Genital Herpes in Pregnancy
Clinical detail
Additional detail checked 2026-10-17 against the linked sources. This check covers the section below; the rest of the module retains its displayed verification status.
Distinguish a first genital herpes episode from recurrence and assess when acquisition occurred. Infection acquired near delivery carries different neonatal implications from established recurrent disease.
Assessment & interpretation
- Use lesion testing when lesions are present and assess for severe or disseminated disease.
- At labour, ask about prodromal pain or burning and examine for genital lesions. Routine HSV-2 serological screening of all pregnant patients is not recommended.
Decisions that change management
- For recurrent genital herpes, CDC suppression begins at 36 weeks: acyclovir 400 mg orally three times daily, or valaciclovir 500 mg orally twice daily, continued through delivery.
- Genital lesions at labour or prodromal symptoms require obstetric assessment for caesarean birth. Absence of lesions and prodrome allows vaginal birth in the CDC pathway.
Follow-up & safety-netting
- Inform the neonatal team about exposure at birth and organise appropriate newborn assessment.
- Explain how to reduce new exposure in late pregnancy, including oral-genital exposure when a partner has oral herpes.
Clinical pitfalls
- Suppressive treatment reduces recurrences at term but does not eliminate neonatal transmission. Antibody positivity alone, without a genital-herpes history, is not an indication for routine suppression.
Admission & discharge
Admission/discharge guidance checked 2026-10-18 against the linked sources. This is a clinical checklist for an individual decision, not an automatic discharge order.
When admission or continued hospital care is needed
- Severe/disseminated infection, neurological illness, hepatitis concern, urinary retention, inability to take oral therapy or obstetric/fetal concern requires hospital assessment.
When clinic, day care or home care may be suitable
- Uncomplicated genital herpes can usually be managed with oral treatment and a documented pregnancy/birth plan.
Before going home
- Pain, hydration and voiding are satisfactory; oral treatment is feasible and the maternity team knows the infection timing/history.
- Review birth/neonatal management when infection is recent or lesions/symptoms are present near labour.
Discharge medicines and treatment changes
- Use the complete initial-episode or indicated late-pregnancy suppression regimen; these are different courses.
Medicine doses — use only when indicated
Use the medicines selected for this patient. Listed alternatives are not instructions to prescribe all of them together. Confirm the actual remaining course, pregnancy/postnatal context and monitoring plan.
For the selected initial episode.
- Indication: First clinical genital-herpes episode
- Suppression reduces recurrence but does not eliminate neonatal transmission; first acquisition near birth needs specialist obstetric/neonatal planning.
- Lesion/symptom response, renal function and delivery/neonatal-risk assessment
Only for the separate late-pregnancy suppression indication.
- Indication: Recurrent genital herpes in pregnancy: CDC suppression from 36 weeks
- Suppression reduces recurrence but does not eliminate neonatal transmission; first acquisition near birth needs specialist obstetric/neonatal planning.
- Lesion/symptom response, renal function and delivery/neonatal-risk assessment
Tests, pending results and their reviewer
- Assign any pending virology and specialist/neonatal assessment results.
Home care and counselling
- Explain lesion hygiene, transmission precautions, partner discussion and why labour symptoms must be reported promptly.
Follow-up: when and what to review
| When | Action / responsible service |
|---|---|
At the scheduled antenatal/STI review | Review response and the late-pregnancy/birth plan. |
At labour or a recurrent outbreak near birth | Contact the maternity unit to reassess delivery/neonatal precautions. |
Return urgently
- Inability to void, severe illness, jaundice, severe headache/confusion or an unwell newborn requires urgent care.
Open the complete discharge checklist →
Treatment
① Immediate stabilization — first minutes
③ First-line treatment & drug regimens
- First clinical genital-herpes episode
- Suppression reduces recurrence but does not eliminate neonatal transmission; first acquisition near birth needs specialist obstetric/neonatal planning.
- Lesion/symptom response, renal function and delivery/neonatal-risk assessment
- Recurrent genital herpes in pregnancy: CDC suppression from 36 weeks
- Suppression reduces recurrence but does not eliminate neonatal transmission; first acquisition near birth needs specialist obstetric/neonatal planning.
- Lesion/symptom response, renal function and delivery/neonatal-risk assessment
Definitive treatment
- Primary-episode lesions near term -> caesarean offer
- Recurrent lesions at birth -> individualised (risk lower) documented choice
Post-treatment care
- Swab-culture newborn if lesions exposed; paediatric informed
Diagnosis & assessment
- Haemodynamic instability -> sepsis pathway
Initial assessment
See treatment table for testing and regimens.
Principles & follow-up
Management principles
Sources (7)
2021-07 · updated 2025-12-22 (page review; guidance itself unchanged) · checked 2026-08-23 · verified-live
Open source ↗
CDC pages + wall chart: uncomplicated gonorrhoea cervix/urethra/rectum → ceftriaxone 500 mg IM single dose (<150 kg; 1 g if ≥150 kg); pharyngeal same; conjunctivitis 1 g IM; DGI 1 g IV/IM q24h; PID outpatient → ceftriaxone 500 mg IM ×1 + doxycycline 100 BD ×14 d + metronidazole 500 BD ×14 d; chlamyd…
· checked 2026-10-18 · verified-live
Open source ↗
Scope: additional clinical-detail explanation for sti-hsv. Checked the assessment, management-decision and follow-up statements in that section against this source. This does not certify all pre-existing regimens, calculations or recommendations in the module. Medication audit: acyclovir 400 mg thre…
· checked 2026-10-18 · verified-live
Open source ↗
Maternal/newborn transfer assessment, first void and effective feeding, handover, support/safeguarding, first midwife visit within 36 hours after transfer, postnatal danger symptoms. Full recommendations page read.
· checked 2026-10-18 · verified-live
Open source ↗
Normal-delivery discharge not less than 48 hours: full primary SOP PDF normal-delivery/discharge passages read. Corroborated by NHM CEmONC 2024 Part 1, chapter 8. This does not define a universal post-caesarean or complicated-case stay.
· checked 2026-10-18 · verified-live
Open source ↗
Official WHO summary read: at least 24-hour facility care after birth; additional contacts at 48–72 hours, 7–14 days and week 6; individual assessment/support. Summary facts only, not a claim that the full 242-page PDF was reviewed.
· checked 2026-10-18 · verified-live
Open source ↗
Full primary patient recovery page read: pain control, wounds, activity/VTE, urinary/bowel and infection warning signs, adult support and no driving/important decisions during the first 24 hours after general anaesthesia. Used as general recovery/handover principles, not operation-specific discharge…
· checked 2026-10-18 · verified-live
Open source ↗
Full primary recommendations read, focusing on critical-care-to-ward transfer: structured written handover, shared plan, monitoring, rehabilitation and receiving-team capability. Step-down is distinct from home discharge; no universal organ-support discharge cutoff is asserted.