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Primary HSV Labour Caesarean — SCE Infectious Diseases MCQ

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ModerateSTIsPrimary HSV Labour CaesareanSCE Infectious Diseases

A 35-year-old pregnant woman (34 weeks) has active genital HSV-2 lesions at the onset of spontaneous labour. She was diagnosed with genital herpes during this pregnancy (first episode at 28 weeks). What is the recommended mode of delivery?

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Correct answer: D — Emergency caesarean section — primary genital HSV acquired in the third trimester with active lesions at labour carries 30–50% neonatal transmission risk; caesarean section significantly reduces this

Primary genital HSV acquired in the third trimester (within 6 weeks of delivery) with active lesions at labour is an indication for caesarean section — the neonatal transmission risk with vaginal delivery is 30–50% (due to high viral shedding and absent protective maternal IgG antibodies). For RECURRENT HSV (acquired before pregnancy), the risk with active lesions at labour is much lower (~1–3%), and vaginal delivery with suppressive Aciclovir from 36 weeks is acceptable. This distinction between PRIMARY and RECURRENT HSV at delivery is critical.

Reference: BASHH 2014 – Genital herpes; RCOG 2014 – HSV in pregnancy; BHIVA 2025