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Identification

Herpes simplex infection (HSV) is a viral infection characterized by local and systemic symptoms, latent and recurring localized at the entrance gate. There are two Herpes simplex, HSV1 and HSV2 viruses; which produce distinct clinical syndromes according to the input gate, respectively, oral or genital mucosa.

 Primary infection with HSV1 generally occurs in childhood at oral level, can be easy and inapparent. The signs disappear but the virus remains dormant. Due to a stimulus that varies from person to person, the infection may recur (relapse). [1]Cernescu C., Virusologie medicala, Ed Medicala 2008 [2]CDC, Heymann D.L., Manual de management al bolilor transmisibile. 2012.

Manifestations cliniceîn infection with HSV1:

  1. Primary genital Herpes: with local lesions that last 3-6 weeks
  2. Non-primary genital Herpes: In a patient presenting antibodies for HSV2, the manifestations are similar to recurring episodes
  3. Recurring genital Herpes: The manifestations are lighter, the lesions persist 3-10 days
  4. Asymptomatic genital Herpes: Patient presenting anti HSV1 antibodies without symptoms of herpes in history; 2/3 of the seropositive women acquired the asymptomatic infection. [5] Greene MF … and Resnik`s Maternal-Fetal Medicine: Principles and Practice. Elsevier, 2008, In: Herpes Simplex Infection. [6] *** Medscape. 2017 Genital Herpes in Pregnancy...

The primary infection with HSV2 has several clinical forms:

  • Vulvovaginită,
  • Cervicitis
  • Endometritis
  • Urethritis
  • Herpes perianal,
  • Panariţiu herpes,
  • Pharyngitis herpes,
  • Herpes meningitis.

Pregnant:

All pregnant women should be asked if they have a history of genital herpes. At the beginning of labor, all women should be asked carefully about the symptoms of genital herpes, including symptoms of prodromal (starting), all women should be carefully examined for herpes lesions.

Attention! The woman infected with HSV can develop infectious lesions for the newborn during childbirth.

Women without symptoms or signs of genital herpes may be born vaginally. Although the C-section does not completely eliminate the risk of HSV transmission in the newborn, women with recurrent genital herpes lesions at the onset of labour should be given a caesarean to reduce the risk of neonatal infection with HSV. [7]*** CDC, 2015 Sexually Transmitted Diseases Treatment Guidelines.\..

The transmission of the infection to the fetus depends on the type of maternal infection; This distinguishes several situations encountered in medical practice with different frequencies.

The risk of neonatal herpes according to Mother’s Status: [8]Vlădăreanu R., Afecțiunile medicale asociate sarcinii. Infomedica, Bucuresti, 1999, p.279.

  1. Primoinfecțiala pregnant in Prepartum (or 1 month before birth) is at risk of neonatal herpes 50-75%.
  2. Recurrence of pregnant in prepartum (or a month before birth) is at risk of neonatal herpes 2-5%.
  3. History of genital herpes in pregnant or partner, without genital lesions in prepartum give a risk of neonatal herpes 1 to 1,000 births.
  4. The absence of a history of genital herpes and genital lesions in pregnant prepartum give a risk of neonatal herpes 1 to 10,000 births.

If the prepartum (or a month before birth) occurs Primoinfecţia or a recurrence, the protocol is to perform the Caesarean.

The risk of transmission to the fetus is significantly higher in the case of women who acquire infection with HSV1 or HSV2 during pregnancy compared to those who have a chronic infection that reactivates at birth, 25-50% vs. < 1%. [9]Cernescu C., Virusologie medicala, Ed Medicala 2008`' [10]CDC, Heymann D.L., Manual de management al bolilor transmisibile. 2012`' [11]*** CDC, 2015 Sexually Transmitted Diseases Treatment Guidelines~’.. Therefore, 50-80% of cases of neonatal herpes are derived from mothers who are infected during pregnancy towards the end of it.

 

Congenital herpes defined prenatal cainfecţie of the fetus with HSV is extremely rare and frequently balances with the death of the fetus in the uterus. Those who survive have the following manifestations:

  • Vesicular eruption,
  • Ocular disorders (corioretinită, microphthalmia, cataract),
  • Neurological disorders (Calcificăriintracerebrale, microcephaly, convulsions, multicystic),
  • Growth retardation,
  • Disorders in psychomotor development.

In the newborn mother infected with HSV:

  1. Skin, eye, mouth (SEM)
  • Damage to the skin, eyes and mouth.
  • SEM is the most common, most characteristic and most readily diagnosed form of neonatal HSV.
  • It comes from birth or zilele2-7.
  • At the cutaneous level, blisters appear in the bouquet at the level of breech.
  • The eye appears conjunctivitis or keratoconjunctivitis herpes.
  • Herpes gingivostomatită and pharyngitis occur in the oral cavity.
  • Without treatment, this form can be transformed into the next two forms.
  1. Central nervous system damage
  • Debuts after the 11th day of life with a painting of Pascal-severe encephalitis:
  • Fever
  • Irritability
  • Encephalitis syndrome (lethargy, convulsions, Fontanelle, Opistotonus)
  • It can evolve to a coma after 2-3 days.
  • In CSF there are changes that may suggest diagnosis: pleocytosis, Albuminorahie, interferon
  • Despite initiation of treatment, more than 50% of children with this form present neurological sequelae:
    • Developmental Disorders,
    • Epilepsy
    • Blindness
    • Cognitive disabilities.
  1. Disseminated neonatal herpes is manifested as bacterial sepsis, with plurivisceraleal impairments, which is nediferențiabil clinically.

