Objectives After completing this article, readers should be able to:1. Describe the three presentations of neonatal herpes. 2. Delineate the primary routes of acquisition of neonatal herpes. 3. Explain why herpes simplex virus type-specific serology should be used to identify at-risk pregnant women. 4. Describe approaches to prevention of neonatal herpes.
EpidemiologyAt the midpoint of the third National Health and Nutrition Survey (NHANES) (approximately 1991), herpes simplex virus (HSV)-2 seroprevalence in the United States was approximately 22%. This represented an approximately 30% increase since the midpoint of the second NHANES study in the early 1980s. (1)(2)(3) Because sexual practices in the adult population probably have not changed, it is reasonable to assume that over the decade since the third NHANES study, HSV-2 seroprevalence in the United States increased by an additional 30%. To this must be added another 10% to account for genital herpes due to HSV-1. Accordingly, the prevalence of genital herpes in the United States may be as high as 40%, an average prevalence that suggests some regions (eg, urban and coastal) may have substantially higher rates than others (eg, central and rural). The NHANES study and others have demonstrated that women have higher seroprevalence rates than men, a finding consistent with the increased susceptibility of women to acquire sexually transmitted diseases. (1)(2)(3)(4) Finally, HSV-1 is increasingly responsible for initial episodes of genital herpes both in the United States and Europe. (5)
TransmissionGenital herpes is transmitted primarily from persons who have unrecognized infection or during periods of asymptomatic shedding. (4)(6) Approximately 75% to 90% of persons who have HSV-2 antibodies are unaware of their infection and are experiencing genital reactivations that take the form of either mildly symptomatic recurrences (two thirds of persons) that are attributed to problems other than genital herpes or intermittent asymptomatic genital viral shedding (one third of persons). (1)(6) When they seek care for recurrent genital symptoms, both women and men frequently are misdiagnosed. (7) The symptoms in women often are attributed to recurrent genital yeast infections, cystitis, or vaginitis or to allergies to condoms, spermicides, sperm, or pantyhose. Men most frequently attribute their genital symptoms to "jock itch," condom allergies, insect bites, folliculitis or irritation from tight jeans, sexual intercourse, or bike seats. In a recent study, approximately two thirds of women purchasing over-the-counter vaginal antifungal drugs were found to have something other than a vaginal yeast infection. (8) The three major consequences of a vast pool of adults who have an unrecognized genital ulcerative disease are: 1) continued spread of the infection among the adult population, 2) continued spread of human immunodeficiency virus (HIV) disease, and 3) infection of newborns. Although the focus of this article is the prevention of neonatal herpes, it is important to st...