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Genital Herpes — SCE Infectious Diseases MCQ

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ModerateSTIsGenital HerpesSCE Infectious Diseases

A 22-year-old woman presents with vulval pain and multiple shallow tender ulcers. This is her first episode. She is 34 weeks pregnant. HSV-2 PCR from an ulcer swab is positive. What is the most important consideration regarding her delivery?

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Correct answer: C — Primary genital herpes in the third trimester carries high risk of neonatal transmission; consider elective caesarean section and start Aciclovir 400 mg TDS

Primary genital HSV in the third trimester (particularly within 6 weeks of delivery) carries a 30–50% risk of neonatal herpes with vaginal delivery due to high viral shedding and lack of protective maternal antibodies. BASHH and RCOG recommend: starting Aciclovir 400 mg TDS (safe in pregnancy) and planned caesarean section to reduce neonatal transmission risk. For recurrent genital herpes, the risk is much lower (<3%) and suppressive Aciclovir from 36 weeks with vaginal delivery is acceptable in the absence of active lesions at labour.

Reference: BASHH 2014 – Genital herpes guidelines; RCOG 2014 – Genital herpes in pregnancy