Running head : MANAGEMENT STRATEGIES DURING PREGNANCY 1 Management Strategies During Pregnancy to Prevent Neonatal Herpes : An Educational Intervention for Health Care Providers

Neonatal herpes is a significant yet preventable outcome of genital herpes exposure. Approximately 1,500-2,000 new cases of neonatal herpes infection are diagnosed annually (Ural & Cheng Peng, 2013). The purpose of this project is to increase the knowledge of health care professionals about genital herpes and its prevention, so that the general public can become better informed. Ultimately, the hope is that by increasing the general public’s awareness about genital herpes and its prevention, genital herpes acquisition in pregnancy will be decreased, thus reducing cases of neonatal herpes. The educational intervention Neonatal Herpes Prevention: Management Strategies During Pregnancy combines lecture and interactive formats and is intended for use during an educational meeting. The envisioned use for the educational intervention is a continuing education course, specifically among health care professionals caring for pregnant women or women of childbearing age. The literature suggests that in-person educational meetings, web-based educational modules, and printed educational materials are all effective at improving professional practice among health care providers. Thus, the educational content is designed for adaptation to various educational methods in order to meet the diverse educational needs and learning style preferences of health care providers. The anticipated outcome is a reduction in occurrences of neonatal herpes as a result of increased awareness among providers, patients and the general public, behavioral changes regarding sex practices, and improved management of genital herpes. MANAGEMENT STRATEGIES DURING PREGNANCY 3 Management Strategies During Pregnancy to Prevent Neonatal Herpes: An Educational Intervention for Health Care Providers The risk of maternal transmission of herpes simplex virus (HSV) to the newborn is a significant health concern. One in five American women is infected with the herpes virus and about 2% of women acquire genital herpes during pregnancy (Ural & Cheng Peng, 2013; Wood, 2011). Neonatal transmission is highest among women who are seronegative because there is not adequate time to develop antibodies needed to suppress viral replication prior to labor (Straface, 2012; Ural & Cheng Peng, 2013). Therefore, the possibility of transmission to the neonate is highest (30-50%) among pregnant women who acquire genital herpes close to the time of delivery (Centers for Disease Control and Prevention [CDC], 2011b). Among women acquiring genital herpes during pregnancy, two-thirds remain asymptomatic and have no symptoms suggestive of a genital herpes infection (Kimberlin & Baley, 2013). Furthermore, 60% to 80% of women who deliver a baby infected with herpes have neither a past history of infection nor a sexual partner reporting a history (Kimberlin & Baley, 2013). This considerable risk of unknown genital herpes transmission from the pregnant mother to the neonate indicates a need for preventive action. The Current Situation Neonatal HSV is defined as infection in a newborn in the first 28 days of life (Corey & Wald, 2009). The frequency of neonatal herpes is estimated to be about 10-60 cases per 100,000 live births in the United States (U.S.) (Jaiyeoba, Amaya, Soper, & Kilby, 2012). Untreated neonatal HSV infection is associated with a mortality rate of 60%, and even with prompt treatment, survivors experience great disability (Ural & Cheng Peng, 2013). Severe cases can lead to lifelong complications; thus, prevention is the basis for decreasing the negative effects of MANAGEMENT STRATEGIES DURING PREGNANCY 4 herpes in the neonate (Woods, 2011). Prevention of neonatal herpes depends on preventing initial acquisition of genital herpes infection during late pregnancy, recognizing asymptomatic infections, and avoiding exposure of the infant to herpetic lesions during delivery (CDC, 2011b; Ural & Cheng Peng, 2013). In the framework of childbirth, the risks of genital herpes are frequently misunderstood (Kriebs, 2008). Studies conducted by Handsfield, Stone, and Graber (1998), and Romanowski, Zdanowicz, and Owens (2008) found that knowledge regarding genital herpes was low among health care providers and those with herpes themselves. Hence, many infected persons and their sex partners, as well as others at risk, were receiving suboptimal and insufficient health care information and prevention guidance (Handsfield et al., 1998). Education and counseling for women without known genital herpes, as well as for those known to be infected and their sex partners, are recognized as key components in the prevention of sexual and perinatal transmission of HSV (Glass, Nelson, & Huffman, 2005). This highlights a need for educational efforts aimed at health care providers. By equipping health care professionals with the knowledge necessary to educate and counsel patients, the general public will become better informed about genital herpes and its prevention in order to minimize transmission of HSV.