Møller B R
Odense Universitetshospital, gynaekologisk/obstetrisk afdeling D.
Ugeskr Laeger. 1994 Nov 28;156(48):7189-92.
The incidence of genital herpes infection is increasing. About 50% of infections in women are asymptomatic. Neonatal infection is the most serious complication of genital HSV-infection, the mortality being 70% if untreated. The incidence of asymptomatic HSV-infection in pregnant women at the time of giving birth is 0.2%. These women cannot be identified on the basis of clinical symptoms and medical history, and the diagnostic methods currently in use are not sufficiently sensitive for the screening of low risk groups. Pregnant women with primary HSV-infection shed larger quantities of virus than women with recurrent infection, furthermore the foetus has not received passive immunisation by maternal antibody transfer. There is an increased risk of miscarriage, intrauterine infection and premature birth in connection with primary HSV-infection in pregnancy. Almost 50% of children born to mothers with primary HSV-infection at the time of birth become infected neonatally, compared with only 2-5% of children born to mothers with active recurrent HSV-infection. Recommendations are given for monitoring primary HSV-infection in the third trimester with viral cultures, monitoring recurrent HSV-infections clinically and indications for when delivery should be by caesarean section. Children born to women with active primary HSV-infection should be treated with antiviral agents. Children born to women with recurrent infection should have their secretions cultured for HSV.
生殖器疱疹感染的发病率正在上升。女性感染中约50%无症状。新生儿感染是生殖器单纯疱疹病毒（HSV）感染最严重的并发症，若不治疗，死亡率为70%。分娩时孕妇无症状HSV感染的发生率为0.2%。这些女性无法根据临床症状和病史来识别，且目前使用的诊断方法对低风险人群的筛查不够敏感。原发性HSV感染的孕妇比复发性感染的孕妇排出的病毒量更多，此外，胎儿未通过母体抗体转移获得被动免疫。孕期原发性HSV感染会增加流产、宫内感染和早产的风险。分娩时母亲患有原发性HSV感染的儿童中，近50%会发生新生儿感染，而母亲患有活动性复发性HSV感染的儿童中，只有2 - 5%会感染。文中给出了关于在孕晚期用病毒培养监测原发性HSV感染、临床监测复发性HSV感染以及剖宫产指征的建议。母亲患有活动性原发性HSV感染所生的儿童应接受抗病毒药物治疗。母亲患有复发性感染所生的儿童应进行HSV分泌物培养。
