First episode genital herpes

First or second trimester acquisition (until 27 +6 weeks)

  • Refer women with suspected genital herpes for assessment by a GUM physician
  • Confirm diagnosis with HSV PCR
  • Complete STI screen

Aciclovir 400mg every 8 hours orally for 5 days

Severe or disseminated cases: Aciclovir 5mg/kg every 8 hours IV
Daily suppressive Aciclovir 400 mg every 8 hours orally from 36 weeks reduces HSV lesions and asymptomatic shedding at term and hence the need for delivery by caesarean

Third trimester acquisition (from 28 weeks)

Aciclovir 400mg every 8 hours orally for 5 days

Severe or disseminated cases: Aciclovir 5mg/kg every 8 hours IV

Continue daily suppressive Aciclovir 400 mg every 8 hours orally until delivery

  • Recommend discussion of serological testing with a virologist or GUM physician
  • Type-specific HSV antibody (IgG) testing is advisable to distinguish between primary and recurrent genital HSV infection

Recurrent genital herpes

  • Recurrences usually resolve within 7–10 days without antiviral treatment
  • Consider daily suppressive aciclovir 400 mg every 8 hours orally from 36 weeks

Primary or recurrent genital lesions at the onset of labour

Management will be based on clinical assessment as there will not be time for confirmatory laboratory testing:

  • History to ascertain if primary or recurrent episode
  • Viral swab from the lesion(s) - it may influence management of the neonate
  • The neonatologist should be informed

Primary episode

  • Consider intrapartum IV aciclovir for the mother (5 mg/kg 8 hourly) and the neonate (20 mg/kg 8 hourly) if opting for vaginal delivery

Recurrent genital herpes

  • Specific antiviral is not recommended