Picone O
Department of Gynaecology and Obstetrics, hôpital Louis-Mourier, hôpitaux universitaires Paris Nord, 147, rue des Renouillets, 92700 Colombes, France.
Gynecol Obstet Fertil Senol. 2017 Dec;45(12):642-654. doi: 10.1016/j.gofs.2017.10.002. Epub 2017 Nov 13.
To analyze the consequences of genital herpes infections in pregnant women.
The PubMed database and the recommendations from the French and foreign obstetrical societies or colleges have been consulted.
The symptomatology of herpes genital rash is often atypical (NP2) and not different during pregnancy (Professional consensus). It is most often due to HSV2 (NP2). Seventy percent of pregnant patients have a history of infection with Herpes simplex virus, without reference to genital or labial localization, and this is in most cases type 1 (NP2). The prevalence of clinical herpes lesions at birth in the event of recurrence is about 16% compared with 36% in the case of initial infection (NP4). In HSV+ patients, asymptomatic herpetic excretion is 4 to 10%. The rate of excretion increases in HIV+ patients (20 to 30%) (NP2). The risk of HSV seroconversion during pregnancy is 1 to 5% (NP2), but can reach 20% in case of sero-discordant couple (NP2). Questioning is not always sufficient to determine the history of herpes infection of a patient and her partner (NP2) and the clinical examination is not always reliable (NP2). Herpetic hepatitis and encephalitis are rare and potentially severe (NP4). These diagnoses should be discussed during pregnancy and antiviral therapy should be started as soon as possible (Professional consensus). There is no established link between herpes infection and miscarriages (NP3). There appears to be an association between untreated herpes infection and premature delivery (NP3) but not in the case of treated infections (NP4). Herpetic fetopathies are exceptional (NP4). There is no argument for recommending specific prenatal diagnosis for herpes infection during pregnancy (Professional consensus). Condom use reduces the risk of initial infection in women who are not pregnant (NP3). There is no evidence to justify routine screening during pregnancy (Professional consensus).
There is a strong discrepancy between the prevalence of herpetic excretion at the time of delivery and the scarcity of neonatal infections. There is a lack of data on the impact of herpes infections during pregnancy in France. Fetal and maternal consequences are potentially serious but rare.
分析孕妇生殖器疱疹感染的后果。
查阅了PubMed数据库以及法国和国外产科协会或学会的建议。
生殖器疱疹皮疹的症状通常不典型（NP2），在孕期无差异（专业共识）。最常见由单纯疱疹病毒2型（HSV2）引起（NP2）。70%的孕妇有单纯疱疹病毒感染史，不论感染部位是生殖器还是唇部，且多数情况下为1型（NP2）。复发时出生时临床疱疹病变的发生率约为16%，而初次感染时为36%（NP4）。在HSV阳性患者中，无症状性疱疹病毒排出率为4%至10%。在HIV阳性患者中排出率增加（20%至30%）（NP2）。孕期HSV血清学转换的风险为1%至5%（NP2），但在血清学不一致的夫妇中可达20%（NP2）。询问并不总是足以确定患者及其伴侣的疱疹感染史（NP2），临床检查也并非总是可靠的（NP2）。疱疹性肝炎和脑炎罕见但可能严重（NP4）。孕期应讨论这些诊断并尽早开始抗病毒治疗（专业共识）。疱疹感染与流产之间尚无既定联系（NP3）。未经治疗的疱疹感染与早产之间似乎存在关联（NP3），但治疗后的感染情况并非如此（NP4）。疱疹性胎儿病罕见（NP4）。孕期没有理由推荐针对疱疹感染进行特定的产前诊断（专业共识）。使用避孕套可降低未怀孕女性初次感染的风险（NP3）。没有证据支持孕期进行常规筛查（专业共识）。
分娩时疱疹病毒排出率与新生儿感染的罕见性之间存在强烈差异。法国缺乏关于孕期疱疹感染影响的数据。胎儿和母体后果可能严重但罕见。