 

Diagnosis of HSV infection in pregnant:

  • In the case of symptomatic infection in pregnant, diagnosis is clinical, based on the appearance of lesions.
  • Most of the time, however, non-specific presentations or light manifestations require a diagnosis of certainty, with importance in pregnancy management and the risk of transmitting the infection to the fetus.

 

The diagnostic methods of the HSV infection are:

  1.  Virological Diagnosis
  1. Serological diagnosis

 Histopathological Diagnosis:

  • Cytodiagnosis Tzanck or Pap test (quick and inexpensive but not specific and subjective test according to the evaluator).

 

Diagnosis of infection in the newborn:

 

Note Bene. In this document, the laboratory diagnosis was not treated in HSV infection, but there were several elements related to pregnancy and newborn. For the complete diagnosis of this infection, those interested will be addressed to infectionists physicians.

 

The infectious agent

HSV1 and HSV2 belong to the from Herpesviridae family family, subfamily Alfaherpesvirinae. The characteristic of this family is latency. Once the virus enters through skin lesions in the epithelial cells of the mucous membranes or epithelium, it persists in a dormant condition in the nerve tissues where it migrates:

  • HSV1 usually persists in the trigeminal ganglion and causes orofaciale lesions,
  • HSV2 has as its headquarters the lumbosacral ganglion and affects the genitourinary-annals area.

Both types can cause injuries in any of the 2 areas and cannot be clinically differentiated. [24]Cernescu C., Virusologie medicala, Ed Medicala 2008`|`.

 

Incidence and prevalence

Source

The infected man is the only source. [28]CDC, Heymann D.L., Manual de management al bolilor transmisibile. 2012.,..

Method of transmission

Risk groups

 

Incubation period

2 to 12 days. [36]Cernescu C., Virusologie medicala, Ed Medicala 2008`.' [37]CDC, Heymann D.L., Manual de management al bolilor transmisibile. 2012`.'.

Infectiousness Period

2-7 weeks after primary infection. The virus may intermittently remove the mucous membranes (asymptomatic excretion). In the case of recurrences, the virus can be removed up to 7 days after the lesions have disappeared. [38] CDC, Heymann D.L., Manual de management al bolilor transmisibile. 2012.|.

 

Prophylaxis

Pregnant:

In newborn

Vaccination

There is currently no vaccine. [53]Cernescu C., Virusologie medicala, Ed Medicala 2008.~' [54]CDC, Heymann D.L., Manual de management al bolilor transmisibile. 2012.~' [55] *** CDC, 2015 Sexually Transmitted Diseases Treatment Guidelines.’|..

Birth to the infected woman with HSV 

All pregnant women with suspicion of genital herpes infection or prodromal symptoms should be subjected to caesarean, even if the membranes are intact. [56] *** Medscape. 2017 Genital Herpes in Pregnancy.’...

Breastfeeding

If the mother has perimamelonare lesions there is a danger of transmitting the virus to the newborn. [57]CDC, Heymann D.L., Manual de management al bolilor transmisibile. 2012.`'.

Treatment

Acyclovir and Acyclovir derivatives. [58]Cernescu C., Virusologie medicala, Ed Medicala 2008.,`.

 

Bibliography

  1. Cernescu C., Virusologie Medicală, Ed Medicala 2008
  2. CDC, Heymann D.L., Management Manual of communicable diseases. 2012
  3. Greene MF, Creasy RK, Resnik R, Iams JD, Lockwood CJ, Moore T. Creasy and Resnik’s maternal-Fetal Medicine: Principles and Practice. Elsevier, 2008, In: Herpes Simplex infection.
  4. Vlădăreanu R., Medical conditions associated with pregnancy. Infomedica, Bucharest, 1999, p. 279.
  5. *** CDC, 2015 Sexually transmitted diseases Treatment Guidelines. Retrieved: https://www.cdc.gov/std/tg2015/herpes.htm
  6. Kimberlin DW, Baley J, Committee on Infectious diseases, et al. Guidance on management of asymptomatic neonates born to women with active genital herpes lesions. Paediatrics 2013; 131:383 – 6.
  7. Brown ZA, Hedersleben S, Zeh J, et al. The acquisition of herpes simplex virus during pregnancy. N Engl J Med 1997; 337:509 – 15.
  8. Pinninti SG, Kimberlin DW. Maternal and neonatal herpes simplex virus infections. Am J Perinatol 2013; 30:113 – 9.
  9. Brown ZA, Wald A, Morrow RA, et al. Effect of serological status and cesarean delivery on transmission rates of herpes simplex virus from mother to infant. JAMA 2003; 289:203 – 9.
  10. Brown ZA, Benedetti J, Ashley R, et al. Neonatal herpes simplex virus infection in relation to asymptomatic maternal infection at the time of labor. N Engl J Med 1991; 324:1247 – 52.
  11. *** Medscape. 2017 Genital Herpes in Pregnancy. Retrieved: Http://emedicine.medscape.com/article/274874-overview

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