Management of neonates born to mothers with active genital herpes simplex virus infection: an alternative approach

PURPOSE OF REVIEW: Although considered a rare disease, neonatal HSV infection represents a disease in urgent need of preventive strategies, as it results in substantial neonatal morbidity and mortality. This review summarizes its current epidemiology and discusses guidances on the management of the asymptomatic neonate born to mothers with active genital HSV infection. RECENT FINDINGS: Timely detection and early high-dose acyclovir treatment of neonatal HSV infection decreases mortality. All neonates born to mothers with active genital HSV infection in the third trimester or at delivery should be tested for HSV infection. The newborn management has depended on whether the mother has experienced a primary or recurrent genital HSV infection based on maternal serologic testing and PCR testing of the genital lesion. An alternative strategy on neonatal management is proposed that is based on type of maternal HSV infection and perinatal risk factors. SUMMARY: The incidence of neonatal HSV infection is increasing with more infections due to HSV-1 than HSV-2. Guidances addressing management of the asymptomatic newborn exposed to active maternal genital HSV infection are discussed.