**HERPES SIMPLEX VIRUS (HSV) MODULE**

**CASE STUDY**

Roberta Patterson is a 26-year-old woman who presents for her first
prenatal visit. She is concerned for her baby because of her husband
Franklin's history of genital herpes. She states that she is 6 weeks
pregnant.

**History**

-   Roberta has never had symptoms of vaginal or oral herpes.

-   She was diagnosed and treated for chlamydia seven years ago (age
    19); no other STD diagnoses reported.

-   Her 26-year-old husband had his first episode of genital herpes
    during his last year of high school; no other STD diagnoses
    reported.

-   Her husband (and sex partner for the last 16 months) has not had HSV
    lesions visible since she's been sexually active with him, and
    reports having had no prodromal symptoms or symptoms of active
    disease.

-   She has had no sex partners, other than her husband, for the last 16
    months.

**Physical Exam**

-   Vital signs: blood pressure 112/68, pulse 58, respiration 13,
    temperature 38.5° C

-   Cooperative, good historian

-   Chest, heart, musculoskeletal, and abdominal exams within normal
    limits

-   Uterus consistent with a 6-week pregnancy

-   Normal vaginal exam without signs of lesions or discharge

-   No lymphadenopathy

1\. Which HSV general education messages should be discussed with
Roberta?

2\. Given that Roberta's husband Franklin has a history of genital
herpes, would it be appropriate to test Roberta for genital herpes using
a type-specific serologic test?

3\. What other STD screening should be considered for Roberta?

**Roberta's Laboratory Results**

-   HSV gG-based type-specific serologies: HSV-1 negative; HSV-2
    positive

-   DNA probe for *Chlamydia trachomatis*: negative

-   Culture for *Neisseria gonorrhoeae*: negative

-   RPR: nonreactive

-   HIV antibody test: negative

-   Pregnancy test: positive

4\. What would you tell Roberta about her HSV infection, based on
clinical manifestations and test results?

5\. Would routine viral cultures during Roberta\'s pregnancy be
recommended?

**Partner Management**

Sex partner and exposure information:

Franklin Patterson

-   First sexual exposure: 16 months ago

-   Last sexual exposure: 1 month ago

-   History of genital herpes infection; first episode 8 years ago. No
    HSV testing or treatment at time of first episode or with subsequent
    episodes.

-   No history of other STDs.

6\. Franklin reports genital lesions during Roberta\'s sixth month of
pregnancy. Which laboratory tests should be performed on him?

**Laboratory Results for Franklin**

-   Franklin\'s laboratory test results are as follows:

-   HSV cultures: HSV-1 negative; HSV-2 positive

-   DNA probe for *Chlamydia trachomatis*: negative

-   Culture for *Neisseria gonorrhoeae*: negative

-   RPR: nonreactive

-   DFA: negative for *Treponema pallidum*

-   HIV antibody test: negative

7\. What is an appropriate episodic treatment for Franklin?

**Follow-Up**

Roberta had no HSV symptoms during her pregnancy.

Roberta opted to take the acyclovir treatment in late pregnancy after a
discussion with her certified nurse-midwife that included the following
points:

-   The safety of systemic acyclovir therapy in pregnant women has not
    been established.

-   Preliminary data suggest that acyclovir treatment late in pregnancy
    might diminish the frequency of HSV occurrence at term that would
    necessitate an abdominal delivery.

At onset of labor, she reported no prodromal or other HSV symptoms and
no lesions were found on examination.

After a 14-hour labor, she vaginally delivered a healthy 7.2 lb baby
girl.

8\. What questions should ALL women beginning labor (regardless of their
history of genital HPV infection) be asked?

9\. If Roberta had genital herpetic lesions at the onset of labor,
should she deliver vaginally or abdominally? What is the risk to the
infant?

10\. Roberta is asymptomatic at the time of delivery. Is it medically
appropriate for her to deliver vaginally?

11\. If Roberta had acquired genital herpes around the time of delivery,
would she be more or less likely to transmit genital herpes to her baby
during a vaginal delivery than if she had a history of recurrent genital
herpes?