) at the time of delivery. Antiviral prophylaxis should be offered for women with first episode genital herpes or recurrent genital herpes during pregnancy from 36 weeks of gestation and until delivery (grade B). In case of a history of genital herpes without episode of recurrence during pregnancy, it is not recommended routinely offer a prophylactic treatment (professional consensus). A cesarean section should be performed if there is a suspicion of first episode genital herpes at the onset of labor (grade B), in the event of premature rupture of the membranes at term (professional consensus), or in case of first episode genital herpes less than 6 weeks before delivery (professional consensus). In case of recurrent genital herpes at the onset of labor, cesarean delivery will be all the more considered if the membranes are intact and vaginal delivery will be all the more considered in case of prolonged rupture of membranes (professional consensus). Neonatal herpes is rare and mainly due to HSV-1 (LE3). In most of the case of neonatal herpes, the mothers have no history of genital herpes (LE 3). In case of suspicion of neonatal herpes, different samples (blood and cerebrospinal fluid) for HSV PCR must be carried out to confirm the diagnosis (professional consensus). Any newborn suspected of neonatal herpes should be treated with intravenous acyclovir (60mg/kgs/day 3 times daily) (grade A) prior to the results of HSV PCR (professional consensus). The duration of the treatment depends on the clinical form (professional consensus) CONCLUSION: There is no formal evidence that it is possible to reduce the risk of neonatal herpes in genital herpes during pregnancy. However, appropriate care can reduce the symptoms associated with herpes, the risk of recurrence term and the cesarean rate performed to decrease the risk of neonatal herpes.
确定孕期、分娩期诊断、预防和治疗生殖器疱疹感染及新生儿感染的措施。
从Medline、Cochrane图书馆数据库进行文献检索，并查找国际临床实践指南。
生殖器疱疹皮损最常见由单纯疱疹病毒2型（HSV2）引起（证据等级2）。孕期HSV血清学转换风险为1%至5%（证据等级2）。有生殖器疱疹病史的女性孕期出现生殖器疱疹溃疡属于复发情况。在此情况下，无需进行病毒学确诊（B级）。对于既往无生殖器疱疹报告的孕妇出现生殖器病变，建议通过聚合酶链反应（PCR）和HSV型特异性IgG进行病毒学确诊（专业共识）。孕期首次发作生殖器疱疹，建议使用阿昔洛韦（每日5次，每次200mg）或伐昔洛韦（每日2次，每次1000mg）进行抗病毒治疗5至10天（C级）。孕期复发疱疹，可给予阿昔洛韦（每日5次，每次200mg）或伐昔洛韦（每日2次，每次500mg）进行抗病毒治疗（C级）。分娩时首次发作（证据等级2）新生儿疱疹风险估计在25%至44%之间，复发时（证据等级3）为1%。对于孕期首次发作生殖器疱疹或复发生殖器疱疹的女性，应从妊娠36周起至分娩给予抗病毒预防（B级）。对于孕期有生殖器疱疹病史但无复发的情况，不建议常规进行预防性治疗（专业共识）。如果临产后怀疑首次发作生殖器疱疹（B级）、足月胎膜早破（专业共识）或分娩前不到6周首次发作生殖器疱疹（专业共识），应行剖宫产。临产后复发生殖器疱疹，如果胎膜完整，更应考虑剖宫产；如果胎膜长时间破裂，则更应考虑阴道分娩（专业共识）。新生儿疱疹罕见，主要由HSV-1引起（证据等级3）。大多数新生儿疱疹病例中，母亲无生殖器疱疹病史（证据等级3）。怀疑新生儿疱疹时，必须采集不同样本（血液和脑脊液）进行HSV PCR以确诊（专业共识）。任何怀疑患有新生儿疱疹的新生儿，在HSV PCR结果出来之前，应先用静脉注射阿昔洛韦（每日3次，每次60mg/kg）进行治疗（A级）（专业共识）。治疗持续时间取决于临床类型（专业共识）。结论：尚无正式证据表明孕期生殖器疱疹可降低新生儿疱疹风险。然而，适当护理可减轻疱疹相关症状、降低复发风险及为降低新生儿疱疹风险而行剖宫产的比例。
